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28 November 2022, Volume 26 Issue 33 Previous Issue   

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Mechanics analysis of sacral lumbarization based on finite element method Li Jian, Guan Tianmin, Zhu Ye 2022, 26 (33):  5249-5253.  doi: 10.12307/2022.746 Abstract ( 549 )   PDF (2285KB) ( 56 )   Save BACKGROUND: Sacral lumbarization will lead to changes in spinal segments, so that mechanical structure of spine is going to change, more likely to cause spinal lesions. OBJECTIVE: To analyze statics difference between the sacral lumbarization model and the normal model. METHODS: According to principle of reverse engineering and data based on CT, lumbosacral geometric models were set up. The sacral lumbarization model was in the experimental group and normal model was in the control group. Gradient was attributed to the material based on gray value of CT data and ligament model was set up. A concentrated force of 200 N was applied to the L4 vertebral body surface to simulate gravity. Simultaneously, a moment of 2 N·m was applied to the positive and negative directions of the X axis, Y axis and Z axis to simulate six conditions of sports: anteflexion and posterior extension, right and left lateral flexion and rotation. The stress distribution of the model, the deflection angle of the vertebral body, and the stress distribution between the intervertebral disc L5 and the sacrum were analyzed.  RESULTS AND CONCLUSION: (1) Under six conditions, the stress concentration of sacral lumbarization model obviously occurred at the contact of the articular processes of S1 and S2 in the experimental group. Deflection angle was significantly larger in the experimental group than that in the control group. (2) From the stress nephogram of intervertebral disc distribution, the stress distribution area of experimental group and control group was close, which was fit for the stress characteristics of the spine. However, the stress of intervertebral disc in the experimental group was significantly higher than that in the control group. The max value of 2.480 MPa appeared in the experimental group under the anteflexion condition. The max intervertebral disc stress difference value between experimental group and control group was 1.722 5 MPa. (3) To sum up, the overall structure of sacral lumbarization is more unstable. Especially, the stress concentration is more obvious at the junction of transitional vertebra and sacral vertebra, thereby affects the stability of the whole spinal force line, and then leads to the occurrence of spinal diseases. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element analysis of congenital pseudarthrosis of the tibia in a child after treatment with 3 in 1 osteosynthesis Liu Xiaowei, Yang Ge, Mei Haibo 2022, 26 (33):  5254-5258.  doi: 10.12307/2022.740 Abstract ( 357 )   PDF (1849KB) ( 37 )   Save BACKGROUND: Congenital pseudarthrosis of the tibia with intact fibula undergoing 3 in 1 osteosynthesis will increase the cross-sectional area in healed segments and may reduce the incidence of refracture. However, it also changed the morphology and biomechanics of the tibiofibula, and this change is not clear at present.  OBJECTIVE: To reconstruct the congenital pseudarthrosis of the tibia using three-dimensional finite element model method, which was treated with 3 in 1 osteosynthesis and achieved bony union, and to analyze its Von Mises stress peak value and distribution characteristics under different stress states.  METHODS: The CT images of lower limbs of a girl with Crawford type IV congenital pseudarthrosis of the tibia were collected from Hunan Children’s Hospital. CT images were used to build a three-dimensional model through Mimics software and 3-Matic was used to build a finite element model for adaptive meshing. After defining the material properties of the model, 75, 62.5, 50, 37.5, 25, 12.5, 0 N mechanical loadings were applied on the proximal tibia of the affected side respectively; the side of the proximal end of the fibula received 0, 12.5, 25, 37.5, 50, 62.5, 75 N mechanical loadings correspondingly using ANSYS software. A loading of 62.5 N was applied to the proximal tibia of the healthy side as the control. The maximum Von Mises stressing and distributional characteristics of the three-dimensional finite element model of the affected tibia and fibula and the healthy tibia were analyzed.  RESULTS AND CONCLUSION: (1) The maximum Von Mises stress was 26.73 MPa and the minimum was 6.97 MPa. As the stress load shifted to the fibula, the maximum Von Mises stress was decreased gradually, and the loading areas were mainly distributed in the two aspects of front and back in the tibial lower distal one third. (2) The maximum Von Mises on the healthy tibia (5.44 MPa) was lower than that in each group on the pseudarthrosis tibia, and stress area was mainly distributed in the lower 1/3 of the front of the tibia. (3) The 3 in 1 osteosynthesis for congenital pseudarthrosis of the tibia changed the normal tibial stress distribution and may cause excessive stress concentration in the tibia, speculating that it may increase the risk of refracture. Figures and Tables | References | Related Articles | Metrics

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Biomechanical finite element analysis of lower tibiofibular ligament Ding Junwen, Mi Tao, Li Zeqing, Ren Rong, Tang Baoming, Luo Wei, Li Zhaowei 2022, 26 (33):  5259-5264.  doi: 10.12307/2022.723 Abstract ( 430 )   PDF (1598KB) ( 56 )   Save BACKGROUND: The lower tibiofibular ligament plays a great role in maintaining the stability of the ankle. Now more and more scholars begin to pay attention to the biomechanical research of the lower tibiofibular ligament, but there are few reports on the biomechanical research of the lower tibiofibular anterior ligament, interosseous ligament, lower tibiofibular posterior ligament, and transverse ligament alone.   OBJECTIVE: To establish a three-dimensional finite element simulation model of ankle joint including lower tibiofibular ligament, distal tibiofibula, and talus and study the effect of lower tibiofibular ligament on ankle joint stability. METHODS:  Based on the image information of computed tomography, combined with Mimics software and Geomagic Studio software, the ankle joint simulation model including tibia, fibula, talus, and some cartilages was established, and then the model was imported into the finite element analysis software Abaqus, so as to construct the three-dimensional finite element model of ankle joint including ligament and other soft tissues. Finally, the specific changes of stress distribution and displacement of anterior tibiofibular ligament, interosseous ligament, posterior tibiofibular ligament, and transverse ligament under four different types of stress environments were simulated.   RESULTS AND CONCLUSION: (1) The posterior tibiofibular ligament was the most stressed under internal rotation load. Under external rotation load, the stress of transverse tibiofibular ligament was the largest, followed by anterior tibiofibular ligament. Under vertical + internal rotation load, the stress of posterior tibiofibular ligament was the largest, but the maximum stress value increased compared with simple internal rotation load. Under the vertical + external rotation load, the stress of the lower tibiofibular transverse ligament was the largest, followed by the lower tibiofibular anterior ligament, but the maximum stress value increased compared with the simple external rotation load. (2) It is concluded that posterior tibiofibular ligament plays a prominent role in preventing ankle pronation injury. The lower tibiofibular transverse ligament and anterior ligament play a prominent role in preventing ankle external rotation injury. Figures and Tables | References | Related Articles | Metrics

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Establishment and validation of finite element model of cervical facet joint in children He Yujie, Li Pei, Xue Mingming, Li Zhijun, Li Xiaohe, Wang Xing, Gao Mingjie, Wu Chao, Kang Zhijie, Zhang Shaojie, Wang Haiyan 2022, 26 (33):  5265-5270.  doi: 10.12307/2022.712 Abstract ( 475 )   PDF (2178KB) ( 93 )   Save BACKGROUND: The cervical vertebra in children is not yet mature. The ligaments are relatively relaxed. The articular surface is relatively horizontal. The uncinate vertebra joint begins to develop. Therefore, the superior cervical junction area and the lower cervical vertebra in children are vulnerable to injury. It is of great significance to study the mechanical properties and injury mechanism of children’s neck for its protection and treatment.   OBJECTIVE: The finite element model of the whole cervical vertebra of a 4-year-old child was established to compare and analyze the maximum stress value of the joint surface of each segment, so as to understand the mechanical change rule under different motion states. METHODS: The original data of continuous cervical spine tomography images were imported into Mimics 21.0 in DICOM format to reconstruct C0-T1 respectively, imported into 3-Matic to establish a preliminary geometric model of the disc, and then processed with denoising, paving, and smoothing. The improved model was imported into Hypermesh software for mesh division. After attribute assignment, the material was imported into the finite element model displayed in ANSYS 19.2, and the boundary and load conditions were set to observe the range of motion of the joint and the stress and strain values of the joint surface of each segment.   RESULTS AND CONCLUSION: (1) The maximum range of motion of the facet joint was C4/5 (4.71°, 4.13°, 7.21°, 7.22°) in the forward flexion, backward extension, left flexion, and right flexion, and C2/3 (9.54°, 9.65°) in the axial rotation (left rotation and right rotation). (2) The maximum stress of the disc in the right flexion state was significantly greater than that in the other motion states. The maximum stress of the disc in the forward flexion state was at C5-6 (0.235 MPa) and the maximum stress of the disc in the other states was at C6-7. The maximum stress of the disc at C2-3 segment was smaller than that at  the other segments under the six conditions. (3) Under the same vertebral articular process joint surface, maximum stress under six conditions was greater than articular process on the joint surface, increasing trend with the increase of the operation sequence. The peak was located in the stretched position C6 articular process under the joint surface (1.481 MPa) and the valley value was located in forward flexion joint surface on a C2 (0.005 MPa). (4) In conclusion, the maximum range of motion of the cervical facet joint was located at C2/3, which was negatively correlated with its maximum displacement and maximum stress. Therefore, cervical instability was more common at the upper cervical segment. At the right flexion of the cervical spine, the stress value of the disc at the C6-7 level was the greatest, which was easy to cause cervical disc herniation. The C6/7 facet joint has the largest pulling load no matter what kind of working condition it is in and it is a common site of cervical facet joint induced cervical spondylosis. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of three internal fixation methods for treating femoral shaft fracture Xu Zhi, Zhong Hehe, Xiang Hao, Li Enchao, Huang Yushun, Lu Hao, Jin Ying, Zou Gang, Liu Yi 2022, 26 (33):  5271-5277.  doi: 10.12307/2022.717 Abstract ( 492 )   PDF (1745KB) ( 42 )   Save BACKGROUND: At present, the mainstream treatment strategy for femoral shaft fracture is surgical treatment, including intramedullary nail fixation, steel plate fixation, and Bridge combined fixation system, which is becoming more and more popular in recent years. However, there are relatively few studies on the biomechanical properties of the three internal fixation methods.   OBJECTIVE: To simulate the fracture of the middle femur using finite element technique, and analyze the biomechanical characteristics of locking plate, Bridge combined fixation system, and intramedullary nail internal fixation under different working conditions. METHODS:  The CT data of left femur of a healthy volunteer from the Affiliated Hospital of Zunyi Medical University meeting the inclusion and exclusion criteria were collected in this study. The digital model of middle femoral fracture with defect was constructed by Mimics and Geomagic software. According to the principle of internal fixation, the fracture model was assembled with appropriate size locking plate, Bridge combined fixation system, and intramedullary nail respectively after introducing the fracture model into Pro/E software. After geometric cleaning and gridding, the model was incorporated into Abaqus software to analyze the displacement and stress of three internal fixation methods of middle femoral fracture under different stress conditions by finite element analysis.   RESULTS AND CONCLUSION: In the results of finite element analysis, three kinds of femoral internal fixation models showed different mechanical properties under different working conditions. (1) Under the loading of vertical stress, the force of the intramedullary nail was uniformly distributed along the direction of the main nail, and the stress was the least, and the Z-shaped deformation of the two connecting rods in the bridging system near the fracture end distributed the overall stress, resulting in the smallest displacement and the best stability. (2) Under the loading of horizontal stress, the stress and displacement of the bridging system were the smallest, and the stability was the best. Stress was concentrated on the 1-3 fixing block on the bridging system connection rod and its adjacent metal components. (3) Under the loading of torsional stress, the displacement of the intramedullary nail was the smallest and the stability was the best, while the stress and displacement of the bridging system were the largest, and the stress was concentrated on the interface between the proximal locking nail and the bone, and the stability was the worst. (4) The results show that the femoral bridging system has good mechanical properties of anti-compression and anti-bending, while the femoral interlocking intramedullary nail has more advantages in anti-torsion force. As a conventional eccentric fixation, locking plate is less stable in vertical compression and bending, but better resistant to torsion than double-bar bridging system and inferior to the interlocking intramedullary nail. Figures and Tables | References | Related Articles | Metrics

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Stability of 3D-printed titanium trabecular metal socket cups during total hip arthroplasty Ma Ning, Wang Cong, Liu Ningqiang, Xie Tong, Yang Chaojian, Guo Chongjun, Niu Dongsheng, Liang Yuqi 2022, 26 (33):  5278-5282.  doi: 10.12307/2022.741 Abstract ( 435 )   PDF (1378KB) ( 129 )   Save BACKGROUND: The number of total hip arthroplasty is increasing year by year. There are many surface treatment methods of biological prosthesis. The survival rate and clinical effect of prosthesis have become the common concern of doctors and patients. OBJECTIVE: To compare and analyze the short-term follow-up results of 3D-accurate constructive technology socket cups and Pinnacle socket cups after total hip arthroplasty to investigate the stability of 3D-printed titanium alloy bone trabecular socket cup prostheses.  METHODS: Medical records of 96 patients (98 hips) who underwent total hip arthroplasty from January 2016 to December 2019 in the Department of Joint Surgery, People’s Hospital of Ningxia Hui Autonomous Region were retrospectively analyzed. According to the choice of prosthesis, they were divided into two groups. Among them, 69 hips in the observation group used the 3D-printed titanium alloy bone trabecular socket cup (accurate constructive technology cup), and 29 hips in the control group used the Pinnacle cup. Short-term postoperative follow-up was performed by visual analogue scale pain score, forgotten joint score, Harris hip function score, and imaging assessment for clinical efficacy analysis.  RESULTS AND CONCLUSION: (1) There were significant differences in the visual analogue scale score and hip Harris score between the two groups at 1 week after operation (P < 0.05). There was no significant difference in the visual analogue scale score and hip Harris score between the two groups at 1, 6, and 12 months after operation (P > 0.05). There was no significant difference in the forgotten joint score between the two groups at 6 and 12 months after operation (P > 0.05). (2) At 12 months after operation, the visual analogue scale score and hip Harris score in both groups were significantly improved compared with those before operation (P < 0.05). (3) During the postoperative follow-up of the two groups, no radiolucent lines were found around the acetabular cup in the X-ray films of the hip joint. All the cups were in satisfactory position, and no obvious signs of displacement were found. All of them achieved stable fixation, and the bone ingrowth between the cup and the bone interface was good. (4) In conclusion, the 3D-printed titanium trabecular metal socket cups had better short-time initial stability, good bone ingrowth between the prosthesis and bone interface, and satisfactory short-term clinical results; long-term results require further follow-up.  Figures and Tables | References | Related Articles | Metrics

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3D-CT-guided unilateral biportal endoscopic localization of L5 and S1 nerve roots and intervertebral space Bi Jingwei, Ren Jiabin, Liu Xin, Sun Ning, Li Rui, Li Yuefei, Sun Zhaozhong 2022, 26 (33):  5283-5289.  doi: 10.12307/2022.748 Abstract ( 463 )   PDF (2318KB) ( 71 )   Save BACKGROUND: Unilateral biportal endoscopy can more directly and clearly identify tissue structure characteristics at close range, while indirect X-ray fluoroscopy is difficult to locate the dura mater, nerve roots and intervertebral disc. OBJECTIVE: To investigate the relationship between L5 and S1 nerve roots and intervertebral space under unilateral biportal endoscopy, and to provide theoretical basis for the treatment of lumbar spinal stenosis with unilateral biportal endoscopy. METHODS: Totally 29 patients with lumbar spinal stenosis underwent lumbar CT myelography. The images were imported into Mimics 17.0 software to establish a three-dimensional model. The relevant parameters of L4/5 and L5S1 levels were measured: The distance from the intersection of the lower edge of upper lumbar lamina and the medial edge of the base of the lower articular process (point A) to the lateral edge of the dural membrane (a1), the upper edge of the starting nerve root (a2), the lower endplate of upper lumbar spine (a3), and the upper endplate of lower lumbar (or sacral) vertebrae (a4); the distance from the intersection of the upper edge of the lower lumbar (or sacral) vertebral lamina and the medial edge of the base of the superior articular process (point B) to the lateral edge of the dural membrane (b1), the upper edge of the nerve root origin (b2), the lower endplate of the upper lumbar spine (b3), and the upper endplate of the lower lumbar (or sacral) vertebral body (b4); the distance from the intersection point of the medial edge of the inferior articular process of the upper lumbar spine to the medial edge of the inferior lumbar (or sacral) superior articular process (point C) to the lateral edge of the dural membrane (c1), the upper edge of the nerve root origin (c2), the lower endplate of the upper lumbar spine (c3), and the upper endplate of the lower lumbar (or sacral) vertebral body (c4); the distance from the intersection of the upper lumbar spinous process and the lower edge of the lamina (point D) to the lateral edge of the dural membrane (d1); the distance from the upper edge of the nerve root to the upper endplate of the lumbar spine (n1) and the upper endplate of the lumbar spine (or sacral) (n2). The position relationship between the triangle area (C area) surrounded by A, B and C and nerve roots and intervertebral space was observed. All 29 patients underwent unilateral biportal endoscopic lumbar decompression, and were evaluated by visual analogue pain score, Oswestry disability index, and Japanese Orthopaedic Association evaluation score. The parameters were analyzed and their reliability was verified clinically.  RESULTS AND CONCLUSION: (1) There was no significant difference in the relationship between the affected side and the healthy side in the same segment (P > 0.05). There were significant differences between A, B and C of L4/5 and L5S1 and the distance between the lateral dural edge and intervertebral space (P < 0.05) and had no significant difference with the distance from the upper edge of nerve root origin (P > 0.05). The distance between the upper edge of L5 and S1 nerve root and the intervertebral space of the corresponding segment was significantly different (P < 0.05). (2) In L4/5 and L5S1 segments, the projection of point A was mostly near the upper and lower endplates of L5. AB line projection was located near and outside the lateral edge of the dural membrane. (3) The level of intervertebral space in L4/5 segment was mostly above C area, above point A; L5S1 segments were all in region C, below point A, and most of them corresponded to the intervertebral space at the level of point C. (4) Most of L5 at the upper edge of nerve root origin was projected at the level of L4/5 intervertebral space, while S1 was projected above L5S1 intervertebral space. (5) The observed results were consistent with the intraoperative findings. (6) The obtained data can guide the positioning of unilateral biportal endoscopy, and the constant bone markers are exposed under unilateral biportal endoscopy microscope. At the L4/5 segment, above point A is the intervertebral space. The herniated disc is explored and removed, and the starting point of L5 nerve root is found at the intervertebral space level, and the nerve root canal is decompressed along the nerve alignment. At L5S1, point C was located at the intervertebral space level, and the disc was explored from this level. A window was opened slightly above point A to find the origin of S1 nerve root and decompress the nerve outward and downward. The location of intervertebral space and nerve root was determined by each marker point, and the scope of decompression was determined to make the operation more safe, accurate, effective, and efficient. Figures and Tables | References | Related Articles | Metrics

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Femoral neck fractures in middle-aged and young adults using femoral neck system assisted by 3D printed guide plate Sheng Xiaolei, Liu Su, Wang Jin, Zhao Lei, Zhu Yi, Zhang Wei, Gu Qi, Yuan Feng, Tian Shoujin, Ge Jianfei 2022, 26 (33):  5290-5296.  doi: 10.12307/2022.713 Abstract ( 463 )   PDF (2172KB) ( 101 )   Save BACKGROUND: Internal fixation is often the first choice for patients in middle-aged and young adults. However, there are some risks in traditional internal fixation treatment, such as failure of internal fixation, nonunion of fracture and avascular necrosis of the femoral head. Therefore, it is of great clinical significance to choose a suitable internal fixation system for femoral neck fracture.   OBJECTIVE: To explore the application value of 3D printed guide plate assisted new femoral neck system in the treatment of femoral neck fracture in middle-aged and young adults. METHODS:  Totally 24 patients of middle-aged and young adults with femoral neck fracture who underwent surgery with femoral neck system in the Department of Orthopedics, Zhangjiagang Hospital Affiliated to Soochow University from 2020 to 2021 were randomly divided into two groups (n=12 per group). The experimental group designed and made 3D printed guide plate to assist the femoral neck system internal fixation operation before operation, while the control group was treated with freehand new femoral neck system for internal fixation. The general data, operation and follow-up results (fracture healing time, visual analogue scale score and Harris score before operation, 1 week and 6 months after operation), and complications were compared between the two groups.   RESULTS AND CONCLUSION: (1) All the 24 patients were followed up for more than 6 months. (2) The operation time, the times of fluoroscopy and the amount of intraoperative blood loss in the experimental group were significantly less than those in the control group (P < 0.05). (3) During the last follow-up, all patients in the experimental group and control group achieved bone healing. There were no complications such as internal fixation failure and avascular necrosis of the femoral head in the experimental group and control group. (4) The hip pain was significantly relieved in the two groups. The visual analogue scale score in the experimental group was lower than that in the control group at 1 week and 6 months after operation, and the difference was not statistically significant (P > 0.05). (5) The hip joint function of the two groups was significantly improved after operation. The Harris score of the experimental group was better than that of the control group at 1 week and 6 months after operation, and the difference was not statistically significant (P > 0.05). (6) The results show that the new femoral neck system has achieved a good surgical efficacy in the treatment of femoral neck fracture in middle-aged and young adults. Femoral neck system assisted by 3D printed guide plate can reduce the operation time and fluoroscopy times, and the amount of intraoperative blood loss. Figures and Tables | References | Related Articles | Metrics

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Effect of intravenous dexamethasone preoperatively on pain and complications after unicondylar arthroplasty Wang Zhenheng, Wang Zhidong, Liu Naicheng, Chen Guangdong, Gao Maofeng, Shi Weidong, Zhu Ruofu 2022, 26 (33):  5297-5302.  doi: 10.12307/2022.749 Abstract ( 612 )   PDF (1205KB) ( 42 )   Save BACKGROUND: At present, dexamethasone is widely used in hip and knee arthroplasties to reduce postoperative pain, nausea and vomiting, and speed up the recovery of patients. However, domestic and foreign studies on the role of dexamethasone in the perioperative period of unicondylar arthroplasty have not been reported.  OBJECTIVE: To investigate the effect of intravenous dexamethasone on the perioperative period of unicondylar arthroplasty.    METHODS: Sixty-nine knee osteoarthritis patients who underwent primary unicondylar arthroplasty in Department of Orthopedics, The First Affiliated Hospital of Soochow University from January 2020 to May 2021 were randomly divided into two groups. Patients in the trial group (n=35) were given dexamethasone 8 mg intravenously before skin incision. Patients in the control group (n=34) were given an equal volume of normal saline intravenously. Before surgery and 1, 2, and 3 days after surgery, the visual analogue scale scores of the patients at rest and walking were evaluated; the occurrences of nausea and vomiting at the corresponding time points after the surgery were recorded. Before surgery and 1 and 3 days after surgery, leukocyte count and C-reactive protein value were detected. The postoperative follow-up was conducted for 3 months to record the presence of complications such as wound infection, joint prosthesis infection, peptic ulcer bleeding and so on.  RESULTS AND CONCLUSION: (1) The visual analogue scale scores of pain in the trial group were significantly lower than those in the control group when walking on the 1st and 2nd day after the operation and resting on the 1st day after the operation (P < 0.05). (2) The incidence of nausea and vomiting at 0-6 and 6-24 hours after operation was significantly lower in the trial group than that of the control group (P < 0.05). (3) The leukocyte count and C-reactive protein value were significantly lower in the trial group than those of the control group on the 1st postoperative day (P < 0.05). (4) The patients in the two groups were followed up for 3 months without complications such as wound infection, joint prosthesis infection, or peptic ulcer bleeding. (5) The results suggest that intravenous injection of dexamethasone used during unicondylar arthroplasty can effectively relieve early postoperative pain, reduce postoperative nausea and vomiting, inhibit early inflammation, and is beneficial for patient recovery.  Figures and Tables | References | Related Articles | Metrics

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Intra-articular tranexamic acid at different volumes and doses affects blood loss during total knee arthroplasty Liu Jinlei, Yin Li, Zhang Yi, Wang Haitao, Lu Yingzi 2022, 26 (33):  5303-5310.  doi: 10.12307/2022.806 Abstract ( 371 )   PDF (1517KB) ( 52 )   Save BACKGROUND: Massive blood loss often produces during the perioperative period of total knee arthroplasty. Local injection of tranexamic acid can effectively reduce perioperative blood loss. However, the protortion of tranexamic acid solution has not been unified.   OBJECTIVE: To study the effect of intra-articular tranexamic acid at different volumes and doses on blood loss in total knee arthroplasty. METHODS:  A total of 120 patients aged 42-89 years who underwent unilateral total knee arthroplasty in the First Affiliated Hospital of Zhengzhou University from February 2019 to January 2020, including 45 males and 75 females, were randomly divided into four groups (n=30 per group). Patients undergoing total knee arthroplasty in the A, B, C, and D groups were injected with tranexamic acid solution 1 g/20 mL, 1 g/50 mL,1 g/100 mL, and 2 g/100 mL, respectively, along the incision after joint capsule suturing. Postoperative blood loss, inflammatory indexes, coagulation indexes, complications and adverse reactions, and visual analogue scale scores of the knee joint at resting and active states were compared among the four groups after operation.   RESULTS AND CONCLUSION: (1) Blood loss and blood transfusion: the drain output, total blood loss and hemoglobin drop in the C and D groups were significantly lower than those in the A and B groups (P < 0.05), and hidden blood loss in the C and D groups was significantly lower than that in the A group (P < 0.05). The drain output, total blood loss, and hemoglobin drop in the B group were lower than those in the A group (P < 0.05). There were no significant differences in blood transfusion rate and blood transfusion among all the groups (P > 0.05). (2) Inflammation and coagulation indexes: There were no significant differences in erythrocyte sedimentation rate, C-reactive protein, D-dimer and fibrinogen among the four groups (P > 0.05). (3) Complications and adverse reactions: No deep vein thrombosis and other adverse reactions occurred in any patients. (4) There was no significant difference in visual analog scale scores at resting and active states among the four groups at 3 hours and 7 days after operation (P > 0.05). (5) In conclusion, intra-articular injection of 1 g/100 mL tranexamic acid solution is better than 1 g/20 mL and 1 g/50 mL in the reduction of blood loss during total knee arthroplasty, without increasing the risk of complications such as deep venous thrombosis and superficial wound necrosis. 1 g/100 mL and 2 g/100 mL tranexamic acid solutions have the same hemostatic effect, but 1 g/100 mL tranexamic acid solution is more economical and convenient in clinical practice. Therefore, 1 g/100 mL tranexamic acid solution is recommended for intra-articular injection in total knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Early hip abductor training to improve balance and walking ability after total knee arthroplasty Quan Honglei, Zheng Jiejiao, Feng Youyan, Zhang Jie, Zhu Yinghui 2022, 26 (33):  5311-5316.  doi: 10.12307/2022.725 Abstract ( 418 )   PDF (1225KB) ( 88 )   Save BACKGROUND: The functional recovery of patients after total knee arthroplasty is not ideal. Routine rehabilitation pays more attention to the rehabilitation of the tissue around the knee joint, but neglects the training of the abductor muscle of the hip. There is a correlation between hip abductor and limb function of patients with total knee arthroplasty, but the specific effect remains to be studied.   OBJECTIVE: To explore the effect of hip abductor training on balance and walking function recovery in patients with total knee arthroplasty. METHODS:  From March 2020 to May 2021, 60 patients with unilateral total knee arthroplasty from Huadong Hospital Affiliated to Fudan University were randomly divided into trial group (n=30) and control group (n=30). The control group received conventional treatment. The trial group received conventional treatment and hip abductor training. Hip abductor isokinetic muscle strength, knee function score, single leg stance, Timed Up and Go test, and three-dimensional gait analysis were assessed in both groups before and 4 weeks after treatment.   RESULTS AND CONCLUSION: (1) The hip abductor isokinetic muscle strength was significantly higher in the trial group than that of the control group 4 weeks after treatment (P < 0.05). (2) At 4 weeks after treatment, Knee Society Score was significantly higher in the trial group than that of the control group (P < 0.05). (3) At 4 weeks after treatment, single leg stance time was significantly longer in the trial group than that in the control group; Timed Up and Go test time was significantly shorter in the trial group than that in the control group (P < 0.05). (4) At 4 weeks after treatment, the proportion of walking amplitude and affected side support phase was significantly better in the trial group than that in the control group (P < 0.05). (5) These findings have verified that early hip abductor training after total knee arthroplasty can increase hip abductor muscle strength and improve patients’ balance and walking function. However, its rehabilitation program and long-term efficacy still need further research. Figures and Tables | References | Related Articles | Metrics

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Adjective application of dexamethasone combined with furosemide for early pain and swelling after total knee arthroplasty Song Wei, Zhang Yaxin, Jia Dazhou, Sun Yu 2022, 26 (33):  5317-5322.  doi: 10.12307/2022.744 Abstract ( 851 )   PDF (1147KB) ( 49 )   Save BACKGROUND: Total knee arthroplasty is an effective treatment for end-stage knee osteoarthritis, but some patients will experience severe knee pain in early postoperative period. How to reduce postoperative knee pain is an important issue for clinicians. OBJECTIVE: To investigate the effect of adjuvant dexamethasone combined with furosemide on early pain and swelling after unilateral total knee arthroplasty.  METHODS: Ninety-two patients who underwent primary unilateral knee arthroplasty due to knee osteoarthritis in the Northern Jiangsu People’s Hospital from June to December 2020 were retrospectively analyzed. The patients in the treatment group (n=46) were given intravenous infusion of dexamethasone 10 mg + 100 mL normal saline on the first day of surgery and after surgery, and intravenous injection of furosemide 20 mg on the second to fourth days after surgery. The patients in the control group (n=46) were given intraoperative intravenous infusion of dexamethasone 10 mg + 100 mL normal saline, and intravenous injection of the same amount of normal saline on the second to fourth days after surgery. Postoperative knee visual analogue scale score, knee range of motion, knee HSS score, and the affected limb circumference were assessed. The incidence of postoperative adverse reactions was recorded.  RESULTS AND CONCLUSION: (1) The visual analogue scale scores at 2, 3, 4 and 5 days after surgery in the treatment group were lower than those in the control group in resting state (P < 0.05), and the visual analogue scale scores at 2, 3, 4 and 5 days after surgery in the treatment group were lower than those in the control group in the moving state (P < 0.05). (2) The range of motion of knee joint in the treatment group was higher than that in the control group at 2, 3 and 5 days after operation (P < 0.05). The knee HSS score at 2, 3 and 5 days after operation was higher in the treatment group than that of the control group  (P < 0.05). The lower limb circumference of the treatment group at 2, 3 and 5 days after surgery was significantly decreased compared with the control group (P < 0.05). (3) There was no significant difference in the incidence of adverse reactions such as hypokalemia, nausea and vomiting, dizziness, constipation, delirium, and lower limb venous thrombosis between the two groups after surgery (P > 0.05). (4) Adjuvant application of dexamethasone combined with postoperative use of furosemide can effectively reduce postoperative swelling and early pain of the affected limb, improve postoperative joint activity of the knee joint, and effectively promote the early rehabilitation after total knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Femoral neck system or combined cannulated screws for femoral neck fracture Li Yongwang, Long Yubin, He Rongli, An Ming, Zhang Qian, Qi Hui, Han Zhe, Ma Wenhai 2022, 26 (33):  5329-5334.  doi: 10.12307/2022.745 Abstract ( 493 )   PDF (2970KB) ( 63 )   Save BACKGROUND: Femoral neck fractures can be treated with cannulated screws, dynamic hip screws, locking plates, and intramedullary nails. However, there are still high risks of internal fixation failure, femoral neck shortening, varus deformity, femoral head necrosis and nonunion. The femoral neck system is minimally invasive and provides stable rotation resistance with minimal screw cutting and screw withdrawal. OBJECTIVE: To compare early clinical effects of femoral neck system and femoral neck system combined with cannulated screw on femoral neck fracture.   METHODS: The data of 42 patients with femoral neck fracture treated in Department of Orthopedics, Baoding First Central Hospital from March 2020 to October 2021 were retrospectively analyzed. Of them, 33 patients were followed up and divided into femoral neck system group (group A; n=26) and femoral neck system combined with cannulated screw group (group B; n=7). Operation time, intraoperative fluoroscopy times, intraoperative blood loss, length of hospital stay, fracture healing time, curative effect (Harris score) and complications at the last follow-up were recorded.    RESULTS AND CONCLUSION: (1) Thirty-three patients were followed up for 3-19 months. (2) Operation time, intraoperative fluoroscopy times, and intraoperative blood loss were significantly less in group A than those in group B (P < 0.05). Length of hospital stay and Harris score postoperatively and at final follow-up were not significantly different (P > 0.05). Hip function was evaluated as follows: excellent in 15 cases, good in 9 cases, and average in 2 cases in group A; excellent in 6 cases and good in 1 case in group B. (3) Postoperative X-ray films showed that all fractures healed, and the healing time was 3-6 months, with an average of 4.5 months. (4) There was no significant difference in the degree of femoral neck shortening between the two groups after operation and at the final follow-up (P > 0.05). (5) None of the patients had complications such as infection and loosening of internal fixation during follow-up. (6) The treatment of femoral neck fractures with femoral neck system or combined with cannulated screw fixation is simple and minimally invasive with satisfactory short-term results. Figures and Tables | References | Related Articles | Metrics

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Risk factor analysis and prediction of deep venous thrombosis of lower extremity in elderly patients with hip fracture after operation Rong Yi, Yu Hao, Yang Junfeng, Wang Lan, Zhang Jiannan, Shao Yang 2022, 26 (33):  5357-5363.  doi: 10.12307/2022.786 Abstract ( 540 )   PDF (1335KB) ( 77 )   Save BACKGROUND: For elderly patients with hip fractures, improving the ability to screen for deep vein thrombosis of the lower extremities and implementing individualized prevention programs are important measures to improve the prognosis of patients and reduce the burden on patients' families and socioeconomics. OBJECTIVE: To investigate the risk factors of deep venous thrombosis in elderly patients with hip fracture after operation, and to establish a risk model to predict the occurrence of deep venous thrombosis.  METHODS: Clinical data of 325 hospitalized patients with hip fracture over 70 years old from January 2017 to December 2019 were retrospectively analyzed, and they were divided into deep venous thrombosis group (n=50) and non-deep venous thrombosis group (n=275) according to the results of deep vein color Doppler ultrasound examination of lower extremities. The univariate and multivariate Logistic regression analyses were used to identify the independent risk factors for postoperative deep venous thrombosis in elderly patients with hip fracture. Receiver operating characteristic curve was used to analyze the diagnostic efficacy of independent risk factors and combined models for deep venous thrombosis. Furthermore, R Studio software was used to construct a column chart to predict the risk of postoperative deep venous thrombosis of lower limbs in elderly patients with hip fracture, and calibration curves were made to verify the accuracy of the model.  RESULTS AND CONCLUSION: (1) The univariate analysis results showed that age, fracture type, the time between injury to operation, anesthesia, operation time, preoperative basic diseases, potassium, cholesterol, creatinine, and total protein were significantly different between the two groups (P < 0.05). (2) Multivariate Logistic regression analysis showed that fracture type of intertrochanteric fracture of femur, time from injury to operation, presence of diabetes before operation, and cerebrovascular disease were independent risk factors for postoperative deep venous thrombosis in elderly patients with hip fracture  (P < 0.05). (3)  Receiver operating characteristic curve of each independent risk factor and combined model exhibited that the time from injury to operation, the presence of diabetes, cerebrovascular disease, and the combined model had predictive ability, but the type of hip fracture did not have predictive ability, and the combined model had better predictive ability than the single independent risk factor. (4) The column chart has good diagnostic efficiency and accuracy. Figures and Tables | References | Related Articles | Metrics

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Application of height adjustable titanium fusion cage in endoscopic lumbar fusion Xu Wei, Li Zhifei, Wan Tong, Yu Weibo, Zhang Yisheng, Zhou Jinyan, Bu Xianzhong, Zhong Yuanming 2022, 26 (33):  5335-5341.  doi: 10.12307/2022.807 Abstract ( 442 )   PDF (2251KB) ( 76 )   Save BACKGROUND: Percutaneous endoscopic interbody foraminal interbody fusion is an advanced minimally invasive method for the treatment of lumbar degenerative diseases. The traditional interbody fusion cage is not fully suitable for minimally invasive surgery. The choice of fusion cage for endoscopic lumbar fusion is still controversial.   OBJECTIVE: To explore the clinical effect of percutaneous spinal endoscopic implantation of height adjustable titanium fusion cage for interbody fusion in the treatment of lumbar degenerative diseases. METHODS:  A retrospective study investigated 55 patients who underwent percutaneous endoscopic lumbar fusion in the Department of Orthopedics of First Affiliated Hospital of Guangxi University of Chinese Medicine from December 2018 to June 2019. According to the different types of fusion cages implanted, they were divided into two groups. The stretch group (n=23) was implanted with a retractable height adjustable titanium fusion cage, and the general group (n=32) was used with an ordinary lumbar fusion cage. Postoperative complications were recorded in the two groups. The JOA score, Visual Analogue Scale score, and Oswestry Disability Index in the two groups were compared before and after treatment. This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi University of Chinese Medicine.   RESULTS AND CONCLUSION: (1) All 55 patients were followed-up for more than 12 months. All patients obtained bony fusion without complications, such as internal fixation loosening, fracture, fusion cage displacement, or settlement. (2) Compared with those before treatment, Visual Analogue Scale scores of low back pain and leg pain, JOA score, and Oswestry Disability Index were significantly improved in the two groups at 2 weeks, 3, 6, and 12 months after operation  (P < 0.05). JOA score at 12 months and Oswestry Disability Index at 6 and 12 months were significantly better in the stretch group than those in the general group (P < 0.05). (3) Compared with those before treatment, the height of the intervertebral space, the height of the intervertebral foramen of the fusion segment, the lordosis angle of the operative segment, and the lumbar lordosis angle of the two groups were significantly improved after treatment (P < 0.05). The height of the intervertebral space, the height of the intervertebral foramen of the fusion segment, the lordosis angle of the operative segment, and the lumbar lordosis angle were better in the stretch group than those of the general group at 5 days and 12 months after treatment (P < 0.05). (4) It is concluded that percutaneous endoscopic lumbar fusion is a reliable minimally invasive method for the treatment of lumbar degenerative diseases. Its combination with highly adjustable titanium fusion cage can improve its clinical efficacy. Figures and Tables | References | Related Articles | Metrics

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Oblique lumbar interbody fusion combined with lateral plate versus combined with pedicle screw fixation via the posterior approach for lumbar degenerative diseases: a six-month follow-up Lang Zhao, Ge Tenghui, Wu Jingye, Zhang Ning, Tian Wei, Sun Yuqing 2022, 26 (33):  5364-5369.  doi: 10.12307/2022.711 Abstract ( 535 )   PDF (1403KB) ( 90 )   Save BACKGROUND: The advantage of oblique lumbar interbody fusion for lumbar degenerative diseases is affected by the cage settlement. Supplementary fixation can provide extra biomechanical stability and may reduce the occurrence of settlement. Among them, oblique lumbar interbody fusion combined with lateral plate fixation can avoid the damage caused by the posterior approach.   OBJECTIVE: To analyze the early clinical and radiological results of oblique lumbar interbody fusion combined with lateral plate in the treatment of lumbar degenerative diseases, and to combine with bilateral pedicle screws to analyze whether there is a difference in the degree of cage settlement. METHODS:  Fourteen patients (17 segments) with oblique lumbar interbody fusion combined with lateral plate fixation (lateral plate group) and 12 patients (15 segments) with oblique lumbar interbody fusion combined with bilateral pedicle screw fixation (bilateral pedicle screw group) were included. The clinical and radiological data of patients before operation, 3 days and 6 months after operation were recorded. The clinical evaluation included low back pain and lower limb pain visual analogue scale scores and Oswestry disability index score. Radiological evaluation included measurement of disc height, segmental lordosis, and degree of cage settlement.  RESULTS AND CONCLUSION: (1) There was no significant difference between the two groups in age, gender, body mass index, quantitative CT bone mineral density, and preoperative diagnosis. The operation time of the bilateral pedicle screw group was significantly higher than that of the lateral plate group (P=0.025). The complication rate was 43% in lateral plate group and 33% in bilateral pedicle screw group. There was no significant difference between the two groups in operation segment, blood loss, and complication rate. (2) There was no significant difference in low back pain and lower limb pain visual analogue scale scores and preoperative Oswestry disability index scores between the two groups. The Oswestry disability index score of the bilateral pedicle screw group was significantly lower than that of the lateral plate group at 6 months after operation (P=0.007). At 6 months after operation, the visual analogue scale scores and Oswestry disability index scores were significantly improved in both groups compared with those before the operation (P < 0.05). (3) At 3 days after operation, disc height and segmental lordosis were significantly improved compared with before operation, but there was a significant loss of disc height in both groups at 6 months after operation (P < 0.05). There was no significant difference in disc height between the two groups before and 3 days after the operation. The disc height of the lateral plate group was significantly lower than that of the bilateral pedicle screw group at 6 months follow-up (P=0.044). (4) No statistical difference was found in segmental lordosis between the two groups. (5) There was no significant difference in the cage settlement rate between the two groups at 6 months follow-up. There were two cases of severe subsidence in the lateral plate group and none in the bilateral pedicle screw group. (6) Compared with oblique lumbar interbody fusion combined with bilateral pedicle screws, oblique lumbar interbody fusion combined with lateral plate fixation in the treatment of lumbar degenerative diseases is less effective in preventing early cage settlement. Both have similar pain relief effects at the early stage, but in terms of quality of life, oblique lumbar interbody fusion combined with bilateral pedicle screw fixation is better than oblique lumbar interbody fusion combined with lateral plate fixation. Figures and Tables | References | Related Articles | Metrics

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A machine learning prediction model based on MRI radiomics for refracture of thoracolumbar segments Liu Jin, Yin Hongkun, Chen Guo, Zhang Yu, Gu Zuchao, Tang Jing 2022, 26 (33):  5323-5328.  doi: 10.12307/2022.724 Abstract ( 451 )   PDF (13911KB) ( 32 )   Save BACKGROUND: Radiomics can be used to quantify image heterogeneity. Whether radiomics can be used to screen out features such as fingerprint from MRI images of osteoporotic vertebral bodies to predict the occurrence of new fracture is worth studying.   OBJECTIVE: To explore the feasibility of constructing a machine learning prediction model for thoracolumbar refracture after vertebral augmentation through combining MRI radiomics features and clinical information. METHODS:  This study retrospectively collected the data of patients who were diagnosed with osteoporotic vertebral compression fracture by MRI and treated with percutaneous vertebral augmentation in Chengdu First People’s Hospital from May 2014 to April 2019. PyRadiomics was used to extract the imaging features of T1 sequences of vertebral MRI at the T11-L2 segments before percutaneous vertebral augmentation. All models were constructed in the training set, and prediction performance evaluation was performed in the validation set. Feature dimension reduction was conducted by applying least absolute shrinkage and selection operator regression. The corresponding refracture prediction models were constructed by multivariate logistic regression, random forest and adaptive lifting algorithm analysis using clinical parameters, selected features or the integrating of both. The diagnostic efficacy of the model was evaluated using the receiver operating characteristic curve. The decision analysis curve was used to compare the clinical value of each model.   RESULTS AND CONCLUSION: (1) A total of 336 vertebrae were included in 135 patients, of which 67 vertebrae had refractures. 1 746 features were extracted from each vertebra, and 13 important features were obtained through dimension reduction. (2) Among the three models, area under curve of the combined model in the training set and validation set was significantly higher than that of the clinical model (P < 0.05), and the decision analysis curve also showed that the net benefit of the combined model in predicting thoracolumbar refracture was higher than that of the clinical model in most threshold intervals. (3) The results indicated that it was feasible to construct a refracture prediction model based on MRI T1 sequence imaging and clinical information, which could help to identify the vertebrae with high risk of refracture at early stage. Figures and Tables | References | Related Articles | Metrics

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Correlation between pelvic incidence-lumbar lordosis and clinical outcome in patients with degenerative lumbar scoliosis Pan Xian, Liang Simin, Liu Bingxia, Song Tianzeng, Ma He, Wu Peng, Ge Zhaohui 2022, 26 (33):  5370-5375.  doi: 10.12307/2022.718 Abstract ( 350 )   PDF (3113KB) ( 97 )   Save BACKGROUND: The sagittal parameters of the spine and pelvis in patients with degenerative scoliosis are closely related to the clinical efficacy. Professor SCHWAB once proposed the standard of lumbar lordosis = pelvic incidence angle ±9°, but statistics showed that the pelvic incidence angle of the domestic population was smaller than that of the European and American population. The application of this formula to the correction of lumbar lordosis in domestic patients is controversial.   OBJECTIVE: To evaluate the correlation between pelvic incidence-lumbar lordosis and clinical outcomes after posterior spinal pedicle screw internal fixation for degenerative lumbar scoliosis, and explore the appropriate matching of lumbar vertebrae and pelvis. METHODS:  A retrospective analysis of the medical records of 32 patients with degenerative scoliosis who underwent posterior pedicle screw fixation at the General Hospital of Ningxia Medical University from January 2015 to August 2017 was performed. The follow-up time was all > 6 months. Cobb angle, lumbar lordosis, T1 pelvic angle, sagittal vertical axis, pelvic incidence, pelvic til, sacral slope, and pelvic incidence-lumbar lordosis were measured and calculated preoperatively and at final follow-up. Visual analogue scale score, Oswestry disability index, and Short-Form-12 Health survey score were recorded preoperatively and at final follow-up.   RESULTS AND CONCLUSION: (1) Cobb angle, T1 pelvic angle, pelvic til, pelvic incidence-lumbar lordosis, Visual analogue scale score, and Oswestry disability index at final follow-up were significantly less than those before operation (P < 0.05-0.001). Lumbar lordosis, sacral slope, and Short-Form-12 Health survey score were significantly increased at final follow-up compared with those before operation (P < 0.05-0.001). Sagittal vertical axis was not significantly different before and after operation (P > 0.05). Symptoms were significantly relieved at the final follow-up postoperatively, and the efficacy was satisfied. (2) Pelvic incidence-lumbar lordosis was associated with sagittal vertical axis, T1 pelvic angle, pelvic incidence, pelvic til, sacral slope, visual analogue scale score, Oswestry disability index, and Short-Form-12 Health survey score at the final follow-up (r=0.387, 0.433, 0.660, 0.575, 0.313, 0.400, 0.378, -0.352, P < 0.05). (3) The scatter diagrams and fitting curve results suggested that the patients could get a better clinical match when the pelvic incidence-lumbar lordosis of final follow-up was in the -10°-7° interval (postoperative visual analogue scale score < 3, Oswestry disability index < 20%, and Short-Form-12 Health survey score > 130 as standards). (4) Patients whose postoperative pelvic incidence-lumbar lordosis was in -10°-7° interval were as group A; those whose postoperative pelvic incidence-lumbar lordosis was not in -10°-7° interval were as group B. Independent sample t-test showed that there was no significant difference in the visual analogue scale score, Oswestry disability index, and Short-Form-12 Health survey score preoperatively in both groups A and B (all P > 0.05). Visual analogue scale score and Oswestry disability index were lower (P < 0.05, P < 0.01), but Short-Form-12 Health survey score was higher (P < 0.01) in group A postoperatively. (5) It is concluded that pelvic incidence-lumbar lordosis has a correlation with clinical outcomes. The patients whose pelvic incidence-lumbar lordosis was in the  -10°-7° interval can obtain better clinical outcome at the final follow-up. Figures and Tables | References | Related Articles | Metrics

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Effect of Miao medicine Jiuxian Luohan Jiegu Decoction on osteogenic differentiation and fracture healing in tibial fracture rats Li Yi, Yang Yanjun, Peng Songyun, Cheng Zhigang, Zhong Kai, Yin Tianping, Tang Lianghua 2022, 26 (33):  5350-5356.  doi: 10.12307/2022.808 Abstract ( 435 )   PDF (1754KB) ( 32 )   Save BACKGROUND: Jiuxian Luohan Jiegu Decoction can promote blood circulation, remove blood stasis, reduce swelling, and relieve pain. However, its specific mechanism underlying tibial fractures has not yet been fully elucidated. OBJECTIVE: To explore the effect of Miao medicine Jiuxian Luohan Jiegu Decoction on the osteogenic differentiation and fracture healing ability of rats with tibial fractures mediated by bone morphogenetic proteins (BMPs)/Smad signaling pathway.  METHODS: Sixty Sprague-Dawley rats were randomly divided into a fracture group, a Miao medicine group, and a Panax notoginseng group. The Miao medicine group was given Jiuxian Luohan Jiegu Decoction (2 mL/kg) by gavage; the Panax notoginseng group was given the same volume of panax notoginseng powder      (1 mL/kg) by gavage; and the model group was given the same amount of distilled water by gavage, once a day, for 28 days in total. Alizarin red staining was used to measure osteogenic differentiation of bone marrow mesenchymal stem cells. RT-PCR and western blot were used to measure BMP-2, transforming growth factor-β, Smad1, and Smad2 at mRNA and protein levels. Three-point bending test was used to measure biomechanical indexes. Hematoxylin-eosin staining was used to detect bone tissue morphology. ELISA was used to measure serum vascular endothelial growth factor and insulin growth factor-1.  RESULTS AND CONCLUSION: (1) Compared with the model group, the differentiated cells of the Miao medicine group and the Panax notoginseng group grew in multiple layers and formed focal shapes, and a large number of calcium nodules were formed. The Miao medicine group showed better effects than the Panax notoginseng group. (2) Compared with the model group, the mRNA levels of BMP-2, transforming growth factor-β, Smad1, and Smad2 were increased in the Panax notoginseng group and the Miao medicine group increased (P < 0.05). (3) The maximum load and stiffness of the panax notoginseng group and the Miao medicine group were higher than those of the model group (P < 0.05). (4) The bone trabeculae of the model group were thin, arranged disorderly, and relatively loosely, the space between the medullary cavities was large, and a large number of uncalcified chondrocytes appeared. Similar bone tissue morphology was found in the Panax notoginseng group and the Miao medicine group is similar, in which the bone trabecula was thicker, the medullary cavity space was reduced, the distribution was more orderly, and the chondrocytes were more ossified compared with those in the model group. (5) Compared with the model group, the expression levels of vascular endothelial growth factor and insulin growth factor-1 in the Panax notoginseng group and the Miao medicine group increased to a certain extent (P < 0.05). (6) Radiological observations showed that there were obvious fracture lines in the model group, while the fractured ends of the samples in the Panax notoginseng group and the Miao medicine group reached complete healing. However, the scab density at fractured ends of the Miao medicine group was slightly higher than that of the Panax notoginseng group. (7) To conclude, Miao medicine (Jiuxian Luohan Jiegu Decoction) can promote osteoblast differentiation and accelerate fracture healing. Its mechanism of action may be achieved by activating the BMPs/Smad signaling pathway. Figures and Tables | References | Related Articles | Metrics

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Subarachnoid injection via the posterior atlanto-occipital interspace is an alternative way of administration in a rat model of spinal cord injury Li Chuanhong, Yu Xing, Yang Yongdong, Yang Kaitan, Zhao He 2022, 26 (33):  5376-5383.  doi: 10.12307/2022.951 Abstract ( 507 )   PDF (11027KB) ( 24 )   Save BACKGROUND: Subarachnoid injection is a commonly used intervention method in animal experiments of spinal cord injury. However, at present, there is a lack of methods for one-time large dose of subarachnoid injection that can cooperate with sustained-release/controlled-release dosage forms to reduce the frequency of administration and avoid subarachnoid catheterization.   OBJECTIVE: To investigate a method of subarachnoid injection for one-time large dose administration in a rat spinal cord injury model. METHODS:  Sprague-Dawley rats were randomly divided into six groups: a spinal cord injury group, a subarachnoid injection group, a spinal cord injury+subarachnoid injection group, a subarachnoid injection sham operation group, a spinal cord injury+subarachnoid injection sham operation group, and a control group. In the spinal cord injury group, New York University spinal cord impactor was used to establish the rat spinal cord injury model. In the subarachnoid injection group, 200 μL of simulated liquid (stroke-physiological saline solution) was injected into the subarachnoid space of rats via the posterior atlanto-occipital interspace. Rats in the spinal cord injury+subarachnoid injection group received subarachnoid injection after modeling. Rats in the control group were given no treatment. In the subarachnoid injection sham operation group, the posterior atlanto-occipital membrane was exposed and the incision was then sutured. In the spinal cord injury+subarachnoid injection sham operation group, the posterior atlanto-occipital membrane was exposed and the incision was then sutured after modeling. Toluidine blue staining was used to detect drug diffusion and distribution in the subarachnoid space at 1.5 hours after injection. Open field test, inclined plane test, hot-plate test, and body mass measurement were used to verify the occurrence of subarachnoid injection-related complications.   RESULTS AND CONCLUSION: (1) Subarachnoid injection via the posterior atlanto-occipital interspace did not cause abnormal results of Basso-Beattie-Bresnahan score, hot-plate test, and inclined plane test in each group. (2) Rats in the subarachnoid injection sham operation and the subarachnoid injection groups regained their preoperative body mass at 1 week after operation (P > 0.05). Rats in the spinal cord injury group, the spinal cord injury+subarachnoid injection sham operation group, and the spinal cord injury+subarachnoid injection group regained their preoperative body mass at 2 weeks after operation (P > 0.05). (3) No special signs of central nervous system injury caused by subarachnoid injection were observed intraoperatively and postoperatively. No leakage of cerebrospinal fluid/simulated solution was found. After the operation, all rats could raise their head normally, and no listlessness or self-mutilating behavior occurred. Rats in the subarachnoid injection sham operation and the subarachnoid injection groups did not have dysuria and dysporia. (4) At 1.5 hours after subarachnoid injection, toluidine blue solution was widely diffused in the subarachnoid space and distributed throughout the whole spinal cord. (5) The above data indicate that subarachnoid injection via the posterior atlanto-occipital interspace is safe and reliable. A single dose of 200 μL administrated can reach the injured segment of the spinal cord quickly and has a less risk of serious complications in the rat model of spinal cord injury. Therefore, it is an alternative method of subarachnoid administration in the rat model of spinal cord injury. Figures and Tables | References | Related Articles | Metrics

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Screening key genes in synovium of osteoarthritis by a combination of differentially expressed genes and weighted co-expression network analysis Qian Xiaofen, Zeng Ping, Liu Jinfu, Wang Hao, Zhou Shulong, Pan Haida 2022, 26 (33):  5342-5349.  doi: 10.12307/2022.952 Abstract ( 572 )   PDF (11426KB) ( 33 )   Save BACKGROUND: Osteoarthritis is a common chronic degenerative disease with a high correlation with age. However, its specific pathogenesis is still unclear, and there are many deficiencies in early diagnosis and treatment. OBJECTIVE: To screen the key expressed genes in the synovium of osteoarthritis by bioinformatics method, so as to lay a foundation for finding biomarkers for the diagnosis of osteoarthritis and elucidating its underlying pathogenesis. METHODS: Four osteoarthritic synovial tissue data sets were downloaded from the Gene Expression Omnibus database (GSE32317, GSE55235, GSE55457, GSE82107), including 27 normal synovial tissue samples and 49 osteoarthritic synovial tissue samples. The intersection genes of differentially expressed genes and Weighted Co-expression Network Construction Analysis results were screened using R language. Functional annotation, protein-protein interaction network, and immune infiltration analyses of the intersection genes were performed, and cytoscape was used for network visualization. Prism was used to draw receiver operating characteristic curve for the top 10 genes for degree ranking and screen out key genes, and then another synovial data set, GSE12021, was used for verification. Finally, the key genes in the synovial samples from four osteoarthritis patients and four non-osteoarthritis patients (joint injury) were further detected by PCR. RESULTS AND CONCLUSION: (1) In this study, 263 differentially expressed genes and 1 237 key module genes of Weighted Co-expression Network Construction Analysis were identified, with a total of 98 intersection genes. (2) Protein-protein interaction node number of the top 10 most genes included interleukin 6, JUN, ATF3, MYC, DUSP1, VEGFA, FOSB, CXCL8, PTGS2, and NR4A1. (3) According to the receiver operating characteristic curve, ATF3 and DUSP1 had a higher diagnostic accuracy (area under the curve > 0.8). (4) Verification with the data set GSE12021 and PCR detection indicated that the gene expression difference of ATF3 and DUSP1 between the osteoarthritis group and the control group was statistically significant (P < 0.01), which was consistent with the results of network analysis. (5) Through bioinformatics analysis, ATF3 and DUSP1 are considered to have high diagnostic value for osteoarthritis and may be potential biomarkers and therapeutic targets for osteoarthritis diagnosis and treatment. Figures and Tables | References | Related Articles | Metrics

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Molecular mechanism of magnesium ion promoting bone regeneration Zhang Jingxin, Liu Linfeng, Zhang Shiwen, Lin Jie 2022, 26 (33):  5384-5392.  doi: 10.12307/2022.779 Abstract ( 528 )   PDF (2053KB) ( 112 )   Save BACKGROUND: In recent years, the role of magnesium ion in promoting bone regeneration has been widely recognized in experiment and clinic. Magnesium materials are widely used in bone regeneration. The molecular mechanism of magnesium promoting bone regeneration involves a variety of cells and cytokines in the local environment of bone, but it has not been fully clarified. OBJECTIVE: To review the molecular mechanism of magnesium ion on promoting bone regeneration. METHODS: The PubMed, CNKI and Wanfang databases were searched for relevant articles with the key words of “magnesium OR magnesium ion”, “bone regeneration OR bone repair OR bone repairing OR osteogenesis OR osteanagenesis OR osteanaphysis OR osteoanagenesis”, “mechanism OR molecular mechanism OR cell mechanism OR signal pathway OR signaling pathway OR endothelial cell OR vascular OR immune” in English and Chinese, respectively. The search time was from database establishment to December 2021. According to the exclusion and inclusion criteria, 81 articles were included for review. RESULTS AND CONCLUSION: (1) For mesenchymal stem cells, magnesium ion can significantly promote their proliferation, migration, adhesion and osteogenic differentiation. In particular, it can not only directly promote their osteogenic differentiation through the classical Wnt pathway and MAPK/ERK pathway, but also indirectly promote their osteogenic differentiation by promoting the secretion of CGRP by ganglion cells and bone morphogenetic protein by macrophages. (2) For osteoblasts, magnesium ion mainly promotes their proliferation, migration, adhesion, osteogenic activity and inhibits their apoptosis through TRPM/PI3K signaling pathway. (3) For osteoclasts, magnesium ion inhibits osteoclast formation and bone resorption mainly through nuclear factor-κB signaling pathway. (4) Magnesium ion regulates the immune response in the bone environment, transforms the phenotype of macrophages, promotes the secretion of bone factors, and reduces the secretion of inflammatory factors, thereby reducing the inflammatory response. Simultaneously, magnesium ion promotes the proliferation, migration, adhesion and angiogenesis of vascular endothelial cells, thereby contributing to angiogenesis. (5) The role of magnesium ion in promoting bone regeneration has rich molecular mechanisms. The molecular mechanism that magnesium ions can improve the microenvironment of bone regeneration by regulating immune response and angiogenesis has become a research hotspot in recent years, especially the role of macrophage nuclear factor κB pathway and H-type vascular endothelial cells on bone regeneration, which jointly created a good microenvironment for bone regeneration. (6) Although the molecular mechanism is rich, a lot of researches are still needed to further clarify the molecular mechanism of immune regulation and pro-angiogenesis on bone regeneration and the appropriate concentration of magnesium ion on promoting bone regeneration. Figures and Tables | References | Related Articles | Metrics

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Relationship between hypoxia-inducible factors and bone homeostasis disorders Li Hongyuan, Yang Liu, Jin Xianhui 2022, 26 (33):  5393-5399.  doi: 10.12307/2022.778 Abstract ( 448 )   PDF (1402KB) ( 55 )   Save BACKGROUND: Hypoxia-inducible factor is a key gene expression regulator in the bone hypoxia microenvironment. It is of great significance to understand the mechanism of hypoxia-inducible factors in bone formation and remodeling, and to analyze its effect on bone homeostasis imbalance diseases for exploring new ways to prevent and treat bone homeostasis imbalance diseases.  OBJECTIVE: To consult relevant medical articles at home and abroad to review and analyze the mechanism of hypoxia-inducible factors in the process of bone formation and bone remodeling, as well as the research progress of the relationship between hypoxia-inducible factors and bone homeostasis disorders.  METHODS: In April 2021, we searched CNKI, Wanfang, VIP, NCBI, and PubMed for articles published from 2000 to 2021, with the Chinese and English key words of “hypoxia inducible factor, bone formation, bone remodeling, bone homeostasis disorders, regulatory mechanism”. Through the sorting and analysis of relevant data, the mechanisms of hypoxia-inducible factors on bone formation and bone remodeling were reviewed and the effect of hypoxia-inducible factors on bone homeostasis disorders was analyzed.  RESULTS AND CONCLUSION: (1) Hypoxia-inducible factor-1α overexpression in osteoblasts under the hypoxic stress promotes bone formation and increases long bone volume, while the significant upregulation of hypoxia-inducible factor-2α expression in osteoblasts promotes osteoclast maturation and differentiation and causes progressive bone loss. (2) Inhibition of hypoxia-inducible factor-1α expression in osteoblasts impairs osteoclast activity, reduces bone resorption, and improves bone remodeling. Hypoxia-inducible factor-2α mediates the regulation between osteoblasts and osteoclasts to achieve bone remodeling. (3) The mechanism of hypoxia-inducible factor-3 in bone formation and bone remodeling has not been studied yet. (4) In osteoporosis, the decrease in osteoblast number, osteogenic function and angiogenic capacity inhibits the expression of hypoxia-inducible factor-α, causing a decrease in bone mass and bone density, which increases the risk of fracture. (5) In osteoarthritis, hypoxia-inducible factor-2α is significantly overexpressed, which stimulates chondrocyte apoptosis mediated by regulating the expression of inflammatory factors, matrix catabolic enzymes and other catabolic genes, and accelerates cartilage component. (6) In chondrosarcoma, neoangiogenesis is associated with hypoxia-inducible factor-1α overexpression, and hypoxia-inducible factor-1α can be used as a malignant marker associated with tumor neoangiogenesis in chondrosarcoma, and hypoxia-inducible factor-1 inhibition therapy can interfere with angiogenesis in chondrosarcoma. (7) Hypoxia-inducible factor plays an important role in regulating the angiogenesis process and the proliferation and activity of osteoblasts, osteoclasts, and chondrocytes in bone homeostasis imbalance diseases. The development of hypoxia-inducible factor-related activating or inhibiting drugs is very positive for repairing bone defects, accelerating fracture healing, improving bone joint inflammation and other bone homeostasis imbalance lesions. Figures and Tables | References | Related Articles | Metrics

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Skeletal muscle function and exercise regulating cognitive function of the older adults Xiao Youding, Gao Qianjin, Wang Erli 2022, 26 (33):  5400-5406.  doi: 10.12307/2022.716 Abstract ( 423 )   PDF (1239KB) ( 99 )   Save BACKGROUND: The cognitive functions such as the speed of processing problems, memory and thinking imagination of the brain tend to decline with age, but many life factors can positively affect cognitive function, such as education, social activities, and regular exercise. Exercise can affect brain health through a variety of mechanisms, in which the functional changes of skeletal muscle may play an important role.   OBJECTIVE: To review the mechanism of skeletal muscle in exercise regulating brain health, in order to provide reference and new ideas for the prevention of Alzheimer´s disease and the maintenance of brain health. METHODS:  On PubMed, Web of Science, CNKI, and Wanfang databases, “skeletal muscle, exercise, brain health, cognitive function, myokine” were searched as the search terms, and the relevant articles in recent years were reviewed through literature summary.   RESULTS AND CONCLUSION: Sendentary hypoactivity and sarcopenia reduce muscle function, and the decrease of skeletal muscle function reduces cognitive function in the elderly. Resistance training and aerobic exercise enhance skeletal muscle function, which improves the cognitive function of the elderly. There was a positive correlation between skeletal muscle function and cognitive function in the elderly. Exercise can also enhance the endocrine function of skeletal muscle and secrete a variety of myokine. Myocytokines improve brain health and cognitive function by regulating muscle-brain interaction. Therefore, the change of skeletal muscle function is an important way for exercise to regulate brain health, and there is a direct cross-talk between muscle and brain. Figures and Tables | References | Related Articles | Metrics

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Joint mobilization treatment for chronic ankle instability function recovery: a meta-analysis Yin Yikun, Wang Jialin, Wu Chaoming, Sun Junzhi 2022, 26 (33):  5407-5412.  doi: 10.12307/2022.742 Abstract ( 583 )   PDF (1414KB) ( 179 )   Save OBJECTIVE: The characteristics of chronic ankle instability are often manifested as varying degrees of decreased balance and stability, proprioception, and limited dorsiflexion range of motion. Joint mobilization can effectively improve the range of joint motion and stimulate the recovery of proprioception. This article systematically analyzed the effect of joint mobilization on the functional recovery of patients with chronic ankle instability. METHODS: Electronic databases such as CNKI, PubMed, EBSCO, Web of Science, and Cochrane Library were searched. Randomized controlled trials on joint mobilization intervention for chronic ankle instability were collected. The key words were “mobilization with movement, joint mobilization, Maitland, Mulligan’s, chronic ankle instability, CAI, ankle instability” in Chinese and English. The search time was from the establishment of the database to June 2021. According to the “Bias Risk Assessment” tool in the Cochrane Intervention System Evaluation Manual, the risk assessment of the selected literature was carried out, and the RevMan 5.3 software was used for meta-analysis.  RESULTS: (1) Nine randomized controlled trials involving 336 subjects were finally included. (2) Meta-analysis results showed that joint mobilization could effectively improve the Cumberland ankle instability tool score of chronic ankle instability patients [MD=5.79, 95%CI(4.95, 6.62), P < 0.000 01]. After a single joint mobilization intervention, there was no significant improvement in the ankle dorsiflexion range of motion measured in weight bearing lunge test [MD=0.93, 95%CI(-0.53, 2.38), P=0.21] or non-weight bearing inclinometer test [MD=1.53, 95%CI(-1.69, 4.76), P=0.35]. After six joint mobilization interventions, the ankle dorsiflexion range of motion measured by weight bearing lunge test had been significantly improved [MD=4.45, 95%CI(0.41, 8.49), P=0.03]. Joint mobilization surgery had a better improvement in balance (star excursion balance test) intervention [MD=6.17, 95%CI(3.12, 9.23), P < 0.000 01], especially the forward and backward inward improvement was the most obvious (P < 0.05). However, joint mobilization surgery failed to effectively improve the pain of chronic ankle instability [MD=-0.74, 95%CI(-2.01, 0.53), P=0.25]. (3) A subgroup analysis based on different intervention methods found that dynamic joint mobilization was better than joint mobilization in improving ankle dorsiflexion range of motion (weight bearing lunge test). CONCLUSION: (1) Joint mobilization can effectively improve the range of motion and balance of the ankle joint, but the effect of improving pain is not obvious, and further research should be done. (2) Mobilization with movement improves ankle dorsiflexion range of motion (weight bearing lunge test) better than joint mobilization.  Figures and Tables | References | Related Articles | Metrics