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28 December 2022, Volume 26 Issue 36 Previous Issue    Next Issue

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Design and finite element analysis of a new type of high adhesion elastic internal fixation alloy plate for anterior cervical spine Tong Ling, Xu Yangyang, Li Zhijun, Ma Yuan, Wang Haiyan, Li Xiaohe 2022, 26 (36):  5741-5749.  doi: 10.12307/2022.997 Abstract ( 556 )   PDF (2684KB) ( 125 )   Save BACKGROUND: Anterior cervical discectomy and fusion is performed with anterior cervical auxiliary plate. However, due to the large volume of traditional plate, protruding at the anterior edge of vertebral body, and high elastic modulus caused by steel plate material, postoperative patients often have complications, such as swallowing discomfort and adjacent segment degeneration.   OBJECTIVE: Three-dimensional finite element method was used to compare and analyze the stress distribution characteristics of three new types of self-developed anterior cervical discectomy and elastic internal fixation alloy plates after operation, so as to provide the reference for the improvement and clinical application of implants. METHODS: Three kinds of inner plants were designed by using Ni-Ti alloy: alloy plate A was ladder type; alloy plate B was arc surface ladder type; and alloy plate C was arc surface type. The thin slice CT images of C5 and C6 segments of a 21-year-old healthy female volunteer were randomly collected and processed by Mimics 21.0, Geomagic Studio 2013, and Abaqus 2020 to construct the finite element models of three new types of anterior cervical alloy plates. The C5 was loaded with 50 N vertical force and 1.5 N·m pure torque load to simulate seven motion states of cervical vertebra: neutrality, flexion, extension, left and right flexion, and left and right rotation. The stress values of six stress concentration areas of three kinds of alloy plates were collected.   RESULTS AND CONCLUSION: (1) In the neutral position, the stress distributed in each stress concentration area of the three kinds of alloy plates was the smallest relative to the other working conditions. Under the flexion and extension conditions, the average stress of the upper part of the alloy plate A was higher than that of the alloy plate B (P < 0.05). The average stress of the lower part of the alloy plate C was higher than that of the alloy plate B (P < 0.05). Under the lateral flexion condition, the average stress of the flexion side was larger than that of the extension side (P < 0.05). Under the rotating condition, the average stress of the upper part of the rotating opposite side and the lower part of the same side was relatively larger (P < 0.05). During lateral flexion and rotation, the average stress in most areas of alloy plate A was much lower than that of alloy plates B and C (P < 0.05). (2) The average stress of the three kinds of alloy plates was smaller in the neutral position and larger in the rotation, and the maximum stress was almost concentrated around the threaded hole. (3) Alloy plate A was more suitable for patients who need to do a variety of similar lateral flexion and rotation movements. Alloy plate B had little effects on the vertebral body and was suitable for patients with underlying diseases of the vertebral body. Alloy plate C could appropriately increase the lower thickness under the premise of considering related complications. The new alloy plate still needs further experimental and clinical research. Figures and Tables | References | Related Articles | Metrics

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Finite element simulation surgical modeling of Lenke 3 adult idiopathic scoliosis: modeling evaluation twice in 5 years Xin Daqi, Wang Guoqiang, Han Di, Xing Wenhua, Fu Yu, Zhu Yong, Zhou Yang, Bai Xianming, He Chenyang, Zhao Yan 2022, 26 (36):  5755-5763.  doi: 10.12307/2022.784 Abstract ( 470 )   PDF (4935KB) ( 97 )   Save BACKGROUND: Adult idiopathic scoliosis is a common clinical disease leading to adult spinal deformity. Surgical correction is an effective means to treat the disease, but the choice of surgical timing and surgical correction strategy poses a challenge to clinicians. OBJECTIVE: To follow up the same Lenke 3 adult idiopathic scoliosis volunteer and carry out finite element modeling and simulated posterior orthopedic surgery before and after 5 years, so as to understand the disease progression of this type of adult scoliosis, the biomechanical changes of spinal column and implant, and the changes of orthopedic effects of different orthopedic methods, and to provide data reference for the treatment of this type of disease. METHODS: A typical Lenke 3 adult idiopathic scoliosis volunteer, male, aged 28 years old, was selected as the research object. The volunteer’s spine was scanned by continuous CT. The original image was imported into the finite element software for modeling, and the model was further cleaned. After optimization, a complete Lenke 3 adult idiopathic scoliosis finite element model including thoracic structure was established, and finite element surgical simulation was carried out on this model. Case 1: bilateral screw placement from the upper to lower vertebrae and removal of the corresponding posterior joint capsule to achieve the purpose of joint release; Case 2: posterior key vertebrae were nailed and the corresponding segments of posterior joint capsule were removed for joint release; Case 3: posterior key vertebra nailing, removal of posterior joint capsule of corresponding segments, and release of thoracic vertebrae at anterior scoliosis; Case 4: posterior key vertebra nailing, removal of posterior joint capsule of corresponding segments, and release of lumbar spine at anterior scoliosis; Case 5: posterior key vertebra nailing, removal of posterior joint capsule of corresponding segments, and release of the thoracic and lumbar spine at the anterior scoliosis. Five years later, the volunteer’s scoliosis was modeled again by finite element method and simulated surgery, so as to understand the disease progression, biomechanical changes of spine and implant, and the changes of orthopedic effects of different orthopedic methods. RESULTS AND CONCLUSION: (1) On the scoliosis model established five years later, the surgical correction scheme for Case 1-Case 5 was successfully completed. The correction rates of thoracic scoliosis were 56.8%, 48.9%, 49.8%, 55.9%, and 57.0%, and the correction rates of lumbar scoliosis were 33.0%, 36.9%, 29.4%, 30.0%, and 34.3%. The orthopedic effects of simulated surgery of Cases 3 and 5 were significantly lower than those 5 years ago. At the same time, the maximum screw stress area and the minimum screw stress area were different. (2) The lumbar scoliosis deformity of Lenke 3 adult idiopathic scoliosis volunteers increased with age, but there was no significant progress in thoracic scoliosis. Five years later, the correction rate and effect of each operation scheme on thoracic and lumbar scoliosis decreased significantly, and the area with the largest screw stress under each operation also changed. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of medial and lateral locking plates for fixation of externally rotated spiral fractures of the lower tibia Zhang Qiang, Wu Zongde, Liu Liang, Wei Guohua, Peng Liang 2022, 26 (36):  5750-5754.  doi: 10.12307/2022.785 Abstract ( 555 )   PDF (2335KB) ( 74 )   Save BACKGROUND: At present, there is a lack of research on the biomechanical properties of the medial and anterolateral anatomical locking plates of the tibia for the treatment of external rotation fractures of the tibia. OBJECTIVE: To compare stress distribution of the medial and anterolateral anatomical locking plates of the tibia for the treatment of external rotation fractures of the tibia using three-dimensional finite element analysis. METHODS: Tibia CT images of one healthy volunteer were selected. Digital technology was used to construct the medial and anterolateral locking plate model of the distal tibia. The model combination was set according to the principle of internal fixation. The axial compression force, valgus/varus force, and torsion force were given respectively to simulate the internal fixation force of human body under different stress conditions and analyze the displacement of the tibial fracture model.  RESULTS AND CONCLUSION: (1) In the axial compression force, the maximum equivalent stress and the fracture surface displacement of the distal lateral plate were about 31.6% and 8.8% smaller than those of the distal medial plate. (2) In torsion-external rotation, the maximum equivalent stress was similar and the displacement of the fracture surface was also similar between the distal medial and lateral plates. (3) Under torsion-internal rotation, the maximum equivalent stress and torsional angular displacement of the fracture surface of distal lateral plate was about 23.8% and 65.3% smaller than those of the distal medial plate. (4) When subjected to valgus violence, the maximum equivalent stress and displacement of the fracture surface of distal lateral plate were about 38.2% and 86.5% smaller than those of distal medial plate. When subjected to varus violence, the maximum equivalent stress and the displacement of the fracture surface of distal lateral plate were about 4.8% and 7.6% smaller than those of distal medial plate. (5) In external rotation spiral fractures of the middle and lower tibia, distal tibial anterior lateral plate has better ability to resist axial, twist-clockwise rotation, varus and valgus violence. The distal lateral plate has more biomechanical advantages than the distal medial plate.  Figures and Tables | References | Related Articles | Metrics

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Biomechanical properties of a single inferior tibiofibular screw with different angles for fixing inferior tibiofibular injury Mi Tao, Ding Junwen, Li Zeqing, Tang Baoming, Ren Rong, Li Zhaowei 2022, 26 (36):  5770-5774.  doi: 10.12307/2022.788 Abstract ( 476 )   PDF (1677KB) ( 104 )   Save BACKGROUND: There are still many controversies about how to implant the tibiofibular joint screw. With the gradual development of computer technology, finite element method has been continuously applied in the field of orthopedics, and the reliability of this technology has been greatly improved. OBJECTIVE: To study the biomechanical characteristics of different angle fixation of the tibiofibular syndesmosis with a single tibiofibular syndesmosis screw by establishing a three-dimensional finite element model of the ankle joint.  METHODS: Based on the CT image, Mimics software and Geomagic Studio software were used to establish the ankle joint model and verify its validity. The model was imported into Solidworks software. The finite element model of fixing the inferior tibiofibular joints with screws at six different angles (Model a: 15° forward, 10° upward, model b: 15° forward, 15° upward, model c: 15° forward, 20° upward, model d: 25° forward, 10° upward, model e : 25° forward, 15° upward, model f: 25° forward, 20° upward) was established to simulate the force mode of the ankle joint when the human body stood on one foot in neutral position. The maximum stress distribution and the maximum displacement of screws with different angle fixing methods were compared. RESULTS AND CONCLUSION: (1) Under internal rotation and external rotation loads, the maximum stress point of the screw was between the tibia and fibula near the tibia. Under internal rotation load, the maximum stresses of models a, b, c, d, e, and f were 53.38, 52.05, 52.63, 54.39, 53.85, and 52.83 MPa, respectively. Under external rotation load, the maximum stresses of models a, b, c, d, e, and f screw were 73.75, 71.62, 66.81, 77.96, 75.31, and 74.60 MPa, respectively. (2) Under internal rotation load, the maximum displacements of models a, b, c, d, e, and f were 3.27, 3.25, 3.2, 2.83, 2.99, and 2.98 mm, respectively. Under external rotation load, the maximum displacements of models a, b, c, d, e, and f screw were 2.69, 2.71, 2.75, 2.41, 2.53, and 2.55 mm. (3) In conclusion, under internal and external rotation loads, the screw position is fixed at an angle of 25° forward for greater stability. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of femoral neck system for adult Pauwels III femoral neck fracture Yang Tongchi, Hu Juzheng, Wang Renchong, Xie You, Chen Fanglin, Wen Dingfu, Shi Zhanying 2022, 26 (36):  5775-5780.  doi: 10.12307/2022.795 Abstract ( 488 )   PDF (1859KB) ( 85 )   Save BACKGROUND: There is no consensus on the choice of internal fixation for Pauwels type III femoral neck fractures. OBJECTIVE: To analyze biomechanical characteristics of femoral neck system in the treatment of adult Pauwels type III femoral neck fracture by three-dimensional finite element method, providing theoretical basis for its application in clinical practice. METHODS: The model of Pauwels type III femoral neck fracture was established by using CT images of volunteers, and four internal fixation models were established: four cannulated compression screws, biplane double-supported screw fixation, percutaneous compression plate, and femoral neck system. The internal fixation model and femur model were assembled according to common clinical fixation methods. Finally, Ansys software was used for loading and calculation to analyze the stress distribution, stress peak value, and maximum displacement of femur and internal fixation in each model. RESULTS AND CONCLUSION: (1) The stress of the proximal femoral fracture is mainly distributed in the lower part of the femoral neck near the talus femur. The stress peak of four-cannulated compression screw group was the largest and that of femoral neck system group was the smallest. (2) The displacement peak of four-cannulated compression screw group was the largest and that of femoral neck system group was the smallest. (3) The displacement peak of percutaneous compression plate group was the largest and that of biplane double-supported screw fixation group was the smallest. (4) The internal fixation stress was mainly distributed on the surface of the internal fixation device near the fracture surface. The stress peak of percutaneous compression plate group was the largest and that of four-cannulated compression screw group was the smallest. (5) The displacement peak value of percutaneous compression plate group was the largest and that of biplane double-supported screw fixation group was the smallest. (6) Above results concluded that compared with other three groups, the femoral neck system showed smaller proximal fracture mass stress and displacement, more uniform and dispersed stress distribution, and better force conductivity. In addition, biplane double-supported screw fixation internal fixation has the smallest displacement peak, but the internal fixation stress is greater than femoral neck system, and the stress is relatively concentrated, which may lead to screw fracture. The experimental results show that the femoral neck system has better biomechanical stability and can create a better mechanical environment for fracture healing.     Figures and Tables | References | Related Articles | Metrics

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A new evaluation index for patellofemoral instability: tibial nodule torsion angle Li Weixiang, Xu Bin, Jiang Shaowei 2022, 26 (36):  5781-5786.  doi: 10.12307/2022.979 Abstract ( 527 )   PDF (1297KB) ( 32 )   Save BACKGROUND: Patellar dislocation is more common in young female patients, and it is a common cause of adolescent knee pain. For the treatment of patellar dislocation, clinical treatment is divided into surgical treatment and conservative treatment. Surgical treatment generally chooses the medial patellofemoral ligament revascularization. Postoperative recurrence of dislocation may be due to failure to correct risk factors, which requires combined osteotomy and orthopedic treatment. In this way, the anatomical structure of the bone can be changed and the skeletal deformity can be corrected. However, it is still controversial in clinic whether patients need to undergo tibial nodule osteotomy and orthopedic surgery before surgery. OBJECTIVE: A new evaluation index affecting the stability of patellofemoral joint is introduced. Tibial nodule torsion angle: The correlation between tibial nodule torsion angle and patellar dislocation was measured and analyzed. The diagnostic and clinical practical values of tibial nodule torsion angle for patellar dislocation were studied, and the correlation of tibial nodule torsion angle with tibial tubercle-trochlear groove distance and patellar inclination angle was evaluated.   METHODS: A total of 42 patients with bone dislocation were collected from the Department of Sports Trauma and Arthroscopic Surgery of First Affiliated Hospital of Anhui Medical University from January to August 2020, and 46 patients with cruciate ligament injury or meniscus injury were considered as the control group. Tibial nodule torsion angle, tibial tubercle-trochlear groove distance and patellar inclination angle of the two groups were measured under CT. The three parameters of the data of the two groups were statistically analyzed. The correlation between tibial nodule torsion angle and patellar dislocation was analyzed and the clinical application value of tibial nodule torsion angle was evaluated.   RESULTS AND CONCLUSION: (1) Tibial nodule torsion angle was statistically different between the two groups (P < 0.05). (2) Compared with the other two parameters, tibial nodule torsion angle could be used as a risk factor for patellar dislocation, and had a certain diagnostic ability for patellar dislocation (area under curve=0.923). (3) It is indicated that tibial tubercle torsion angle is closely related to patellar dislocation, and has a certain diagnostic ability for patellar dislocation. Tibial tubercle torsion angle compared with the other two parameters can be incorporated into the factors affecting the stability of patellofemoral joint and can be used in preoperative evaluation to provide a reference for the selection of surgical procedure for patellar dislocation. Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of foot balance during walking support Bai Xiaotian, Jiang Tao, Huo Hongfeng, Li Zongtao 2022, 26 (36):  5787-5791.  doi: 10.12307/2022.798 Abstract ( 494 )   PDF (1689KB) ( 138 )   Save BACKGROUND: Walking is the most basic movement mode of the human, exploring the stress characteristics of the foot and the difference between the feet during walking is of great value to deeply understand the law of human walking.  OBJECTIVE: To explore the foot function and walking law of human body in each stage of gait support through the processing and analysis of foot balance curve.  METHODS: 116 subjects with normal foot type were selected by foot type and walked at their own optimal speed to record their plantar pressure data. A foot balance curve was drawn with average value and 1 times standard deviation. The curve rules and eigenvalues of dominant and non-dominant lateral feet were analyzed.  RESULTS AND CONCLUSION: (1) During the walking support period, the force characteristics of the foot on the horizontal side constantly changed. From initial contact phase to forefoot contact phase, the foot stabilized its posture through the force migration. (2) In foot flat phase, the plantar force shifted to the outside. In forefoot push off phase, the plantar force shifted from outside to inside and the human body balanced through bipedal support. (3) There was no significant difference in the relative duration of initial contact phase, forefoot contact phase, foot flat phase, and forefoot push off phase between the dominant foot and the non-dominant foot (P > 0.05). (4) The characteristic similarity of the bilateral foot balance curve was highly consistent and the foot balance curve of the dominant side was lower than that of the non-dominant side (P < 0.05). (5) It is concluded that the changes of foot posture and foot function during human walking are reflected by the foot balance curve. The function of human feet is the same at all stages of the gait cycle, and the force acting on the dominant side is more lateral than that of the non-dominant side, and the pedal and extension function is more fully performed on the horizontal axis. The foot balance curve has an important reference value for the study of human walking law and the evaluation of foot function.  Figures and Tables | References | Related Articles | Metrics

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Morphological changes and strain characteristics of lumbar intervertebral disc during sitting in forward flexion Kou Bowen, Han Ye, Hao Yiguang, Xu Haoxiang, Wen Wangqiang, Zhang Zepei, Lan Jie, Miao Jun 2022, 26 (36):  5792-5797.  doi: 10.12307/2022.797 Abstract ( 538 )   PDF (1747KB) ( 30 )   Save BACKGROUND: More activities in daily life involve sitting forward motion; however, the effect of the sitting forward process on lumbar disc deformation and strain characteristics has been less reported. OBJECTIVE: To analyze the morphological changes of the lumbar disc during sitting forward flexion and the characteristics of strain. METHODS: Dual fluoroscopic imaging system and computed tomography were used to determine the strain characteristics of the intervertebral discs. L4-5 and L5-S1 levels were studied in 10 asymptomatic subjects (male/female: 5/5, age: 25-35 years, body mass index: 22.4±1.8 kg/m2). The height changes of the disc as a whole, the medial and lateral annulus fibrosus in upright sitting and forward flexion sitting was measured. The ranges of tensile and shear strains in the disc during maximum forward flexion motion were determined in the sitting position.  RESULTS AND CONCLUSION: (1) During sitting and forward flexion, L4-5 and L5-S1 showed similar patterns of change in the medial to lateral height ratios in each region of the annulus fibrosus, with a range of 0-0.1 for L4-5 in forward flexion, but a significant decrease in disc height in L5-S1, with a range of 0.02-0.39. (2) During sitting in forward flexion, L5-S1 was under compressive strain in all regions, especially on the right side, where it was 28.3% more compressed than L4-5 (P=0.011). The shear strain of L5-S1 was greater than that of the superior disc, with a significant increase of 14.8% in the central region compared to L4-5 (P=0.011). (3) It is indicated that forward flexion movement during sitting has a greater effect on the height and strain pattern of all parts of the disc at L5-S1, but less at L4-5. L5-S1 is in compression as a whole during the process, with asymmetric compression on the left and right sides, and with greater shear strain in each region. These characteristics help us to gain a better understanding of degeneration due to altered disc strain and to help postoperative patients achieve a better state of recovery. Figures and Tables | References | Related Articles | Metrics

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3D-printed thoracolumbar spine tuberculosis model and guide plate to guide the accuracy and safety of surgery Yang Yi, Cao Guangru, Wang Chong, Yuan Hao, Cai Yuqiang 2022, 26 (36):  5798-5806.  doi: 10.12307/2022.750 Abstract ( 392 )   PDF (3291KB) ( 84 )   Save BACKGROUND: Debridement of spinal tuberculosis lesions with bone graft fusion and internal fixation is a common clinical standard procedure. With the help of the personalized lesion model made by 3D printing, the preoperative planning and the production of surgical nail guides to assist the operation can not only reduce the risk of surgery, but also have higher surgical efficiency and precision compared with traditional methods. OBJECTIVE: To explore the accuracy and safety of 3D-printed thoracolumbar spine tuberculosis model and guide plate to guide the operation.  METHODS: From July 2017 to December 2019, there were 61 cases of tuberculosis of thoracolumbar spine treated in Affiliated Hospital of Zunyi Medical University. The patients were divided into 3D group and traditional group. Before operation, thin-layer CT image data of the diseased segments of 24 patients in the 3D group were collected and the thoracolumbar spine tuberculosis model was printed with a 3D printer. The pedicle screw guide plate was designed and produced by 3D printing technology, and the model and guide plate were used to formulate the surgical plan and guide the surgical treatment. In the traditional group (n=37), after the CT and X-ray imaging examinations before surgery, the patients were discussed and operated according to the traditional surgical methods. The operation time, intraoperative blood loss, nail placement time, C-arm fluoroscopy number, acceptable nail placement percentage, nail placement accuracy rate, and Cobb angle correction of patients were observed and recorded in 3D group and traditional group. Whether it caused complications such as nerves, blood vessels, and visceral injury was observed.  RESULTS AND CONCLUSION: (1) All patients successfully completed the operation. The operation time, intraoperative blood loss, time spent nailing, and C-arm fluoroscopy times were significantly better in the 3D group than those in the traditional group (P < 0.05). The postoperative hospital stay and postoperative drainage were not statistically significant (P > 0.05). (2) There was no statistically significant difference between the parameters of 3D-printed model data before operation and CT data after operation in the 3D group (P > 0.05). (3) There was no significant difference between the two groups in the accuracy of nail placement and the percentage of acceptable nail placement (P > 0.05). (4) There were no complications such as blood vessels, viscera or nerve injury in the two groups. (5) It is concluded that 3D printing technology is used to simulate thoracolumbar spine tuberculosis model planning operation plan; printing pedicle screw guides to guide nail placement is feasible. They have high efficiency, high precision and high safety, and can provide a reference for the surgical treatment of thoracolumbar spine tuberculosis. Figures and Tables | References | Related Articles | Metrics

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Establishment of thoracic and abdominal volume models of adolescent idiopathic scoliosis based on three-dimensional motion capture system Lu Yangyang, Xu Chunxin, Chen Cen, Ren Jie, Zhai Xinyi, Zhu Shenyu, Shen Min 2022, 26 (36):  5807-5811.  doi: 10.12307/2022.802 Abstract ( 379 )   PDF (1524KB) ( 34 )   Save BACKGROUND: Three-dimensional motion capture technology has developed a variety of models for different diseases through its computer-aided characteristics. There are no good models available for clinically instructive assessment of adolescent idiopathic scoliosis.   OBJECTIVE: To establish the thoracic volume and abdominal volume models of adolescent idiopathic scoliosis based on 3D motion capture system.  METHODS: Fourteen patients with adolescent idiopathic scoliosis, aged 10-18 years, were selected from Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai No. 6 People’s Hospital Affiliated to Shanghai Jiao Tong University, and Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University from July 2020 to July 2021, including 2 males and 12 females. Chest circumference and Cobb’s angle of all patients were measured. The models of thoracic volume and abdominal volume were established by three-dimensional motion capture system. The correlation of thoracic volume and abdominal volume with age, chest circumference and Cobb’s angle was analyzed.   RESULTS AND CONCLUSION: The thoracic and abdominal volumes at maximum inhalation and maximum exhalation were positively correlated with chest circumference, but not correlated with Cobb’s angle. The models of thoracic volume and abdominal volume of adolescent idiopathic scoliosis were established based on three-dimensional motion capture system. This method is proven to be a harmless, accurate and quantitative detection of thoracic and abdominal volumes for patients with Cobb’s angle ranging from 10° to 45°.  Figures and Tables | References | Related Articles | Metrics

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Robot-assisted minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: accuracy and safety of screw placement Li Ting, Liu Xilin, Wang Fei, Hu Jiang 2022, 26 (36):  5812-5818.  doi: 10.12307/2022.974 Abstract ( 432 )   PDF (2126KB) ( 65 )   Save BACKGROUND: For the treatment of lumbar degenerative disorders, there are no relevant studies whether robot-assisted minimally invasive transforaminal lumbar interbody fusion is more accurate, less invasive, and more beneficial to the health of patients and operators compared with traditional minimally invasive transforaminal lumbar interbody fusion.  OBJECTIVE: To evaluate the clinical value of robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery by comparing the clinical and radiographic data with conventional minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases.   METHODS: A retrospective study was conducted in 72 patients with lumbar degenerative diseases from January 2018 to November 2020 in Department of Orthopedic Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital.  Of them, 33 patients underwent robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery (robot group) and 39 patients received conventional minimally invasive transforaminal lumbar interbody fusion surgery (traditional group). Basic clinical outcomes included comparison of operative time, intraoperative blood loss, hospital stay, operative complications, fluoroscopic dose, fluoroscopic time and fluoroscopic frequency between the two groups. Clinical outcomes were assessed using Oswestry disability index and visual analogue scale score. Excellent and good rate of the two surgical options was evaluated using Macnab’s criteria. Gertzbein-Robbins’ classification was used to evaluate the accuracy of percutaneous pedicle screws.    RESULTS AND CONCLUSION: (1) There were no statistically significant differences in gender, age and lesion segment between the two groups (P > 0.05). (2) Patients in both traditional and robot groups had improved Oswestry disability index and visual analogue scale scores. There were no statistically significant differences between the two groups at pre-operation, post-operation and at the last follow-up (P > 0.05). No major vascular or neurological complications were found post-operatively in both groups. Moreover, there was no statistical significance in Macnab criteria and complications between the two groups (P > 0.05). (3) Operative time and hospital stay of the robot group were significantly shorter than those in the traditional group. The intraoperative blood loss was significantly lower in the robot group than that in the traditional group. (4) The significantly lower fluoroscopic frequency and dose, as well as shorter fluoroscopic time were found in the robot group compared with the traditional group. (5) Postoperative imaging studies showed that the accuracy of percutaneous pedicle screw placement in the robot group was superior than that in the traditional group (99.24% vs. 91.03%, χ2=9.78, P=0.002). (6) It is concluded that compared with the traditional group, the robot-assisted minimally invasive transforaminal lumbar interbody fusion has higher surgical efficiency, less intraoperative radiation and superior accuracy of screw fixation, which has a good clinical value in the treatment of lumbar degenerative diseases.  Figures and Tables | References | Related Articles | Metrics

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3D printing percutaneous puncture guide plate assisted vertebroplasty for single-level osteoporotic vertebral compression fracture with active registration location combined with anatomic marker localization Huang Taosheng, Chen Jianquan, Lin Xinyuan, Lyu Zhouming, Chen Maoshui 2022, 26 (36):  5819-5825.  doi: 10.12307/2022.794 Abstract ( 367 )   PDF (2301KB) ( 34 )   Save BACKGROUND: The 3D printing guide technology has achieved good results in precise nail placement, but the application and research of 3D printed body surface guide plate with active registration localization combined with anatomical marker localization have not been reported.  OBJECTIVE: To investigate the clinical effect and safety of 3D printing percutaneous puncture guide assisted vertebroplasty in the treatment of osteoporotic vertebral compression fracture with active registration localization combined with anatomic marker localization.  METHODS: The clinical data of 50 patients with osteoporotic vertebral (T10-L2) compression fracture who met the inclusion criteria from October 2020 to June 2021 were analyzed. The patients were randomly divided into the observation group (25 cases) and the control group (25 cases). The observation group received percutaneous vertebroplasty assisted by 3D printing percutaneous puncture guide plate with active registration positioning combined with anatomical marker positioning. The control group received routine percutaneous vertebroplasty. The puncture positioning time, puncture number, fluoroscopy number, fluoroscopic exposure duration, and total operative duration were observed and recorded in the two groups when obtaining the optimal puncture location. Visual analogue scale score and Oswestry disability index were recorded before, 1 week and 3 months after surgery. Vertebral midline height and Cobb angle were compared before, 1 week and 3 months after operation between the two groups. Perioperative complications were recorded. RESULTS AND CONCLUSION: (1) The total puncture time, puncture adjustment times, and fluoroscopy times in the observation group were lower than those in the control group, and the incidence of intraoperative and postoperative complications in the observation group was lower than that in the control group (P < 0.05). (2) Visual analogue scale score and Oswestry disability index in the same group at 1 week and 3 months after surgery were significantly lower than those before surgery (P < 0.05). Visual analogue scale score and Oswestry disability index were lower in the observation group than those in the control group at 1 week and 3 months after surgery (P < 0.05). (3) The number of cases of postoperative bone cement leakage in the observation group was significantly lower than that in the control group (X2=8.754, P < 0.05). (4) Above findings indicate that percutaneous vertebroplasty assisted by active registration combined with anatomic marker location can effectively simplify and optimize the surgical process, shorten the operation time and radiation exposure, improve the success rate of surgery, effectively reduce surgical complications, and improve the safety of percutaneous vertebroplasty.  Figures and Tables | References | Related Articles | Metrics

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Treatment of Schatzker type V and VI tibial plateau fractures with 3D printing preoperative planning combined with double reverse traction device He Guowen, Hu Baijun, Gao Dawei, Chen Liang 2022, 26 (36):  5764-5769.  doi: 10.12307/2022.796 Abstract ( 542 )   PDF (1710KB) ( 76 )   Save BACKGROUND: In the operation of Schatzker type V and VI tibial plateau fractures, the use of double reverse traction device has solved the problems of the traditional operation, such as large trauma and poor surgical effect, and has been popularized and applied in clinic to a certain extent. 3D printing technology has advantages in assisting preoperative assessment of fracture and fracture reduction planning.  OBJECTIVE: To investigate the clinical effect of the treatment of Schatzker type V and VI tibial plateau fractures with 3D printing preoperative planning combined with double reverse traction device. METHODS: From March 2018 to March 2020, 46 patients (25 males and 21 females, aged 19-83 years) with Schatzker type V and VI tibial plateau fractures were admitted to the Department of Orthopedics, Zhongshan Chinese Medicine Hospital. All patients were assigned to two groups. Among them, 23 cases in the observation group were treated with 3D printing preoperative planning combined with double reverse traction device, and 23 cases in the control group were treated with routine double reverse traction minimally invasive operation. The data of the two groups were compared, including the total operation time, the times of intraoperative fluoroscopy, the amount of intraoperative bleeding, and the time of fracture reduction, and the data of the clinical rehabilitation indexes, including the visual analogue scale scores of the patients before and after treatment, the degree of swelling of the affected limb and the occurrence of postoperative complications. Knee function (hospital for special surgery knee score) and motor function (Fugl-Meyer assessment) scores were compared between the two groups in 6-month follow-up. RESULTS AND CONCLUSION: (1) The operation time, fracture reduction time, blood loss, and fluoroscopy times were less in the observation group than those in the control group (P < 0.05). (2) The postoperative visual analogue scale score, the degree of swelling, and the incidence of complications were lower in the observation group than those in the control group (P < 0.05). (3) There was no significant difference in Fugl-Meyer assessment scores and hospital for special surgery knee score knee function scores between the observation group and the control group at 3 and 6 months postoperatively (P > 0.05). (4) It is a safe and effective method to treat Schatzker type V and VI tibial plateau fractures with 3D printing preoperative planning combined with double reverse traction device. It can shorten the operation time and the fracture reduction time, reduce the blood loss, reduce the postoperative pain and swelling, and lower extremity venous thrombosis and other complications. Figures and Tables | References | Related Articles | Metrics

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Comparison of the effects of different modes of balance disorder rehabilitation robots after total hip arthroplasty in the elderly Yuan Bo, Li Kainan, Jia Zishan 2022, 26 (36):  5826-5830.  doi: 10.12307/2022.787 Abstract ( 419 )   PDF (1364KB) ( 70 )   Save BACKGROUND: The clinical application of hip arthroplasty not only improves the quality of life and lower limb function of patients with femoral neck fracture, but also reduces the mortality of patients. However, the postoperative rehabilitation technology of patients is single, the distribution of rehabilitation doctors is uneven, and the efficacy of the whole population is unknown. Therefore, the application of rehabilitation robot in hip arthroplasty is an effective and safe way. OBJECTIVE: To explore effect of multi-scene rehabilitation mode based on balance disorder rehabilitation-assisted robot on lower limb function of the elderly after total hip arthroplasty.  METHODS: A total of 60 patients aged over 60 years old who underwent total hip arthroplasty after femoral neck fracture were recruited from the Orthopedic Ward of Chinese PLA General Hospital and the Affiliated Hospital of Chengdu University from January to June 2021. The patients were randomly divided into study group (n=30) and control group (n=30). The control group was trained by traditional physical therapy combined with walking rehabilitation model of balance disorder rehabilitation-assisted robot, and the study group was trained by traditional physical therapy combined with multi-scene rehabilitation model of balance disorder rehabilitation-assisted robot. After 16 weeks of training, peak torque value data and hip motion data were collected. After 8, 12, and 16 weeks, Berg Scale score and Fugl-Meyer score were collected.  RESULTS AND CONCLUSION: (1) One case in each of the two groups dropped out, and the remaining 58 cases had no accidental injury during the training and successfully completed the training treatment. (2) At 16 weeks after training, the range of motion of hip joint in the study group was less than that in the control group (P < 0.05). The peak torque of the hip joint in the study group was greater than that in the control group (P < 0.05). (3) With the extension of training time, Berg score and Fugl-Meyer score were increased in both groups. Under the same training time, Berg score and Fugl-Meyer score were higher in the study group than those in the control group (P < 0.05). (4) It is concluded that under the same training time, the effect of balance disorder rehabilitation-assisted robot on lower limb function rehabilitation of the elderly after total hip arthroplasty was better in the multi-scene rehabilitation training mode than in the weight-loss walking training mode, but it showed a trend of fast recovery in the early stage of rehabilitation and slow recovery in the late stage of rehabilitation. Figures and Tables | References | Related Articles | Metrics

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Absence of a tourniquet during total knee arthroplasty: a prospective randomized controlled trial Ma Qiaoqiao, Wu Zerui, Guo Zhuotao, Zhang Kai, Zha Guochun, Guo Kaijin 2022, 26 (36):  5831-5836.  doi: 10.12307/2022.790 Abstract ( 465 )   PDF (1189KB) ( 48 )   Save BACKGROUND: Total knee arthroplasty is the most effective method for the treatment of end-stage knee osteoarthritis, but whether to use tourniquets during total knee arthroplasty remains controversial in academic circles.  OBJECTIVE: To investigate the effect of tourniquet on postoperative clinical efficacy and imaging results during total knee arthroplasty. METHODS: From September 2019 to September 2020, a prospective, randomized, controlled study was conducted in patients who underwent primary total knee arthroplasty for degenerative osteoarthritis. All patients were treated with cement-based prosthesis of the same design, and were randomly divided into intraoperative tourniquet use group (control group) and no tourniquet use group (trial group). To make clinical data comparable, the same follow-up time point was set for both groups, 12 months after surgery. A total of 100 cases (49 cases in the trial group; 51 cases in the control group) were included in the final analysis to evaluate the clinical efficacy, penetration depth of bone cement, and incidence of postoperative complications. RESULTS AND CONCLUSION: (1) The operation was successfully completed in both groups. The release rate of external patellar retinacular band was lower in the trial group (0 cases) than that in the control group (6 cases) (P=0.040). (2) The visual analogue scale score of the trial group on the 7th postoperative day was lower than that of the control group (P=0.00). Visual analogue scale score between the trial group and the control group had no statistical significance 1 month after surgery (P=0.61). (3) There was no significant difference in the range of motion at 12 months and KSS score at 1 month between the trial group and the control group. (4) X-ray examination 2 days after the operation showed that the penetration depth of bone cement was similar between the two groups (P=0.281). (5) At 12 months after the operation, there was no periprosthetic infection, prosthesis loosening or symptomatic thrombosis in both groups. (6) It is indicated that whether to use tourniquets during primary total knee arthroplasty does not affect penetration depth of bone cement or clinical effect. However, the use of tourniquet can increase the degree of pain within 7 days after operation and the release rate of external patellar retinacular band. Figures and Tables | References | Related Articles | Metrics

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Distribution, drug resistance, and clinical characteristics of pathogenic bacteria in 102 cases of periprosthetic joint infection Jiang Xu, Cao Fuyang, Xiong Ao, Yang Meng, Tan Jun, Yu Yang, Zhang Shaokun, Xu Jianzhong 2022, 26 (36):  5837-5843.  doi: 10.12307/2022.799 Abstract ( 437 )   PDF (1290KB) ( 41 )   Save BACKGROUND: Periprosthetic joint infection, a serious complication after artificial joint arthroplasty, has always been a thorny problem in clinical practice. At present, the research on the characteristics of the pathogenic bacteria is insufficient, and more research is needed to help clinical diagnosis and treatment.  OBJECTIVE: To explore the distribution and drug resistance of pathogens in periprosthetic joint infection after knee and hip arthroplasties, and to compare the characteristics of different pathogen culture results.  METHODS: A retrospective single-center research was used to study the data of 102 cases of periprosthetic joint infection in the Department of Orthopedics, First Affiliated Hospital of Zhengzhou University from September 2013 to September 2020. Pathogen culture results, drug resistance, and other diagnosis and treatment information were collected. According to the results of pathogen culture, the patients were divided into four groups: gram-positive bacteria, gram-negative bacteria, fungi, and negative culture. The differences in general condition, clinical features, operation methods, and infection control were compared among the four groups. RESULTS AND CONCLUSION: (1) Totally 66 of 102 patients with periprosthetic joint infection were cultured positive for pathogenic bacteria, and 71 strains of pathogenic bacteria were detected. Gram-positive bacteria accounted for 57.8%. Staphylococcus epidermidis (21.1%) and Staphylococcus aureus (15.5%) were the most common. Gram-negative bacteria accounted for 29.6% and Escherichia coli (12.7%) was the most common. Fungi accounted for 12.7%, with Candida parapsilosis (5.6%) being the most common. (2) Gram-positive bacteria had high resistance rates to penicillin G, oxacillin, clindamycin, and erythromycin, and 0% to vancomycin, tigecycline, and linezolid. Gram-negative bacteria had a high resistance rate to antibiotics such as quinolones, gentamicin, ampicillin, and cefazolin; no drug-resistant fungi had been found. (3) There was no significant difference in sex, age, basic disease, operation site, infection type, sinus, operation mode, and infection control rate among the four groups (P > 0.05). In early infection, the C reactive protein in culture negative group was lower than that in gram-positive bacteria group (P < 0.05), and red serum sedimentation rate and white blood cell count in culture negative group were significantly lower than those in gram-negative bacteria group (P < 0.05). Leukocyte, C-reactive protein, and erythrocyte sedimentation rate of hip periprosthetic infection were higher than those of knee periprosthetic infection (P < 0.05). (4) It is concluded that the main pathogen causing periprosthetic joint infection is still gram-positive bacteria, of which Staphylococcus accounts for the largest proportion. The increase of Candida parapsilosis infection is worthy of attention. Multiple pathogenic bacteria have a high drug resistance rate to some conventional antibiotics, so the use of antibiotics should be adjusted in time according to the results of drug susceptibility and efficacy.  Figures and Tables | References | Related Articles | Metrics

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Three approaches of pedicle screw internal fixation for thoracolumbar fractures: spinal function, vertebral height reduction and local Cobb angle recovery Song Dawei, Yu Hao, Yang Ming, Xie Haifeng, Wu Cenhao, Yan Qi, Wang Yingjie, Yang Huilin, Geng Dechun, Niu Junjie, Wang Jinning 2022, 26 (36):  5844-5848.  doi: 10.12307/2022.747 Abstract ( 596 )   PDF (2647KB) ( 74 )   Save BACKGROUND: Pedicle screw internal fixation is one of the main first choices for the treatment of thoracolumbar fractures. The therapeutic effects of percutaneous pedicle screw, Wiltse approach, and conventional approach remain in controversy. OBJECTIVE: To evaluate the clinical effects of percutaneous pedicle screw, Wiltse approach, and conventional approach in the treatment of thoracolumbar fractures. METHODS: A retrospective analysis of the medical records of patients with thoracolumbar fractures admitted to First Affiliated Hospital of Soochow University from February 2017 to October 2019 was performed. A total of 46 cases were enrolled and all received pedicle screw internal fixation, of which 15 cases received percutaneous screw placement, 17 cases through the Wiltse approach, and 14 cases through the posterior median approach. Serum creatine kinase level, visual analogue scale score, Qswestry dysfunction index, Japanese Orthopaedic Association (JOA) score, the relative height of the anterior edge of the injured vertebrae and the sagittal kyphotic Cobb angle were compared before and after the operation in the three groups.   RESULTS AND CONCLUSION: (1) All 46 patients underwent surgeries successfully with no complications such as internal fixation breakage. (2) The creatine kinase levels of the three groups 3 days after operation were higher than those before operation (P < 0.05). The level of creatine kinase at 3 days after operation was percutaneous pedicle screw group < Wiltse approach group < posterior median approach group (P < 0.05). (3) The visual analogue scale scores, Qswestry dysfunction index, and JOA scores of the three groups after surgery were significantly improved compared with those before surgery (P < 0.05). At 3 days after operation and the internal fixation removal, the Qswestry dysfunction index and JOA score of the percutaneous pedicle screw group were better than those of the Wiltse approach group and the posterior median approach group (P < 0.05). Qswestry dysfunction index and JOA score were better in the Wiltse approach group than those of the posterior median approach group (P < 0.05). (4) The relative height of the anterior edge of the injured vertebrae and the sagittal kyphotic Cobb angle of the three groups were significantly improved 3 days after operation and after the internal fixation removal compared with those before surgery (P < 0.05). There was no significant difference in the relative height of the anterior edge of the injured vertebrae and the sagittal kyphotic Cobb angle between the three groups after surgery (P > 0.05). (5) These results indicate that the percutaneous pedicle screw and Wiltse approach have little effect on the paravertebral muscles compared with conventional approach, and it is more conducive to the postoperative functional recovery of patients with thoracolumbar fractures. Figures and Tables | References | Related Articles | Metrics

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Implant-related errors and complications in medial open-wedge high tibial osteotomy Pan Jianke, Zhao Di, Jin Xiao, Yang Weiyi, Luo Minghui, Liu Jun, Han Yanhong, Cao Houran 2022, 26 (36):  5849-5856.  doi: 10.12307/2022.791 Abstract ( 563 )   PDF (3660KB) ( 35 )   Save BACKGROUND: Medial open wedge high tibial osteotomy is one of important methods in the treatment of medial compartment knee osteoarthritis and also an important part of knee preservation therapy. Intraoperative errors and postoperative complications are important factors affecting the success of the operation.  OBJECTIVE: To summarize the common errors and complications of medial open-wedge high tibial osteotomy and analyze the causes.  METHODS: A retrospective analysis was performed in patients who underwent primary medial open-wedge high tibial osteotomy for anterior medial osteoarthritis of the knee in Department of Sports Medicine, Guangzhou University of Chinese Medicine from April 2017 to August 2021 through the hospital medical records information management system. The typical cases of intraoperative errors and postoperative complications were summarized and analyzed.  RESULTS AND CONCLUSION: (1) Common errors and complications of 12 kinds of medial open-wedge high tibial osteotomy were found, including short or long screw selection, forward or upward plate placement, hinge fracture, deviation of osteotomy line positioning from actual osteotomy, insufficient or too much force line correction, bone nonunion, fracture displacement, bone nonunion, nail withdrawal, postoperative infection, postoperative acute intermuscular venous thrombosis, and postoperative wound swelling and pain. (2) After analyzing and treating 12 kinds of common errors and complications in clinic, most patients had achieved good results. (3) We hoped to share these experiences and lessons with the majority of colleagues, and reduce the occurrence of intraoperative errors and postoperative complications as far as possible, as well as improve medical safety and postoperative satisfaction of patients. Figures and Tables | References | Related Articles | Metrics

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Different doses of tranexamic acid affect blood loss after high tibial osteotomy Sun Yiyuan, Li Qi, Xiong Yan, Li Jian 2022, 26 (36):  5857-5861.  doi: 10.12307/2022.789 Abstract ( 378 )   PDF (1201KB) ( 98 )   Save BACKGROUND: Tranexamic acid has been widely used in hip and knee replacements, which could reduce blood on the bone surface. In recent years, the drug has also achieved certain results in high tibial osteotomies. However, how to choose the dosage and assess the risk and benefit is not yet known. OBJECTIVE: To evaluate the effect of different doses of tranexamic acid on blood loss after high tibial osteotomy. METHODS: The clinical data of 62 patients with varus knee joint deformity who received unilateral high tibial osteotomy in West China Hospital of Sichuan University from March 2018 to July 2021 were collected. According to different doses of tranexamic acid, the patients were divided into low-dose group of 22 cases, medium-dose group of 20 cases, and high-dose group of 20 cases. Tranexamic acid was administered intravenously. Patients in the low-dose group and medium-dose group received intravenous infusion of 1 g or 2 g tranexamic acid solution 30 minutes before surgery. Patients in the high-dose group received another infusion of 1 g tranexamic acid 3 hours after surgery on the basis of the medium-dose group. The difference of hematological indexes among the three groups before and after surgery was collected and compared. Operation duration, postoperative blood transfusion volume, incision complications, and thromboembolic events were recorded and compared among the three groups. RESULTS AND CONCLUSION: (1) There was no significant difference in hemoglobin changes and blood loss between the low-dose group and the middle-dose group before and after the operation, but the hemoglobin loss of the high-dose group was significantly less than that of the low-dose group. Blood loss was significantly less in the middle-dose and high-dose groups than that of the low-dose group (P < 0.05). (2) The differences in prothrombin time, fibrinogen, and activated prothrombin time were not significantly different before and after the operation in patients of the three groups (P > 0.05). (3) There were no incision infections or thromboembolic events after the operation in the three groups, and there was no significant difference in complications. (4) It is concluded that perioperative use of high-dose tranexamic acid for high tibial osteotomy can significantly reduce blood loss, and does not increase postoperative incision complications and thromboembolic events.  Figures and Tables | References | Related Articles | Metrics

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C2 and C3 vertebral arch bone impact after posterior cervical single open-door laminoplasty: lateral X-ray evaluation of cervical spine within 2 years Zhong Hua, Guan Haishan 2022, 26 (36):  5862-5867.  doi: 10.12307/2022.793 Abstract ( 364 )   PDF (1652KB) ( 27 )   Save BACKGROUND: The phenomenon of C2 and C3 vertebral arch bone impact is easy to occur after posterior cervical single open-door laminoplasty, which leads to the limitation of postoperative cervical movement. The analysis of related factors is of great clinical significance. OBJECTIVE: To analyze the related factors of C2 and C3 vertebral arch bone impact after posterior cervical single open-door laminoplasty, and to explore the etiology and pathogenesis of C2 and C3 vertebral arch bone impact. METHODS: A retrospective analysis was performed in 95 patients with multi-level cervical spondylotic myelopathy who underwent posterior cervical single open-door laminoplasty and had complete follow-up data, at a mean age of (56.76±7.76) years old, including 33 males and 62 females. The patients were followed up to observe whether C2 and C3 vertebral arch bone impact occurred within 2 years using X-ray films. The patients were divided into impact group (n=31) and non-impact group (n=64). After univariate analysis, it suggested that preoperative ossification of posterior longitudinal ligament, postoperative cervical curvature, postoperative cervical mobility, and postoperative visual analogue scale score were the potential related factors of C2 and C3 vertebral arch bone impact. Finally, multivariable logistic regression analysis was included.  RESULTS AND CONCLUSION: (1) Among 95 patients, 31 cases had C2 and C3 vertebral arch bone impact, accounting for 33%. (2) The incidence of preoperative ossification of the posterior longitudinal ligament in the impact group was significantly higher than that in the non-impact group (P < 0.05). (3) There was no statistical significance in the preoperative cervical curvature, cervical motion range, Japanese Orthopaedic Association score, and visual analogue scale between the impact group and the non-impact group (P > 0.05). Cervical curvature and cervical motion range were significantly higher in the impact group than those in the non-impact group (P < 0.05). At the final follow-up, Japanese Orthopaedic Association score was not significantly different between the impact group and the non-impact group (P > 0.05). Visual analogue scale score was significantly higher in the impact group than that in the non-impact group (P < 0.05). (4) Postoperative axial symptoms occurred in 2 cases (6%) in the impact group and 3 cases (5%) in the non-impact group. (5) Multivariable logistic regression analysis suggested that low postoperative cervical curvature, low postoperative cervical motion range, and high postoperative visual analogue scale score were independent risk factors for C2 and C3 vertebral arch bone impact. It is indicated that C2 and C3 vertebral arch bone impact is one of the important reasons for the occurrence of axial symptoms and has a certain impact on the postoperative curative effect.  Figures and Tables | References | Related Articles | Metrics

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Antioxidative stress of trihydroxyethyl rutin on cervical spinal cord injury in rats Liu Yapu, Su Yuanyuan, Liu Qi, Yang Zhou, Li Rong, Huang Zucheng, Huang Zhiping, Wu Xiaoliang, Zhu Qingan 2022, 26 (36):  5868-5874.  doi: 10.12307/2022.804 Abstract ( 451 )   PDF (2504KB) ( 147 )   Save BACKGROUND: Previous animal studies have found that trihydroxyethyl rutin can improve the neurological function of rats with cervical spinal cord injury, but there is a lack of relevant studies on the mechanism of action. OBJECTIVE: To investigate the antioxidant stress effect of trihydroxyethyl rutin on spinal cord injury in vitro and in vivo, and to explore the possible mechanism.  METHODS: (1) Cell experiment: The rat adrenal gland PC12 cells were purchased from cell bank of American Type Culture Collection. MTT assay was used to detect the effects of gradient concentrations of tert-butyl hydroperoxide (0, 25, 75, 100, 150, 200, and 250 μmol/L) and trihydroxyethyl rutin (0, 50, 100, 200, and 400 μmol/L) on the activity of PC12 cells. Experimental concentrations of tert-butyl hydroperoxide and trihydroxyethyl rutin were determined. (2) Animal experiment: Male Sprague-Dawley rats were assigned to sham operation group, injury group, trihydroxyethyl rutin 50 mg/kg group, trihydroxyethyl rutin 100 mg/kg group, and STAT3 inhibitor group (n=12). In addition to the sham operation group, cervical spinal cord injury was made in rats. Rats in the trihydroxyethyl rutin 50 mg/kg group and trihydroxyethyl rutin 100 mg/kg group were intraperitoneally given trihydroxyethyl rutin 50 mg/kg (once a day) and 100 mg/kg (once a day) after model establishment, respectively. The rats in the inhibitor group were given STAT3 inhibitor 2 000 µg/kg (once a day) immediately after model establishment. Animals in the sham operation group were subjected to laminectomy, but no contusion operation was performed. Rats in the sham operation group and the injury group were injected intraperitoneally with normal saline for 3 consecutive days. DCFH probe was used to detect the effects of trihydroxyethyl rutin on reactive oxygen species production in tert-butyl hydroperoxide-induced PC12 cells. Western blot assay was used to detect the effects of trihydroxyethyl rutin and STAT3 inhibitor on the expression levels of oxidative stress related proteins Catalase and MnSOD in PC12 cells and cervical spinal cord injury tissues. Immunofluorescence staining was used to detect the effects of trihydroxyethyl rutin on STAT3 and MnSOD protein expression in cervical spinal cord injury tissue.   RESULTS AND CONCLUSION: (1) The reactive oxygen species formation in PC12 cells induced by tert-butyl hydroperoxide was significantly decreased by trihydroxyethyl rutin (P < 0.05). (2) Trihydroxyethyl rutin and STAT3 inhibitor significantly up-regulated the expression levels of Catalase protein and MnSOD protein in PC12 cells and cervical spinal cord injury tissue (P < 0.05), while significantly inhibited the expression levels of STAT3 and NCK1 protein (P < 0.05). (3) To conclude, trihydroxyethyl rutin exerts anti-oxidative stress effect and can reduce the damage of oxidative stress after spinal cord injury by regulating the expression of STAT3.   Figures and Tables | References | Related Articles | Metrics

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Accurate simulation of stress state in bone joint and related soft tissue injury by three-dimensional finite element analysis Xiong Hengheng, Nie Weizhi 2022, 26 (36):  5875-5880.  doi: 10.12307/2022.783 Abstract ( 680 )   PDF (1145KB) ( 93 )   Save BACKGROUND: As a new digital research method, finite element analysis is more and more popular in orthopedics, and it is more closely related to orthopedics. Through the establishment of finite element three-dimensional model, it has an irreplaceable role in orthopedic biomechanical analysis and medical device research and design.  OBJECTIVE: To review the development prospects of finite element analysis in the field of orthopedics, and provide a basis for promoting better integration of finite element method with orthopedic clinical practice.   METHODS: Computer search of relevant documents published from 2012 to 2021 was conducted in Wanfang Medical Network, CNKI, PubMed, and Embase. Chinese and English search terms were “finite element analysis”, “biomechanics”, “spine”, “joint”, “trauma”, “osteopathia”, “medical instrument”, “review”. According to the inclusion criteria, 47 relevant documents were finally included for summary.  RESULTS AND CONCLUSION: Finite element analysis can accurately simulate and analyze the stress state of bones, joints and related soft tissues. It can play an active role in assisting various clinical departments in orthopedics to identify the pathogenesis and determine the treatment plan. The system is decomposed into several digital models for biomechanical analysis, guiding the research and development and design of medical devices, which greatly promotes the development of clinical diagnosis and treatment technology, and has good development potential. However, in the current use of finite element analysis, there are still problems such as improper use of methods, inaccurate finite element model establishment, and elastic modulus standards. Further development and improvement are needed to make finite element method better meet the needs of clinical and scientific research.  Figures and Tables | References | Related Articles | Metrics

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Mechanism of bone healing and angiogenesis during distraction osteogenesis Lyu Zichen, Tu Zhenxing, Xu Ao, Cheng Kang, Wang Hongtao, Wang Bin 2022, 26 (36):  5881-5888.  doi: 10.12307/2022.995 Abstract ( 625 )   PDF (1407KB) ( 117 )   Save BACKGROUND: Ilizarov technology has become one of the indispensable technological tools for orthopedic, maxillofacial surgery and prosthetic and reconstructive surgeons worldwide, but the mechanism of bone healing and angiogenesis in the process of distraction osteogenesis is not very clear.   OBJECTIVE: To review the microstructure and molecular mechanisms of bone healing and angiogenesis during distraction osteogenesis. METHODS: The articles on the mechanisms of bone healing and angiogenesis in the distraction osteogenesis process in recent years were reviewed on PubMed and CNKI. Duplicate articles and duplicate studies were excluded, while the included articles were reviewed and analyzed.   RESULTS AND CONCLUSION: (1) There is a 3rd ossification mechanism in distraction osteogenesis distinct from simple fracture healing, “transchondral osteogenesis”. (2) During the healing process of distraction osteogenesis, bone stumps form microcolumn forming zones on both sides and eventually lead to interfibrillar zones, and complete mineralization and remodeling of the newly formed bone during the consolidation phase. (3) Factors such as interleukins, bone morphogenetic proteins and the RANKL/OPG system have different spatiotemporal distributions during distraction osteogenesis, but all play a role in promoting bone formation or remodeling. (4) The process of distraction osteogenesis is accompanied by substantial neoangiogenesis and is highly consistent with the osteogenic cycle, whereas neovascularization and mineralization are the beginnings of bone regeneration. (5) Endothelial progenitor cells and cytokines such as vascular endothelial growth factor play a role in neoangiogenesis by promoting revascularization and mineralization in the distraction area, and their expression is regulated by the inflammatory response and stretch after osteotomy, whereas the induced homing of endothelial progenitor cells to the site of bone regeneration is an important factor in the angiogenesis of distraction osteogenesis. (6) Bone healing is mutually promoted and coupled with angiogenesis. The two ends of the osteotomy form a collagen fiber bundle under traction force, which eventually advances to the interfibrillar zone, where osteoblasts line up, gradually ossify, and undergo consolidation and remodeling to form mature, lamellar bone with bone marrow. Angiogenesis precedes the healing of bone and can occur after osteotomy, with blood vessels on the periosteal and endosteal surfaces at both ends of the osteotomy gradually proliferating and leading to interfibrillar zones, followed by complete communication of periosteal and medullary vascular networks at the distraction site. (7) The current study cannot fully explain the macro - and micro processes of distraction osteogenesis and the roles of various influencing factors and cytokines in distraction osteogenesis, and the healing mechanism of distraction osteogenesis needs further study. Figures and Tables | References | Related Articles | Metrics

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Active components of flemingia in regulating the signaling pathways related to knee osteoarthritis Lin Zhiyu, Han Jie, Ren Guowu, Chai Yuan, Wen Shuaibo, Wu Yukun, Xie Xiaozhong, Jin Wanqing 2022, 26 (36):  5889-5896.  doi: 10.12307/2022.715 Abstract ( 566 )   PDF (1859KB) ( 48 )   Save BACKGROUND: As a common disease of the elderly, the etiology and pathogenesis of knee osteoarthritis have not been clearly defined, and due to its high incidence and high disability rate, it seriously affects the quality of life of patients, requiring active prevention and treatment. Studies have confirmed that flemingia has a significant effect on the prevention and treatment of knee osteoarthritis; and studying its mechanism is of great significance.   OBJECTIVE: By reviewing relevant articles at home and abroad, the research progress of flemingia in the prevention and treatment of knee osteoarthritis was reviewed based on the mechanism-related signaling pathways, providing ideas and reference for the effective prevention and treatment of knee osteoarthritis. METHODS:  Relevant articles published from 2010 to 2020 were retrieved on CNKI, Wanfang, VIP, PubMed, MEDLINE, Cochran and Nature databases. A total of 60 articles were included through inclusion and exclusion criteria to exclude duplicated and old articles.   RESULTS AND CONCLUSION: (1) The main active components of flemingia include genistein, stigmasterol, emodin, chrysophanol, and ononin. (2) The active components of flemingia play an anti-inflammatory role in promoting osteoblast proliferation and differentiation and regulating chondrocyte apoptosis to delay the accelerated progression of knee osteoarthritis. The main regulatory pathways contain Notch, JAK2/STAT3, nuclear factor-κB, MAPK and other related signaling pathways. Figures and Tables | References | Related Articles | Metrics

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Mechanism and application prospects of motor imagery in spinal cord injury Ma Jiang, Zhang Di, Zhao Tianyu, Liu Xiaoxiao, Wang Ju, Lu Li, Wang Ying, Jin Song 2022, 26 (36):  5897-5904.  doi: 10.12307/2022.996 Abstract ( 521 )   PDF (1250KB) ( 103 )   Save BACKGROUND: Spinal cord injury is a kind of common central nervous system disease, causing dysfunction below the injury plane, which affects patient’s living quality and endangering human’s life seriously. The use of motor imagery therapy in the treatment of spinal cord injury is a new rehabilitation field in recent years, and it is a kind of rehabilitation treatment technology with a great development potential.   OBJECTIVE: To review the basic principles of motor imagery, the possible mechanism of motor imagery applied to spinal cord injury and the research progress. METHODS:  “Spinal cord injury, motor imagery” were used as search terms to retrieve articles on PubMed, Web of Science, CNKI, and Wanfang databases from inception to September 2021. The author excluded the articles that were not correlated with the research purpose, were repetitive, and had low credibility, and summarized the 94 articles that finally met the standard.   RESULTS AND CONCLUSION: (1) Motor imagery first was put forward in the 1950s, and then it is identified that motor imagery is a special kind of movement function status, and is repeatedly simulation and rehearse some movement of patients with a mental state. It exists in memory, activates the motor memory center, and without any obvious motor output, and follows the principle of central motion control. (2) The theoretical model of motor imagery therapy is generally recognized as psycho-neuromuscular theory, which holds that motor imagery is similar to the neuromuscular activity induced by motor execution. (3) The mechanism of motor imagery therapy for spinal cord injury is unclear. For patients with spinal cord injury, because brain structure is not damaged, the patient’s ability of motor imagery should be properly preserved. The current studies show that the mechanism may be that spinal cord injury patients and healthy people could activate similar brain regions. In patients with spinal cord injury, similar brain regions are activated by motor imagery and motor execution. Patients can induce the development of central nerve plasticity and functional reorganization through continuous motor imagery training, which can promote the recovery of function. (4) Clinically, current studies have shown that motor imagery training can relieve neuropathic pain, improve motor and bladder function in patients with spinal cord injury. Motor imagery therapy as an adjuvant therapy should be adopted in conventional rehabilitation programs for patients with spinal cord injury. However, there is high heterogeneity in clinical efficacy, and further research is necessary. (5) Brain computer interface can convert the signals generated during the patient’s motor imagery into driving signals to control external devices to achieve the re-movement of paralyzed limbs. The development of motor imagery with brain computer interface is considered to be a revolutionary change in rehabilitation after spinal cord injury and has a very good development prospect. Figures and Tables | References | Related Articles | Metrics