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08 February 2023, Volume 27 Issue 4 Previous Issue    Next Issue

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Mechanical behavior of lumbar disc rupture under quasi-static compression Liu Qing, Song Hao, Du Chengfei, Sun Yanfang, Li Kun, Zhang Chunqiu 2023, 27 (4):  493-499.  doi: 10.12307/2022.991 Abstract ( 595 )   PDF (1795KB) ( 52 )   Save BACKGROUND: Lumbar disc herniation is the main clinical cause of low back pain. The pathogenesis of lumbar disc herniation is very complex, and the accumulation of long-term mechanical loads and sudden overload injuries are usually considered as the main etiological factors. Most herniated discs are affected by alterations in their mechanical state. Therefore, the stress/strain characteristics of the lumbar disc as a whole and internally need to be studied to suggest guidelines for the prevention and treatment of lumbar disc herniation. OBJECTIVE: To evaluate the fatigue characteristics and rupture mechanism of the intervertebral disc from multiple angles by in vitro experiments. METHODS: Lumbar spines of fresh sheep slaughtered within 4-6 hours were used in the experiment, and the intervertebral disc samples made up of them were used in different experiments. In the fatigue experiments, the fatigue characteristics of mild rupture and healthy intervertebral disc were explored. In the internal displacement and load distribution experiment, the optimized digital image correlation technique is used to test the internal displacement distribution of the intervertebral disc during the loading process. Fiber Bragg grating technology was used to measure the internal load distribution of the intervertebral disc during the loading process. RESULTS AND CONCLUSION: (1) For normal and early ruptured lumbar discs, before and after fatigue, all rupture stress-strain curves showed multi-stage characteristics consisting of four main stages: toe stage, linear stage, yielding stage and damage stage. (2) The toe region of normal lumbar discs was very obvious, while the toe region of early ruptured lumbar discs almost disappeared. For both normal and early ruptured lumbar discs, the post-fatigue elastic modulus was slightly greater than the pre-fatigue elastic modulus. For normal lumbar discs, the proportional limit after fatigue was greater than that before fatigue. For early ruptured lumbar discs, the proportional limit after fatigue was less than that before fatigue. For normal lumbar discs, the yield stress after fatigue was greater than before fatigue. For early ruptured lumbar discs, the yield stress after fatigue was less than before fatigue. (3) Ventral annulus fibrosus stress was less than dorsal annulus fibrosus stress. On the dorsal side, the outer annulus fibrosus stress was less than the inner annulus fibrosus stress; while the ventral side showed the opposite pattern. (4) The introduction of damage factors to establish the damage constitutive model can fit the mechanical properties of disc injury well. The experimental results have the theoretical guidance for the prevention of lumbar disc herniation in daily life.  Figures and Tables | References | Related Articles | Metrics

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Finite element model of the 12-year-old child whole cervical spine: establishment and validity verification based on CT data Liu Qinghua, Cai Yongqiang, Jin Feng, Yu Jinghong, Wang Haiyan, Zhang Yunfeng, Wang Lidong, Li Jiawei, Wang Xing, He Yujie, Dai Lina, Wang Jianzhong, Wu Chao, Tong Ling, Kang Zhijie, Li Zhijun, Li Xiaohe 2023, 27 (4):  500-504.  doi: 10.12307/2022.994 Abstract ( 565 )   PDF (1779KB) ( 39 )   Save BACKGROUND: The finite element model of the pediatric cervical spine is mostly established in children aged 10 years old or younger, and the established segments are only a part of the cervical spine, while the finite element model of the 12-year-old child whole cervical spine is rarely reported.   OBJECTIVE: To establish a finite element model of the 12-year-old child whole cervical spine, providing a theoretical basis for studying cervical spine mobility and stress and clinical treatments for cervical spine diseases in children. METHODS:  A healthy child aged 12 years old was selected randomly, and a 64-row spiral CT was used to obtain the image of the child’s cervical spine. Then the CT data were introduced into the Mimics 16.0 to reconstruct a three-dimensional model. CERO 5.0 software was used to input the model into Hypermesh 14.0, which could divide the mesh and add ligaments. Subsequently, ANSYS 6.14 software was used to perform material assignment and set boundaries to construct a three-dimensional finite element model of the cervical spine. The validity of the model was finally verified. The range of motion of each vertebral body was compared with literature data under six working conditions of the model: flexion and extension, left and right flexion and extension, and left and right rotation.  RESULTS AND CONCLUSION: The three-dimensional finite element model of the 12-year-old child whole cervical spine was successfully established using the finite element software. The model had a high degree of reduction and nice similarity to the child’s cervical spine. Under the load of 1.5 N▪m, the mobility of the C4-5 and C6-7 in rotating conditions was lower than previously reported, and the mobility of the remaining segments in various conditions was within the reference range as previously reported. Thus, this model is available for subsequent stress research and clinical treatment. Figures and Tables | References | Related Articles | Metrics

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Gait and biomechanical characteristics of lower limbs in multi-task walking of 4-6-year-old children Liang Xiao, Zhao Panchao, Li Jiahui, Ji Zhongqiu, Jiang Guiping 2023, 27 (4):  505-512.  doi: 10.12307/2022.800 Abstract ( 640 )   PDF (1478KB) ( 63 )   Save BACKGROUND: Falling is one of the most common accidents in children, and its injury has become a global public health problem. Multi-task walking will increase the risk of falls, has a greater impact on abnormal children, and the demand for multi-task walking in daily life is increasing. To study children’s multi-task gait in order to provide a theoretical basis for formulating targeted training and identifying children with developmental abnormalities or diseases. OBJECTIVE: To explore the effects of multi-task walking on gait parameters and lower limb dynamics of 4–6-year-old children.  METHODS: Totally 34 children aged 4-6 years from a kindergarten in Beijing were randomly selected for single-task walking (normal walking), dual-task walking (calculating + walking), and three-task walking (carrying tray + calculating + walking). BTS infrared motion capture system was used to collect gait parameters and Vixta digital video recorder was used to record synchronously. Dynamic parameters of lower limbs were calculated by a simulation model of Anybody. Task differences, gender differences, and interaction effects were compared using repeated measures analysis of variance.  RESULTS AND CONCLUSION: (1) The standardized step speed, step frequency, stride length, and step width of dual-task walking and three-task walking were lower than those of single-task walking. (2) The multi-task cost of step-length increased with the increase of tasks. (3) The joint reaction force-gait cycle images of hip, knee and ankle joints shared the same characteristics. (4) There were task differences and gender differences in the average value of hip flexion moment, and the interaction effect of task × gender was found in the maximum value of subtalar joint eversion moment. (5) There was gender difference in the maximum muscle strength of sartorius, task difference in the maximum muscle strength of gracilis, adductor longus, adductor major, adductor brevis and obturator externus, and gender × task interaction effect in the maximum muscle strength of obturator internus. (6) It is concluded that the gait of 4–6-year-old children will be affected by multi-task, which is characterized by impaired gait and increased task cost. The impact on lower limb joint is reflected in hip joint and subtalar joint. The influence on the muscle strength of lower limbs is concentrated in the adductor and abductor muscle groups of the thigh. Therefore, children should be guided to play interesting games to exercise these two major muscle groups, so as to realize a more optimized multi-task walking mode, reduce the incidence of falls and prevent falls. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional motion analysis of lower limb biomechanical performance in Tai Chi practitioners accompanied by knee joint pain Li Yaping, Liu Hong, Gao Zhen, Chen Xiaolin, Huang Wujie, Jiang Zheng 2023, 27 (4):  520-526.  doi: 10.12307/2022.987 Abstract ( 540 )   PDF (1528KB) ( 68 )   Save BACKGROUND: Tai Chi practice can cause knee pain symptoms in many individuals. There is currently less research on the characteristics of practitioners with knee pain from a biomechanical view. OBJECTIVE: To explore the differences in biomechanical characteristics of the lower limbs in Tai Chi practice by three-dimensional motion system between practitioners who experience knee pain and healthy practitioners. METHODS: Six practitioners with knee pain were selected into an experimental group, while six healthy practitioners were chosen into a control group. Three-dimensional motion capture system was used to record the kinematics and dynamics of the lower limbs during Brush Knee and Twist Step in both groups. The motion characteristics at the characteristic moment of ground reaction force were compared. The characteristic moment of ground reaction force included the front support leg ground reaction force peak time in the left/right Brush Knee and Twist Step propulsion period (T1/T5), the left leg ground reaction force trough time in the right Brush Knee and Twist Step recoil turning period (T2), the ground reaction force first peak time in the right Brush Knee and Twist Step single support period (T3), the ground reaction force second peak time in the right Brush Knee and Twist Step single support period (T4).   RESULTS AND CONCLUSION: (1) Kinematic parameters: The difference in step length, step width and centroid height was not statistically significant between the two groups (P > 0.05). Compared with the control group, the experimental group had a greater hip abduction angle of the posterior support leg (P < 0.05) at T1 and T5; the left knee adducted at T2 and T3, and the right knee adducted at T5 (P < 0.05); a smaller abduction angle in right knee at T2 and T4 (P < 0.05). (2) Kinetic parameters: Compared with the control group, the experimental group had lower vertical ground reaction force (P < 0.05) at T3, T4 and T5; a smaller hip extension moment of the front support leg (P < 0.05) at T1 and T5; a lower hip rotation moment of the front support leg (P < 0.05) at T5. The total support moment contribution of knee joint in the experimental group was greater (P < 0.01) at T1. (3) The results suggested that compared with the healthy trainers, the practitioners with knee pain symptom reduced their force on the ground. The differences in kinematic and kinetic parameters between the two groups were concentrated in the hip and knee joints. They showed less hip extension and rotation, larger knee adduction, and larger the total support moment contribution of the knee joint. Therefore, when retraining Tai Chi for trainers with knee pain, it is necessary to consider the adjustment from the movement patterns of the practitioner’s hip and knee joints.  Figures and Tables | References | Related Articles | Metrics

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Foot-type recognition algorithm based on plantar pressure images Bao Wenxia, Zhan Dongge, Wang Nian, Yang Xianjun, Ding Chengbiao 2023, 27 (4):  527-533.  doi: 10.12307/2022.801 Abstract ( 829 )   PDF (2118KB) ( 60 )   Save BACKGROUND: The arch of the foot plays a supporting and cushioning role in people’s daily physical activities. The abnormal arch of the foot can cause movement disorders and lower limb pain. It is the premise of making the corresponding prevention and nursing corrective measures to accurately identify the pathological foot type.  OBJECTIVE: The accuracy of foot recognition can be improved effectively by extracting common features of quadrupedal foot and designing foot interruption feature combined with gradient boosted decision tree classifier.  METHODS: Totally 1 710 plantar pressure images of 45 people were collected, including high-arch, flat and normal foot. Arch index, footprint index, arch width, and ratio index of plantar pressure images were extracted respectively. At the same time, the foot interruption feature was designed, and the gradient boosted decision tree algorithm was used to recognize different foot types of plantar pressure images. RESULTS AND CONCLUSION: On the constructed data set of 1 710 plantar pressure images of 45 people, the average recognition accuracy of the proposed algorithm reached 96.43%, which was higher than the current commonly used methods based on arch index, footprint index, arch width, and ratio index.   Figures and Tables | References | Related Articles | Metrics

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Design and clinical application of coplanar screw guide for percutaneous pedicle screw in the treatment of thoracolumbar fracture Zhou Changjun, Long Shengli, Zou Wei, Xiao Jie, Long Hao, Feng Mingxing, Zhang Yang, Liu Jie, Zeng Zhongwei 2023, 27 (4):  534-538.  doi: 10.12307/2023.201 Abstract ( 416 )   PDF (4813KB) ( 72 )   Save BACKGROUND: Percutaneous pedicle screw internal fixation is a common minimally invasive operation for clinical treatment of vertebral fractures. The key steps of this operation are puncture positioning and accurate screw placement, which are of great importance for postoperative recovery of patients.  OBJECTIVE: To design a coplanar screw placement guide for minimally invasive percutaneous pedicle screw internal fixation, and to observe its clinical value in the treatment of thoracolumbar fractures.  METHODS: Totally 60 patients with thoracolumbar fracture treated by minimally invasive percutaneous pedicle screw internal fixation were randomly divided into two groups, with 30 cases in each group. The control group was treated with traditional screw placement technique, and the study group was treated with coplanar screw placement guide assisted screw placement. The screw placement and operation, recent orthopedical and reduction effects, long-term functional recovery and quality of life were compared between the two groups.  RESULTS AND CONCLUSION: (1) There were no significant differences in postoperative drainage volume, intraoperative blood loss, hospital stay, fracture healing time, or correction rate between the two groups (P > 0.05). The study group got shorter operation time, fewer intraoperative fluoroscopy times, and higher coplanar rate compared with the control group (all P < 0.05). (2) Visual analogue scale scores in both groups were lower than those before surgery, and the pain scores in the study group at 1, 3 and 6 months after surgery were lower than those in the control group (P < 0.05). (3) At the last follow-up, the anterior edge height ratio, Cobb angle and ODI score of the study group were higher than those of the control group (P < 0.05), while the loss rate of the study group was lower than that of the control group (P < 0.05). (4) It is concluded that the self-made coplanar screw placement guide used in minimally invasive percutaneous pedicle screw technique in the treatment of thoracolumbar fracture has advantages in shortening the operation time, improving the accuracy of screw implantation, reducing radiation leakage and relieving pain, which is benefit for improving long-term quality of life. Figures and Tables | References | Related Articles | Metrics

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Measuring the position relation between nerve tissue and bony structure in lumbar spinal canal decompression area by constructing a three-dimensional model of the lumbar spine Wang Jianye, Liu Xin, Tian Lin, Sun Ning, Li Yuefei, Bi Jingwei, Liu Changzhen, Sun Zhaozhong 2023, 27 (4):  539-546.  doi: 10.12307/2023.251 Abstract ( 765 )   PDF (1906KB) ( 38 )   Save BACKGROUND: There are few articles on the treatment of lumbar spinal stenosis by unilateral two-channel endoscopic contralateral approach, and there is no in-depth analysis of the endoscopic location, decompression scope and adjacent relationship of various structures of this approach.   OBJECTIVE: To observe the bony structure, nerve tissue, intervertebral space, attachment of ligamentum flavum and position of lumbar isthmus in lateral recess and foraminal area through three-dimensional CT imaging. METHODS:  Totally 34 patients with lumbar spinal stenosis admitted to the Affiliated Hospital of Binzhou Medical College from June 2019 to July 2021 were enrolled. Lumbar CT myelography was performed before surgery, and the images were imported into Mimics 21.0 software to reconstruct lumbar three-dimensional CT model. Relevant parameters of L4/5 and L5S1 segments were measured: (1) The vertical distance from the intersection of the lumbar spinous process and the lower edge of the lamina (Q) to the lower edge of the contralateral same lumbar pedicle (a), the upper edge of the contralateral pedicle of the lower lumbar spine (b), the lower endplate of same lumbar (c), the upper endplate of lower lumbar vertebrae (d); (2) The vertical distance from superior articular process to the upper edge of same lumbar pedicle (e), the lower endplate of upper lumbar vertebrae (f); (3) The vertical distance from the lower endplate of lumbar vertebrae to the lower edge of the contralateral lumbar pedicle (g); (4) The vertical distance from the upper endplate of lumbar vertebrae to the upper edge of the same lumbar pedicle (h); (5) The vertical distance from the lower edge of the nerve root origin to the lower edge of the upper lumbar pedicle (i), the upper edge of the lower lumbar spine pedicle (j); (6) A 3 mm diameter guide rod was established through point Q and the lower edge of the contralateral same lumbar pedicle to measure the abduction angle of guide rod (k). Seven patients underwent unilateral biportal endoscopic lumbar decompression through the contralateral approach. The effect of surgery was verified by visual analog scale score, Oswestry disability index, and short form-36 health survey.   RESULTS AND CONCLUSION: (1) The Q points and the upper margin of ligamentum flavum could be used as important localization markers under the endoscopy. The upper margin of the ligamentum flavum was used to locate the exiting nerve root, the upper edge of the foramina, the lumbar isthmus and the inferior articular process. The level of 1/3 of the contralateral foramen of L4/5 and the vicinity of L4 inferior endplate could be reached by Q point perpendicular to the posterior midline of spinous process, and then decompress the lateral recess at the level of the disc. (2) The lower edge of L5 nerve root origin was mostly projected at the level of L4/5 lower 1/3 of the foramen, and it was consistent with the L4/5 intervertebral projection, suggesting that the L5 walking nerve roots were mostly compressed near the level of the L4/5 disc. (3) The Q point, the lower edge of S1 nerve root origin and the L5 the exiting nerve root all corresponded to the level of the upper 1/3 of the L5S1 intervertebral foramen, and the corresponding lateral recess with dense nerve tissue in this area should be prudently decompressed. (4) The intervertebral spaces of L4/5 and L5S1 were projected near the level of the lower 1/3 of the same segment intervertebral foramen and under the Q point. The operation channel should be decompressed through Q point level with moderate tail tilt.  (5) When removing the hyperplastic superior facet osteophytes of L4/5 and L5S1, the superior facet should be retained at approximately normal height to avoid affecting the stability of lumbar spine. (6) All seven patients with contralateral approach surgery successfully completed the operation, and the follow-up time was 6-12 months. With the prolongation of postoperative rehabilitation time, the visual analog scale score and Oswestry disability index were significantly lower than those before surgery, and the score of short form-36 health survey was significantly improved than that before surgery. (7) It is suggested that the results of this study can guide unilateral biportal endoscopy for lumbar spinal stenosis through contralateral approach. Figures and Tables | References | Related Articles | Metrics

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Robot-assisted core decompression and bone grafting for ARCO II osteonecrosis of the femoral head Li Hui, Zhang Kun, Hao Yangquan, Feng Lei, Yang Zhi, Xu Peng, Lu Chao 2023, 27 (4):  547-551.  doi: 10.12307/2023.246 Abstract ( 375 )   PDF (2787KB) ( 51 )   Save BACKGROUND: Core decompression and bone grafting is one of the main hip preservation methods for ARCO II osteonecrosis of the femoral head, but the traditional surgical methods have disadvantages such as long fluoroscopy time and large amount of blood loss.   OBJECTIVE: To analyze the clinical characteristics of robot-assisted core decompression and bone grafting for the treatment of ARCO II osteonecrosis of the femoral head, and to provide new ideas for hip preservation treatment of osteonecrosis of the femoral head. METHODS:  A retrospective analysis was performed in 100 patients who underwent core decompression and bone grafting for osteonecrosis of the femoral head in the Department of Osteonecrosis and Joint Reconstruction, Honghui Hospital, Xi’an Jiaotong University from June 2017 to December 2019. Among them, 50 patients (36 males and 14 females) underwent core decompression and bone grafting assisted by orthopaedic robot navigation. The age ranged from 30 to 74 (47.52±12.50) years old and they were set as the robot navigation group. A total of 50 patients, including 37 males and 13 females, aged from 28 to 77 (50.68±13.60) years, who underwent core decompression and bone grafting, were enrolled as the conventional operation group. All operations were performed by the same surgeon. The preoperative, last follow-up Harris score, postoperative visual analog scale score, femoral head collapse, intraoperative fluoroscopy times, intraoperative blood loss and operation time were recorded in the two groups.   RESULTS AND CONCLUSION: (1) All patients were followed up for 20-38 (28.53±0.50) months. (2) The total number of intraoperative X-ray fluoroscopy, the number of guide wire placement fluoroscopy, the number of bone graft fluoroscopy, the determination time of bone graft channel, and the operation time were (13.84±1.52) times, (5.64±1.14) times, (8.20±1.70) times, (20.39±1.46) minutes, and (39.37±1.96) minutes, respectively in the robot navigation group, and (18.94±1.32) times, (8.64±1.27) times, (10.30±1.79) times, (41.57±1.63) minutes, and (62.53±3.44) minutes, respectively in the conventional operation group (all P < 0.05). (3) There were no significant differences in the last Harris score, postoperative visual analog scale score, collapse of femoral head and intraoperative blood loss between the two groups (P > 0.05). (4) It is concluded that core decompression and bone grafting assisted by orthopaedic robot navigation for the treatment of ARCO II osteonecrosis of the femoral head can significantly improve the accuracy of the operation, reduce the intraoperative fluoroscopy times, shorten the operation time, and reduce the incidence of postoperative complications. Figures and Tables | References | Related Articles | Metrics

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Advantage of medial pivot prosthesis in total knee arthroplasty via medial subvastus approach Wei Bo, Yao Qingqiang, Tang Cheng, Li Xuxiang, Xu Yan, Wang Liming 2023, 27 (4):  552-557.  doi: 10.12307/2022.751 Abstract ( 741 )   PDF (1674KB) ( 84 )   Save BACKGROUND: The most commonly used approach for total knee arthroplasty is the medial parapatellar approach, but due to its damage to the quadriceps tendon, it may lead to the weakening of the extensor device in the later stage, thus affecting the long-term functional recovery of patients.   OBJECTIVE: To evaluate the advantage of total knee arthroplasty with medial pivot prosthesis through medial subvastus approach.   METHODS: Patients with unilateral knee osteoarthritis who underwent total knee arthroplasty with medial pivot prosthesis from August 2018 to October 2019 were enrolled in this study. Of them, 26 patients received medial subvastus approach and 27 patients received medial parapatellar approach. There were no significant differences in age, sex distribution, body mass index, preoperative hemoglobin, visual analogous scale pain score, knee joint score of Hospital for Special Surgery, and knee range of motion between the two groups (P > 0.05). The operative incision length, operative time, the first postoperative straight leg raising time, the first postoperative activity time out of bed and the postoperative hospitalization time were compared and analyzed between the two groups. Postoperative visual analogous scale pain score, knee Hospital for Special Surgery score, and range of motion of the knee joint were evaluated in both groups.  RESULTS AND CONCLUSION: (1) The mean incision length, the first postoperative straight leg elevation time, the first postoperative movement time, and the postoperative hospitalization time in the medial subvastus approach group were significantly shorter than those in the medial parapellar approach group (P <  0.05). There was no significant difference in the operative time between the two groups (P > 0.05). (2) At 2 days after surgery, the visual analogous scale pain score in the medial subvastus approach group was significantly lower than that in the medial parapatellar approach group (P < 0.001). At 1 month after operation, there was no significant difference in visual analogous scale pain scores between the two groups (P = 0.474). (3) The knee Hospital for Special Surgery score of patients in the medial subvastus approach group was significantly higher than that in the medial parapellar approach group at 1 and 3 months after surgery (P < 0.001). At 1 year after surgery, there was no significant difference in knee Hospital for Special Surgery score between the two groups (P=0.656). (4) At 1 month after surgery, the range of motion of knee joint in the medial subvastus approach group was significantly higher than that in the medial parapatellar approach group (P < 0.001). At 3 months and 1 year after surgery, there was no significant difference in the range of motion of knee joint between the two groups (P=0.298, P=0.999). (5) The use of medial subvastus approach for total knee arthroplasty does not damage the medial vastus tendon, and the extensor device is retained, which is convenient for the installation of medial pivot prosthesis and intraoperative evaluation of medial pivot movement. It can significantly improve the pain and swelling of the limb after operation and effectively promote the early functional exercise.  Figures and Tables | References | Related Articles | Metrics

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Retrospective analysis of the influencing factors of chronic pain after total knee arthroplasty Wan Guoli, Shi Chenhui, Wang Weishan, Li Ang, Shi Xunda, Cai Yi 2023, 27 (4):  558-564.  doi: 10.12307/2022.963 Abstract ( 674 )   PDF (1218KB) ( 65 )   Save BACKGROUND: The influencing factors of chronic pain after knee arthroplasty are a hot spot in clinical research. However, there are few reports on how to achieve individualized prediction of the risk of chronic pain after knee arthroplasty at home and abroad.  OBJECTIVE: To explore the influencing factors of chronic pain after knee arthroplasty by constructing and validating an individualized prediction model of chronic pain risk after knee arthroplasty using nomogram.  METHODS: Totally 212 patients who underwent knee arthroplasty in the First Affiliated Hospital of Shihezi University from January 2018 to October 2020 were enrolled in this study. The data of the patients were collected and followed up. Through Logistics regression analysis, the independent risk factors of chronic pain after knee arthroplasty were selected to construct a predictive model. The C-index, ROC curve, calibration chart and decision curve analysis were used to evaluate the identification, calibration and clinical usefulness of the predictive model. The bootstrap verification was used to evaluate internal verification.  RESULTS AND CONCLUSION: (1) Predictors contained in the prediction nomogram included sleep, hip-knee-ankle angle, preoperative pain visual analogue scale score, pain visual analogue scale score at discharge, and time of tourniquet. The constructed model had a good recognition ability. (2) The ROC curve showed that the model predicted the influencing factors of chronic pain after knee arthroplasty. The area under the curve was 0.833, and the C-index calculated by the R software was 0.837 (95% CI: 0.824-0.849). The high C-index value of 0.810 4 could still be reached in the interval verification, with good calibration and good ability to predict. (3) It is concluded that sleep, hip-knee-ankle angle, preoperative pain visual analogue scale score, pain visual analogue scale score at discharge, and time of tourniquet are independent risk factors for chronic pain after knee arthroplasty. A nomogram model is constructed to predict the influencing factors of chronic pain after knee arthroplasty. Good discrimination and accuracy can provide scientific guidance for individualized clinical prevention and treatment of chronic pain after knee arthroplasty.  Figures and Tables | References | Related Articles | Metrics

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Comparison of early efficacy and safety of simultaneous and staged bilateral total knee arthroplasty Gu Mingxi, Wang Bo, Tian Fengde, An Ning, Hao Ruihu, Wang Changcheng, Guo Lin 2023, 27 (4):  565-571.  doi: 10.12307/2022.792 Abstract ( 342 )   PDF (8590KB) ( 78 )   Save BACKGROUND: The choice between simultaneous and staged bilateral total knee arthroplasty remains a matter of debate in orthopaedic practice when primary knee osteoarthritis patients require surgical treatment of both knees. OBJECTIVE: To evaluate the safety and efficacy of two different surgical options for bilateral knees by comparing the differences in perioperative outcomes and early functional improvement between simultaneous bilateral total knee arthroplasty and staged bilateral total knee arthroplasty, with the aim of providing a reference for clinical decision making. METHODS: Data of patients who received bilateral total knee arthroplasty for knee osteoarthritis at the Department of Orthopedics, Zhongshan Hospital of Dalian University from January 2016 to January 2021 were retrospectively analyzed. The patients were divided into simultaneous (n=82) and staged (n=75) groups. The preoperative general information, length of hospital stay, hospital costs, length of surgery, blood transfusion, pain visual analogue scale score, perioperative hemoglobin changes, incidence of hypoalbuminemia and perioperative complication rates, and recovery of joint function 1 year after surgery were compared between the two groups.  RESULTS AND CONCLUSION: (1) Compared with the staged group, the simultaneous group had shorter operative time and length of stay, lower hospital costs, higher incidence of anemia and hypoproteinemia, and more obvious pain. (2) The simultaneous group had higher psychological quality of life scores and forgetfulness index at the one-year postoperative follow-up. However, there were no significant differences in postoperative knee motion range, HSS scores, WOMAC index, and Feller patella scores between the two groups. (3) It is concluded that simultaneous bilateral total knee arthroplasty can limit surgery and anesthesia to a single event, promote symmetrical rehabilitation of both knees and reduce hospital stay, reduce costs for patients and hospitals, improve knee function and feel better, which is a safe and effective method for the treatment of knee arthritis.  Figures and Tables | References | Related Articles | Metrics

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Early warning efficacy of thrombus molecular markers after total knee arthroplasty in patients complicated with venous thromboembolism Zhang Jinbiao, Li Xiaoming, Xing Wanlin, Ma Fei, Yu Qiaoya, Dai Rongqin 2023, 27 (4):  572-577.  doi: 10.12307/2023.203 Abstract ( 492 )   PDF (1235KB) ( 36 )   Save BACKGROUND: Complications such as infection, arrhythmia, pulmonary embolism, heart failure, and deep vein thrombosis exist after total knee arthroplasty, and venous thromboembolism is an important risk factor for surgical failure. Therefore, effective postoperative thrombosis monitoring is particularly important.  OBJECTIVE: To discuss the early warning value of thrombus molecular markers in the patients after total knee arthroplasty complicated with venous thromboembolism.  METHODS: A retrospective analysis of the data of 80 patients, who received total knee arthroplasty in Hebei Hospital of Integrated Traditional Chinese and Western Medicine between April and July 2021, was performed. The patients were divided into thrombus group (n=39) and non-thrombus group (n=41) based on thrombus formation 3 days after operation. Totally 40 people who had a health checkup during the same period were chosen as the control group. Thrombus molecular markers were tested in each group: thrombin-antithrombin complex, plasmin-antiplasmin complex, thrombomodulin, and tissue plasminogen activator inhibitory complex. The markers were examined in total knee arthroplasty patients on the day before surgery and 8 hours after surgery. The markers were tested once in the control group.  RESULTS AND CONCLUSION: (1) One day before surgery: thrombin-antithrombin complex and plasmin-antiplasmin complex levels in the non-thrombus group were higher than those in the control group (P < 0.05). Thrombin-antithrombin complex and thrombomodulin levels in the thrombus group were higher than those in the non-thrombus group (P < 0.05). The thrombus molecular marker levels of the thrombus group were higher than those in the control group (P < 0.05). (2) At 8 hours postoperatively, the thrombus molecular marker levels of the thrombus group were higher than those in the non-thrombus group (P < 0.05). (3) Logistics regression analysis showed that the single index thrombomodulin had the best prediction efficiency (ACU=0.814, sensitivity 76.70%, specificity 83.80%, P=0.000). Combined detection of thrombin-antithrombin complex and thrombomodulin could improve prediction efficiency (ACU=0.822, sensitivity 83.30%, specificity 76.80%, P=0.000). The single index thrombin-antithrombin complex had the best prediction efficiency (ACU=0.898, sensitivity 83.30%, specificity 84.80%, P=0.000). Combined detection of thrombin-antithrombin complex and plasmin-antiplasmin complex could improve prediction efficiency (ACU=0.897, sensitivity 88.30%, P=0.000). (4) Spearman’s linear correlation analysis showed that tissue plasminogen activator inhibitory complex and plasmin-antiplasmin complex had a good positive correlation (r2=0.209, P < 0.05). (5) It is concluded that thrombomodulin can be used as an early warning indicator before total knee arthroplasty. Thrombin-antithrombin complex is a specific indicator of venous thromboembolism occurrence. Combined detection of thrombin-antithrombin complex, plasmin-antiplasmin complex, thrombomodulin, and tissue plasminogen activator inhibitory complex can improve prediction efficiency for venous thromboembolism.   Figures and Tables | References | Related Articles | Metrics

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Application of T-shaped plate for fractures involving the quadrilateral region of acetabulum Chen Lei, Jia Yanfei, Lyu Huicheng, Zhang Lifeng 2023, 27 (4):  578-582.  doi: 10.12307/2022.752 Abstract ( 734 )   PDF (8783KB) ( 74 )   Save BACKGROUND: Studies have shown that the T-shaped plate can be pre-bent to a suitable angle and shape to block the fracture fragments in the quadrilateral region of the acetabulum, especially the fracture line extending to the greater sciatic notch.   OBJECTIVE: To investigate the effect of T-shaped plate in the operation of acetabular quadrilateral fracture.  METHODS: Totally 31 patients who underwent acetabular fracture surgery in Second Affiliated Hospital of Inner Mongolia Medical University from January 2018 to April 2020 were selected as the research object, of which 18 patients were combined with reconstruction plate and T-shaped plate. During the operation, the reconstruction plate and pre-bending of T-shaped plate were carried out according to the fracture situation, and the transverse plate on the head side of T-shaped plate was bent to the tail end, making the whole plate close to a right angle to match the fracture and fix the fracture block at the top of the square area. The 13 patients were not applied with T-shaped plate as the control group. Other operations were the same as in the experimental group. After treatment, the operation time, intraoperative blood loss, incision length and fracture healing were observed; the X-ray score and the function of the affected hip were evaluated after fracture reduction.   RESULTS AND CONCLUSION: (1) The patients were followed up regularly for 24-40 weeks. After good intraoperative reduction of quadrilateral fractures, pre- bent reconstruction plate and T-shaped plate were placed, and the plate was in good contact with the bone surface. (2) The operation time of the trial group was longer than that of the control group (P < 0.05), and the intraoperative blood loss was less than that of the control group (P < 0.05). (3) Fracture reduction was evaluated according to Matta standard. The excellent and good rate of the trial group was 89% (16/18), and the excellent and good rate of the control group was 85% (11/13). The complete weight-bearing time of the trial group [(7.9±1.6) weeks] was better than that of the control group [(9.5±2.1) weeks] (P < 0.05). (4) It is concluded that T-shaped plate combined with reconstruction plate involving fractures in the quadrilateral region of the acetabulum has a good reduction effect, simple operation, less intraoperative blood loss, and short complete weight-bearing time.  Figures and Tables | References | Related Articles | Metrics

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Comparison of dynamic hip screw and anti-rotation screw internal fixation and femoral neck system internal fixation in the treatment of Garden II-IV femoral neck fracture Hong Xiao, Luo Hong, Yang Ruonan 2023, 27 (4):  583-587.  doi: 10.12307/2023.202 Abstract ( 493 )   PDF (1132KB) ( 109 )   Save BACKGROUND:  The biomechanical strength of dynamic hip screw plus anti-rotation screw internal fixation for femoral neck fracture is higher than that of cannulated screw, but it fails to reflect the principle of minimally invasive surgery. Femoral neck system with minimally invasive surgery for the treatment of femoral neck fractures has few surgical complications, strong postoperative stability and good outcomes, and can reduce the incidence of complications such as internal fixation failure and fracture displacement. OBJECTIVE: To compare the short-term effects of dynamic hip screw plus anti-rotation screw internal fixation and femoral neck system internal fixation in the treatment of Garden II-IV femoral neck fracture.  METHODS: Totally 93 patients with Garden II-IV femoral neck fractures in the Guizhou Orthopedic Hospital from January 2019 to February 2021 were enrolled in this study. They were at the age of 24-79 years. All patients were randomly divided into control group (n=43) and trial group (n=50). The control group was implanted with dynamic hip screws and anti-rotation screws for fracture fixation and reduction, while the trial group was implanted with femoral neck system for fracture fixation and reduction. The incision size, blood loss, operation time, fluoroscopy times, and fracture reduction were recorded in both groups. Fracture healing time, Harris score, visual analogue scale score, the incidence of complications, and the rate of reoperation in the two groups were observed after operation.  RESULTS AND CONCLUSION: (1) Incision length, blood loss, operation time, and fluoroscopy times were less in the trial group than those in the control group (P < 0.05). The fracture reduction was good in both groups, and there was no significant difference between the two groups (P > 0.05). (2) Both groups completed the 6-month postoperative follow-up. There was no significant difference in the incidence of internal fixation failure, fracture nonunion and femoral head necrosis between the two groups (P > 0.05). There was no significant difference in the total incidence of postoperative complications and reoperation rate between the two groups (P > 0.05). (3) There was no significant difference in the fracture healing time between the two groups (P > 0.05). Harris score and visual analogue scale score 6 months after treatment in the two groups were significantly improved compared with those before treatment (P < 0.05). There was no significant difference in Harris score and visual analogue scale score between the two groups 6 months postoperatively (P > 0.05). (4) These findings suggest that the mechanical properties of dynamic hip screw plus screw and femoral neck system are good, but the advantages of femoral neck system internal fixation are simple operation, less fluoroscopy, short operation time, less trauma and less bleeding.  Figures and Tables | References | Related Articles | Metrics

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Tibiotalocalcaneal arthrodesis with blood supplied fibular flap combined with hollow screw in the treatment of end-stage ankle osteoarthritis Yu He, Zheng Jiafa, Song Xiufeng, Guan Shengyi 2023, 27 (4):  588-593.  doi: 10.12307/2022.961 Abstract ( 407 )   PDF (38059KB) ( 39 )   Save BACKGROUND: Previous studies have reported that tibiotalocalcaneal arthrodesis via fibular flap support combined with hollow screw has a definite effect in the treatment of ankle osteoarthritis, but the fibular flap does not have blood supply, which affects the recovery of local blood circulation to a certain extent. In this study, the tibiotalocalcaneal arthrodesis via fibular portal with blood supplied fibular flap combined with hollow screw was improved by using the good blood supply of the distal fibula, and the clinical effect of the improved operation in the treatment of ankle osteoarthritis was discussed.  OBJECTIVE: To investigate the biomechanical effects on affected limbs and the clinical effect of tibiotalocalcaneal arthrodesis via fibular portal with blood supplied fibular flap combined with hollow screw for ankle osteoarthritis. METHODS: From January 2018 to October 2020, 30 patients with severe ankle osteoarthritis in Dalian No. 2 People’s Hospital were included in this study, and all patients underwent tibiotalocalcaneal arthrodesis via fibular portal with blood supplied fibular flap combined with hollow screws. After 12 months of follow-up, local blood circulation of distal fibula and the stage I healing of the incision were observed, and the ankle CT was reviewed postoperatively to evaluate the time of bone healing. The postoperative recovery was evaluated by gait analyzer and plantar pressure measurement system and the postoperative complications were mastered. RESULTS AND CONCLUSION: (1) All patients were followed up for 12 months after operation, and no case of loss to follow-up was found. Postoperative Doppler angiography showed that the vascular pedicle of the affected limb and perforating branches of the posterior peroneal artery were accompanied by venous anastomosis; local blood circulation was good; and the incisions were all in stage I healing. (2) After surgery, the ankle CT examination showed that the bone healing time at the fusion site was 8-13 weeks, with a mean of (10.70±2.13) weeks. (3) At 3 months after surgery, the patients’ step length, step speed and step frequency were significantly higher than those before surgery (P < 0.05). (4) According to the measurement of plantar pressure measurement system, the pressure values of the second metatarsal area, the third metatarsal area, the fourth metatarsal area, the middle foot, the medial heel, the lateral heel and the whole plantar of the affected side were significantly lower than the preoperative values during the natural walking at 6 months after surgery (P < 0.05). (5) During the postoperative follow-up, one case showed sural nerve injury symptoms, which disappeared after symptomatic treatment. (6) The excellent and good rate of ankle function recovery was 100%. (7) Above results have confirmed that the treatment of ankle osteoarthritis by tibiotalocalcaneal arthrodesis with blood supplied fibula flap combined with hollow screw through fibula portal approach can effectively improve local blood circulation, improve fusion effect and promote the recovery of ankle function of the affected limb, which has an important clinical significance.  Figures and Tables | References | Related Articles | Metrics

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Posterior single-segment pedicle screw fixation for unstable atlas fractures Bao Kai, Song Wenhui, Liu Changwen, Liang Kaiheng, Wang Jiajia 2023, 27 (4):  594-599.  doi: 10.12307/2022.986 Abstract ( 447 )   PDF (1741KB) ( 69 )   Save BACKGROUND: In recent decades, the treatment of unstable atlantogenic fractures has been controversial, and the choice of surgical methods has evolved from C1-C2 or C0-C2 fusion to the present situation of preserving motor segments as much as possible. However, the reduction effect and postoperative complications of both oral and posterior approaches remain to be improved. OBJECTIVE: To observe the effect of posterior single-segment pedicle screw fixation on unstable atlas fractures.  METHODS: Clinical data of 14 patients with unstable atlas fractures admitted from July 2017 to September 2020 in Second Hospital of Shanxi Medical University were retrospectively analyzed. There were 10 males and 4 females, with an average age of 51.8 years. All patients underwent posterior open reduction and internal fixation using a single-segment pedicle screw-rod system. Medical records and preoperative and postoperative radiographs were reviewed, and preoperative and postoperative CT scans were used to determine fracture types and assess fracture reduction. According to Spence's standard, the sum of displacement on both sides of the atlas in the mouth-opening X-ray film ≥6.9 mm was judged as unstable atlas fractures. At the last follow-up, cervical hyperextension and hyperflexion X-ray films were used to assess the stability of the atlantoaxial joint. RESULTS AND CONCLUSION: (1) All 14 patients were successfully operated. The mean follow-up duration was (21.0±6.4) months. Postoperative cervical X-ray and CT examination showed that the internal fixation position was good and the reduction was good. None of the patients had neurological impairment, vertebral artery injury, wound infection or other surgery-related complications. (2) Visual analogue scale score significantly decreased from (6.5±1.3) before operation to (1.9±0.8) after operation (P < 0.05). Neck Disabilitv Index score significantly decreased from (74.4±4.5) before surgery to (12.1±4.3) at the last follow-up (P < 0.05). (3) At the last follow-up, cervical flexion and extension ranged from 70° to 88° (79.7±6.0)°. Left and right cervical flexion ranged from 76° to 85° (82.1±2.8)°. Left-right rotation ranged from 129° to 155° (143.5±8.4). Cervical range of motion was well recovered in all patients at the last follow-up. X-ray films of cervical hyperextension and flexion at the last follow-up did not show any influence of atlantoaxial joint instability. After surgery, four patients complained of neck stiffness with limited movement, which basically returned to a normal level under standardized rehabilitation and guided treatment. (4) It is concluded that posterior single-segment pedicle screw internal fixation for unstable atlas fractures has short operation time, less blood loss, fewer complications, and better reduction effect. More importantly, the patient’s neck flexion, extension and rotation functions are basically not limited. For C1 fractures, transverse ligament rupture may not be a contraindication for open reduction and internal fixation, but the long-term effects of C1-C2 instability remain to be investigated.  Figures and Tables | References | Related Articles | Metrics

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Bibliometric and visual analysis of the research status and development trend of cortical bone trajectory screws Cheng Yunzhong, Liu Yuzeng, Hai Yong, Guan Li, Pan Aixing, Zhang Xinuo, Tao Luming, Li Yue 2023, 27 (4):  513-519.  doi: 10.12307/2022.957 Abstract ( 797 )   PDF (2992KB) ( 141 )   Save BACKGROUND: Discussing the research status and development trend of cortical bone trajectory screws and understanding the research direction and hotspots of cortical bone trajectory screws will help researchers grasp the latest information and development trends in this field.  OBJECTIVE: To explore the global research status and future development trends of cortical bone trajectory screws.  METHODS: English literature related to cortical bone trajectory screws published from January 1 2000 to October 28, 2021 was searched in the Web of Science core collection database. Bibliometric method was used to count and analyze the collected literature. VOS viewer software was used to perform visualized research on these articles to analyze the research hotspots and development trends of cortical bone trajectory screws.  RESULTS AND CONCLUSION: (1) A total of 426 articles were included. The global research publication volume of cortical bone trajectory screws has increased year by year, with the most published articles in 2020, with a total of 64 articles published. Among them, the United States has the largest number of publications and has the largest contribution to the world, ranking No. 1 (172 papers). China has published 84 papers, ranking second. (2) WORLD NEUROSURGERY has the largest number of related papers at 33; the National Institutes of Health and the US Department of Health Human Services are the most funded. (3) Matsukawa K is the author with the most published articles, with 19 articles; Yato Y ranked second, with 14 articles published. (4) From the visual analysis of cortical bone trajectory screw research, the research in this field still has a lot of room for exploration, and the number of publications will continue to increase. The United States and Japan are leading in this field, followed by China. In recent years, the research direction has mainly focused on the surgical treatment of cortical bone trajectory screws.  Figures and Tables | References | Related Articles | Metrics

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Meniscus extrusion and patellofemoral joint cartilage injury and bone marrow lesions: MRI semi-quantitative score Guo Yingqi, Gong Xianxu, Zhang Yan, Xiao Han, Wang Ye, Gu Wenguang 2023, 27 (4):  600-605.  doi: 10.12307/2022.962 Abstract ( 1088 )   PDF (1161KB) ( 44 )   Save BACKGROUND: The research on the effect of meniscus injury on knee osteoarthritis is mostly concentrated in the tibiofemoral compartment. There are reports on the correlation between meniscus extrusion and patellofemoral osteoarthritis outside China, but there are few related studies in China. OBJECTIVE: To explore the association between meniscus extrusion and patellofemoral osteoarthritis based on published data from the Osteoarthritis Initiative. METHODS: Totally 1 109 participants with complete MRI Osteoarthritis Knee Score and other clinical information at baseline were selected. Meniscal tear, maceration, extrusion, patellofemoral cartilage and bone marrow lesions were scored by MRI Osteoarthritis Knee Score semi-quantitative scoring system. Gender, age, race, body mass index, history of knee injury, and history of surgery were collected by questionnaire. Logistic regression analysis was used to determine the relationship between meniscal extrusion and patellofemoral osteoarthritis.  RESULTS AND CONCLUSION: (1) The cross-sectional study showed that patients with medial and lateral meniscus extrusion had a high incidence of any cartilage injury, full-thickness cartilage injury, and bone marrow lesions in medial and lateral patellofemoral joint. (2) Logistic regression analysis showed that after adjusting for confounding factors (adjustment model 2), the medial meniscus extrusion was positively correlated with any cartilage injury of the medial patellofemoral joint [OR: 2.4(95% CI: 1.6, 3.6)] and full-thickness cartilage injury [OR: 1.5(95% CI: 1.0, 2.1)]; there was no correlation between medial meniscus extrusion and medial patellofemoral joint bone marrow lesions without adjustment [OR: 0.8(95% CI: 0.6, 1.1)] and after adjustment for confounding factors [OR: 1.3(95% CI: 0.9, 1.8)]. (3) After adjusting for confounding factors (adjustment model 2), lateral meniscus extrusion was positively correlated with any cartilage injury of the lateral patellofemoral joint [OR: 2.1(95% CI: 1.0, 4.5)] and full-thickness cartilage injury [OR: 2.3(95% CI:1.1, 4.6)]; while without adjusting for confounding factors [OR: 1.7(95% CI: 1.0, 2.9)], lateral meniscus extrusion was positively correlated with bone marrow lesions of the lateral patellofemoral joint, but not after adjustment for confounding factors [OR: 1.1(95% CI: 0.6, 2.1)]. (4) Meniscus extrusion was positively correlated with cartilage injury of patellofemoral joint among Americans based on published data from the Osteoarthritis Initiative. Figures and Tables | References | Related Articles | Metrics

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Lumbar MRI vertebral bone quality score to evaluate the severity of osteoporosis in postmenopausal women Liu Hao, Yang Hongsheng, Zeng Zhimou, Wang Liping, Yang Kunhai, Hu Yongrong, Qu Bo 2023, 27 (4):  606-611.  doi: 10.12307/2022.966 Abstract ( 1254 )   PDF (1311KB) ( 52 )   Save BACKGROUND: Although the current dual-energy X-ray bone densitometer is still the gold standard for the diagnosis of osteoporosis, the results of bone density measurement may be inaccurate due to vertebral disease and degenerative changes in the lumbar spine. Moreover, bone density can only reflect 60% of bone strength, which makes many scholars devote themselves to the study of diagnostic methods for osteoporosis. This study is dedicated to finding a detection method for screening or diagnosing osteoporosis through MRI.  OBJECTIVE: To explore the role of vertebral bone quality score based on lumbar MRI in the assessment of osteoporosis in postmenopausal women. METHODS: The clinical data of 163 postmenopausal women diagnosed and treated in the First Affiliated Hospital of Chengdu Medical College from January 2017 to June 2021 were retrospectively analyzed. According to the dual-energy X-ray bone densitometer to obtain the hip T value, the subjects were divided into normal bone density group (n=48) and osteopenia/osteoporosis group (n=115). Vertebral bone quality score was measured. The general conditions, T value and vertebral bone quality score were compared between the two groups. The relationship between VBQ score and hip T value was analyzed. Receiver operating characteristic curve was used to evaluate the score in predicting the accuracy, specificity, sensitivity, and the threshold of osteoporosis. RESULTS AND CONCLUSION: (1) There was no significant difference in body mass index, history of hypertension, history of diabetes, and history of long-term hormone use between the two groups (P > 0.05). The age of the osteopenia/osteoporosis group was significantly higher than that of the normal bone density group (P < 0.05). (2) Vertebral bone quality score in the osteopenia/osteoporosis group was significantly higher than that in the normal bone mass group (P < 0.05). (3) Vertebral bone quality score and femoral neck T-score showed the moderately negative correlation (r=-0.625, P < 0.01). (4) The accuracy of vertebral bone quality score in predicting osteopenia/osteoporosis was 81.9%; the cut-off value for diagnosing osteopenia/osteoporosis was 3.08, and the sensitivity was 86.1% and the specificity was 75.0%. (5) The vertebral bone quality score based on lumbar MRI has good values in the assessment of osteoporosis in postmenopausal women, and can be used as a supplementary method for the assessment of osteoporosis and an opportunistic sieve for measuring osteoporosis check method. Figures and Tables | References | Related Articles | Metrics

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Optimal angle for prosthesis implantation in total knee arthroplasty Xu Xiangjun, Wang Chao, Song Qunshan, Li Bingyan, Zhang Jichao, Wang Guodong, Dong Yuefu 2023, 27 (4):  612-618.  doi: 10.12307/2022.975 Abstract ( 857 )   PDF (1504KB) ( 72 )   Save BACKGROUND: The motion of the knee joint is a three-dimensional motion with three translational degrees of freedom and three rotational degrees of freedom. When the prosthesis is implanted in total knee arthroplasty, the varus angle of the coronal plane, the anteroposterior angle of the sagittal plane and the rotation angle of the axial plane should be fully considered.   OBJECTIVE: To summarize the clinical advantages and disadvantages of femoral and tibial prosthesis implantation angle in total knee arthroplasty, so as to provide reference for effective prosthesis implantation in total knee arthroplasty. METHODS:  The first author searched the literature on prosthesis implantation in PubMed database and CNKI database by computer. The English key words were “total knee arthroplasty, total knee replacement, femoral, tibial, coronal, sagittal, axial, prosthesis, component, alignment, osteotomy”. The Chinese key words were “total knee arthroplasty, femur, tibia, prosthesis, osteotomy, coronal, sagittal, axial, alignment”. The articles that meet the search terms are preliminarily screened, and the relevant articles related to the review content and the clinical advantages and disadvantages of prosthesis implantation are retained for further detailed analysis, induction and summary.   RESULTS AND CONCLUSION: (1) On the coronal plane of the femur, the angle between the mechanical axis of the lower limb and the anatomical axis of the femur is measured through the full-length film of the weight-bearing position of the lower limb as a reference for femoral osteotomy. The 4-6° valgus osteotomy is often taken, and the prosthesis is implanted perpendicular to the mechanical axis. (2) In the sagittal plane of the femur, to obtain good knee flexion function, the 0-3°anteversion osteotomy is often taken and the prosthesis is implanted slightly anteversion. (3) In the axial plane of the femur, although surgical transepicondylar axis is regarded as the rotation center of the distal femur, it is more convenient to refer to posterior condylar axis when using surgical instruments, and the prosthesis is rotated 2-5° outward relative to posterior condylar axis. (4) In the coronal plane of the tibia, to obtain the rectangular space and horizontal joint line in the extended position, the prosthesis should be implanted perpendicular to the mechanical axis of the tibia. (5) In the sagittal plane of the tibia, the polyethylene gasket has a certain retroversion angle, and the prosthesis is often implanted with a retroversion of 0-7°. (6) In the axial plane of the tibia, because the Akagi line is approximately parallel to the anterior and posterior axis of the tibia, the anterior and posterior axis of the prosthesis is often implanted parallel to the Akagi line. Figures and Tables | References | Related Articles | Metrics

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Hippo signaling pathway in the regulation of spinal cord injury Tao Xin, Xu Yi, Song Zhiwen, Liu Jinbo 2023, 27 (4):  619-625.  doi: 10.12307/2023.261 Abstract ( 492 )   PDF (1692KB) ( 70 )   Save BACKGROUND: Recent studies have shown that Hippo signaling pathway is closely related to pathological changes after spinal cord injury. Through targeted regulation of this signaling pathway, it can provide new ideas for the treatment of spinal cord injury in clinical practice.   OBJECTIVE: To review the research progress of regulatory mechanism of Hippo signaling pathway in spinal cord injury. METHODS:  PubMed and Web of Science databases were searched by the first author. Search terms were “spinal cord injury, nervous system, Hippo signaling pathway, MST1/2, LATS1/2, MOB1A/B, NDR1/2, YAP, TAZ, neurite, axonal regeneration, myelination, neuronal death, inflammation, glial scar, gliosis”. The search time limit was from September 2007 to February 2022. The articles unrelated to the purpose of this study and repeatability were excluded. Finally, 62 articles that met the criteria were included for review.   RESULTS AND CONCLUSION: Hippo signaling pathway molecules are widely expressed in neuronal cells and YAP regulates central neural development and maintains a dynamic balance of neuronal proliferation and differentiation. In the pathological mechanism of secondary spinal cord injury, the Hippo pathway plays a regulatory role: (1) NDR, MOB1 and YAP molecules can promote the growth of neuropil. (2) YAP/TAZ has an important role in the synthesis of myelin and the dynamic regulation of myelin growth. (3) Inhibition of Hippo pathway expression can reduce neuronal apoptosis and neurological deficits. (4) Both glial cells and fibroblasts can be modulated by YAP to influence glial scar formation. Numerous studies have shown that regulation of Hippo pathway provides new ideas and therapeutic strategies for molecular targeting therapy and development of biomaterials for spinal cord injury. Figures and Tables | References | Related Articles | Metrics

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Plantar pressure and gait analysis in patients with anterior cruciate ligament injury and reconstruction Li Shihao, Li Qi, Li Zhen, Zhang Yuanyuan, Liu Miaomiao, Ouyang Yi, Xu Weiguo 2023, 27 (4):  626-631.  doi: 10.12307/2022.968 Abstract ( 524 )   PDF (1142KB) ( 68 )   Save BACKGROUND: Current research generally believes that the abnormal changes of lower limb gait biomechanics in patients with anterior cruciate ligament injury and reconstruction are an important risk factor for the high incidence of knee osteoarthritis in patients. As a kind of quantitative gait analysis, plantar pressure analysis has a very important clinical value for early identification of abnormal changes in gait and timely correction. OBJECTIVE: To review the application of plantar pressure in gait analysis after anterior cruciate ligament injury and reconstruction, to describe the abnormal gait characteristics of current patients from the aspect of plantar pressure, to understand the current research status and deficiencies so as to provide some ideas for the formulation of rehabilitation programs and research design in future research.  METHODS: CNKI, VIP, Wanfang and PubMed databases were searched using “anterior cruciate ligament, plantar pressure, gait analysis” as Chinese and English search terms. Finally, 41 articles were included according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) Plantar pressure can evaluate the gait pattern of patients with anterior cruciate ligament injury and reconstruction, which will provide information about avoiding pain and knee instability during walking. (2) The size and symmetry of foot load and the symmetry of support phase characteristics in patients with anterior cruciate ligament injury were significantly improved more than 1 year after operation. However, the excessive pronation of the affected foot observed after operation may be related to anterior cruciate ligament injury. (3) Therefore, gait analysis based on plantar pressure can help researchers better understand the gait characteristics of patients and guide the progress of postoperative rehabilitation, which may help to reduce the occurrence of secondary injury and knee osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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Medial open-wedge tibial osteotomy versus lateral closed-wedge tibial osteotomy for unicompartmental knee osteoarthritis: a meta-analysis Yu Jiaan, Liu Xinwei, Lian Hongyu, Liu Kexin, Li Zitao 2023, 27 (4):  632-639.  doi: 10.12307/2022.988 Abstract ( 475 )   PDF (1548KB) ( 43 )   Save OBJECTIVE: High tibial osteotomy is an effective treatment for medial compartment knee osteoarthritis, and the commonly used clinical procedures are medial open-wedge high tibial osteotomy and lateral closed-wedge high tibial osteotomy. There are some controversies about the basis of the two surgical choices. The article evaluated the clinical efficacy and imaging results of medial open-wedge high tibial osteotomy and lateral closed-wedge high tibial osteotomy by meta-analysis.  METHODS: PubMed, Ovid, CNKI, Wanfang, VIP, Cochrane Library, and EMbase databases were searched for articles on the comparison of medial open-wedge tibial osteotomy and lateral closed-wedge tibial osteotomy for osteoarthritis of the knee. The retrieval period was from the database inception to October 2021. Literature screening and data compilation were conducted according to the specified inclusion and exclusion criteria. Randomized controlled trials were evaluated using Cochrane Handbook criteria to assess risk of bias, and cohort studies were evaluated using the NOS scale. RevMan 5.3 software was used for meta-analysis. RESULTS: (1) A total of 13 publications were included, of which 8 were randomized controlled trials, and 5 were cohort studies. The overall quality of the literature was high. (2) Meta-analysis results showed that medial tibial open-wedge osteotomy and lateral tibial closed-wedge osteotomy presented significant differences in postoperative posterior tibial plateau inclination (MD=2.82, 95%CI:1.31-4.33, P=0.000 2), patellar height BPI (MD=-0.09, 95%CI:-0.11 to -0.07, P < 0.000 01), and operative time (MD=-19.48, 95%CI:-31.02 to -7.94, P=0.000 9). Postoperative mechanical axis angle (MD=-0.01, 95%CI:-0.51-0.48, P=0.96), angle of correction (MD=-0.16, 95%CI:-0.75-0.43, P=0.60), HSS score (MD=-0.46, 95%CI:-1.47-0.55, P=0.37), visual analogue scale score (MD=0.12, 95%CI:-0.24-0.48, P=0.51), Lysholm score (MD=-0.17, 95%CI:-2.53-2.19, P=0.89), and complications (OR=0.68, 95%CI:0.25-1.82, P=0.44) were similarly effective.  CONCLUSION: The overall clinical outcomes of the two procedures are similar, and the medial tibial open-wedge osteotomy has the advantage of being easier to perform, but is prone to increased posterior tibial plateau tilt and patellar drop, so adequate preoperative imaging evaluation and individualized selection of the procedure are needed for patients with unicompartmental knee osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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A meta-analysis of the effects of continuous adductor canal block and continuous femoral nerve block on early activity after knee arthroplasty Xu Yangyang, He Peiliang, Meng Qingqi, Li Siming 2023, 27 (4):  640-645.  doi: 10.12307/2022.960 Abstract ( 449 )   PDF (1621KB) ( 53 )   Save OBJECTIVE: To systematically evaluate the effects of continuous adductor canal block versus continuous femoral nerve block on pain relief and functional recovery after total knee arthroplasty.  METHODS: The free words “arthroplasty, replacement, knee; continuous adductor canal block; adductor canal block; continuous femoral nerve block; femoral nerve block” were added according to the subject word. The main databases were searched, including CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, etc., for randomized controlled trials of continuous adductor canal block and continuous femoral nerve block after total knee arthroplasty published from inception to August 31, 2021. Two researchers independently screened the literature, performed quality assessment and offset risk assessment with Cochrane. Relevant outcome indicators, containing analgesic effect (resting pain and post-activity pain score, use of weak opioids), functional recovery (quadriceps muscle strength, timed up & go test, and hospital stay), and complications (nausea, vomiting, and falls), were collected and meta-analyzed by Revman 5.3 software.  RESULTS: (1) A total of 617 patients were included in 9 articles, all of which were randomized controlled trials. The evaluation of literature quality indicated that the overall quality was good. (2) Compared with continuous femoral nerve block, continuous adductor canal block had significant differences in quadriceps strength (MD=1.42; 95%CI, 0.32-2.52; P=0.01) and timed up & go test (MD=-1.23; 95%CI, -2.03 to -0.42; P=0.003). (3) There was no significant difference in pain score after rest and activity (P > 0.05), postoperative opioid consumption (MD =0.51; 95%CI, 0.20 to 1.30; P=0.16), and hospital stay (MD =-0.42; 95%CI, -1.24 to 0.40; P=0.32) between continuous femoral nerve block and continuous adductor canal block. (4) In addition, there was no significant difference in the incidence of complications between the two block methods, including nausea and vomiting (MD=1.04; 95%CI, 0.06-17.15; P=0.98) and falls (MD=0.45; 95%CI, 0.10-2.08; P=0.31). CONCLUSION: The analgesic effect of continuous adductor canal block after total knee arthroplasty is similar to that of continuous femoral nerve block, but continuous adductor canal block reduces the effect on quadriceps muscle strength and is beneficial to early activity after total knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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3D printing personalized osteotomy guide technology versus conventional total knee arthroplasty on the accuracy of lower limb force alignment: a meta-analysis Chai Hao, Yang Deyong, Zhang Lei, Shu Li 2023, 27 (4):  646-654.  doi: 10.12307/2022.743 Abstract ( 467 )   PDF (1417KB) ( 51 )   Save OBJECTIVE: Many scholars have applied 3D printing personalized osteotomy guide technology in patients undergoing total knee arthroplasty. However, there is still a great controversy on whether 3D printing personalized osteotomy technology can obtain better lower limb force line and more satisfactory curative effect than conventional total knee arthroplasty. This study aimed to compare the accuracy and clinical efficacy of 3D printed personalized osteotomy guide and conventional total knee arthroplasty by meta-analysis. METHODS: We retrieved controlled clinical trials which compared the 3D printing personalized osteotomy guide technology and conventional total knee arthroplasty respectively in Chinese databases (Wanfang, CNKI, VIP, and Chinese Biological Medicine) and English databases (Ovid, PubMed, Web of Science, Embase, and the Cochrane Library). Cochrane 5.1.0 bias risk assessment tool was used to evaluate the quality of included studies. The data were analyzed by RevMan 5.3 software.   RESULTS: (1) A total of 775 Chinese and English articles were retrieved and 30 controlled clinical trials were included for final analysis. (2) Meta-analysis results showed that compared with the conventional group, the hip-knee-ankle angle (MD=-0.51, 95%CI:-0.66 to -0.36, P < 0.000 01), deviation of femoral coronal alignment (MD=-0.33, 95%CI: -0.39 to -0.27, P < 0.000 01), the number of femoral coronal alignment outliers (RR=0.52, 95%CI:0.44-0.63, P < 0.000 01), the deviation of tibial coronal alignment (MD=-0.21, 95%CI:-0.32 to -0.10, P=0.000 2), the deviation of femoral sagittal alignment (SMD=-0.16, 95%CI:-0.26 to -0.07, P=0.000 09), the deviation of tibial sagittal alignment (MD=-0.21, 95%CI:-0.32 to -0.10, P=0.000 2), postoperative drainage volume (SMD=-1.11, 95%CI:-1.49 to -0.74, P < 0.000 1), and intraoperative bleeding (MD=-48.60, 95%CI:-68.50 to -28.69, P < 0.000 1) were less and KSS score (MD=3.29, 95%CI:1.35-5.23, P=0.000 9) was better in 3D printing personalized osteotomy guide group.  CONCLUSION: In this meta-analysis, 3D printing personalized osteotomy guide technology in total knee arthroplasty has advantages in lower limb force line and prosthesis position.  Figures and Tables | References | Related Articles | Metrics

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Efficacy of precisely manufactured bionic Implants: Deliberation on the motion preservative artificial atlantoaxial joint by 3D printing Ma Zhiyuan, Lu Bingheng 2023, 27 (4):  655-655.  doi: 10.12307/2023.253 Abstract ( 336 )   PDF (831KB) ( 70 )   Save References | Related Articles | Metrics

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First international clinical report on implantation of a 3D-printed mobile cervical spine prosthesis in China Rainer Kotz 2023, 27 (4):  656-656.  doi: 10.12307/2023.257 Abstract ( 156 )   PDF (740KB) ( 59 )   Save References | Related Articles | Metrics