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28 March 2023, Volume 27 Issue 9 Previous Issue   

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Microstructural indexes that determine the trabecular bone maximum stress of micro-finite element models Zhong Yizheng, Huang Peizhen, Cai Qunbin, Zheng Liqin, He Xingpeng, Dong Hang 2023, 27 (9):  1313-1318.  doi: 10.12307/2023.207 Abstract ( 598 )   PDF (1730KB) ( 52 )   Save BACKGROUND: The mechanical response of trabecular bone under loading can be studied using micro-CT based micro-finite element. It is generally considered that bone volume fraction in animal specimens is the most important index that determines the compressive strength of trabecular bone. However, in the micro-CT based finite element model, the microstructural index leading to stress concentration or determining the maximum stress is not clear.  OBJECTIVE: To investigate the microstructural indexes that affect the maximum stress of trabecular bone micro-finite element model. METHODS:  The microstructural indexes of trabecular bone of 10 normal rats from bilateral femoral metaphysis region of interest were obtained and the differences of trabecular bone in bilateral regions of interest were compared. The 20 trabecular bone finite element models were constructed and loaded. The average stress values of the ranking 5%, 2%, 1% and 0.5% of stress value were taken as the maximum stress value. The reliability of the models was verified according to the stress and effective strain. Finally, with the maximum stress value as the dependent variable and the trabeculae microstructural index as the independent variable, the key factor affecting the maximum stress of trabeculae micro-finite element model was explored by multiple linear stepwise regression method. RESULTS AND CONCLUSION: There was homogeneity in trabecular bone microstructure of bilateral femoral metaphysis (P > 0.05), and then data were combined. The average number of elements and nodes of 20 trabeculae finite element models was 232 813 and 606 82. The average stress of the ranking 5%, 2%, 1% and 0.5% elements was 31.91, 41.96, 50.86 and 61.23 MPa, respectively, and the average effective strain was 3.28%. The results of multiple linear stepwise regression analysis indicated that the structure model index was the most important factor influencing the maximum stress of trabeculae finite element model (P < 0.001, R2=0.807). It is indicated that the trabecular bone structure model index is the most important bone microstructure index that affects the stress concentration of the trabecular bone micro-finite element model. Figures and Tables | References | Related Articles | Metrics

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Correlation of cervical sagittal force line parameters with degenerative segment and Pfirrmann classification in patients with cervical intervertebral disc degeneration Cao Sheng, Kong Lingwei, Xu Kun, Sun Zhijie 2023, 27 (9):  1319-1324.  doi: 10.12307/2023.278 Abstract ( 437 )   PDF (1240KB) ( 48 )   Save BACKGROUND: The sagittal parameters of lumbar spine are significantly correlated with lumbar intervertebral disc degeneration and sagittal balance of lumbar spine, while the research on cervical spine is relatively lacking. OBJECTIVE: To explore the correlation of cervical sagittal force line parameters cervical lordosis, T1 slope, and sagittal vertical axis with degenerative segment, Pfirrmann classification in cervical intervertebral disc degeneration patients and the value of therapeutic evaluation. METHODS:  A total of 80 patients with cervical intervertebral disc degeneration in Affiliated Hospital of Chengde Medical College from July 2017 to December 2019 were selected as the study subjects, all of whom underwent minimally invasive spinal canal enlargement surgery through the posterior cervical approach. The patients were grouped according to the curative effect 6 months after the operation. Among them, there were 62 cases in the good curative effect group and 18 cases in the poor curative effect group. The clinical data, cervical sagittal force line parameters (cervical lordosis, T1 slope, and sagittal vertical axis) and cervical sagittal force line parameters of patients with different degeneration segments and Pfirrmann classification were compared between the two groups. The receiver operating characteristic curve was used to evaluate the value of the efficacy evaluation of the parameters of the cervical sagittal force line.   RESULTS AND CONCLUSION: (1) There was a statistically significant difference in degeneration segments and Pfirrmann classification between the two groups (P < 0.05). (2) At 1 and 6 months after operation, the cervical sagittal force line parameters cervical lordosis and T1 slope of the patients in the good curative effect group were significantly higher than those in the poor curative effect group, and the sagittal vertical axis was significantly lower than that in the poor curative effect group (P < 0.05). (3) Cervical sagittal force line parameters cervical lordosis, T1 slope, and sagittal vertical axis were significantly different in patients with different degeneration segments and Pfirrmann classification (P < 0.05). (4) In cervical intervertebral disc degeneration patients, the cervical sagittal force line parameters cervical lordosis and T1 slope were positively correlated with degenerative segments and Pfirrmann classification (P < 0.05), while sagittal vertical axis was negatively correlated with degenerative segments and Pfirrmann classification (P < 0.05). (5) After controlling for sex, age, course of disease, body mass index, type of cervical spondylosis, degeneration segment, Pfirrmann classification, preoperative cervical sagittal force line parameters and other factors, the cervical sagittal force line parameters cervical lordosis, T1 slope and sagittal vertical axis were still significantly correlated with the efficacy of cervical intervertebral disc degeneration patients at 1 and 6 months after surgery (P < 0.05). (6) Cervical lordosis, T1 slope, and sagittal vertical axis all had higher area under the curve for evaluating curative effect, especially the highest in combined evaluation, reaching 0.815. (7) It is concluded that the parameters cervical lordosis, T1 slope, and sagittal vertical axis of the cervical spine sagittal force line in cervical intervertebral disc degeneration patients are related to the degenerative segment and Pfirrmann classification, and have a good therapeutic evaluation value. They can provide evidence for preventing the occurrence of cervical intervertebral disc degeneration and sagittal imbalance after surgery. Figures and Tables | References | Related Articles | Metrics

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Changes of lower limb force line and knee function after high tibial osteotomy in osteoporotic medial ventricular knee osteoarthritis Li Xiaomin, Tian Xiangdong, Tan Yetong, Zhu Guangyu, Wang Rongtian, Wang Jian, Xue Zhipeng, Ma Sheng, Hu Yuanyi, Huang Ye, Ding Tiansong 2023, 27 (9):  1325-1329.  doi: 10.12307/2023.204 Abstract ( 492 )   PDF (6512KB) ( 47 )   Save BACKGROUND: Elderly patients with knee osteoarthritis are mostly accompanied by osteoporosis. There is still a lack of relevant clinical studies on whether osteoporosis will affect the postoperative efficacy of high tibial osteotomy for medial compartment knee osteoarthritis.   OBJECTIVE: To explore the effect of osteoporosis on the clinical efficacy of medial compartment knee osteoarthritis after high tibial osteotomy from the aspects of imaging and knee joint function. METHODS:  A retrospective analysis was performed in 63 patients with medial compartment knee osteoarthritis who received high tibial osteotomy combined with arthroscopy in Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2018 to January 2019. According to the results of bone mineral density measurement, there were 30 patients in the osteoporosis group (mean T value was  -2.9 SD). There were 33 patients in the control group (non-osteoporosis, mean T value was -0.9 SD). The knee joint pain was evaluated by visual analogue scale score before and 3, 12, and 24 months after operation. Knee function was evaluated by Western Ontario and McMaster University Osteoarthritis Index and Lysholm knee score. The ratio of lower limb force line was used to evaluate the change of lower limb force line before, after intraoperative correction and 24 months after surgery.   RESULTS AND CONCLUSION: (1) All patients completed surgery and were followed up. (2) Visual analogue scale score, Western Ontario and McMaster University Osteoarthritis Index and Lysholm knee score in both groups improved over time after surgery compared with that before surgery (P < 0.05). The ratio of lower limb force line in both groups improved after intraoperative correction and 24 months after operation compared with that before operation (P < 0.05). (3) There was no difference in visual analogue scale scores, Western Ontario and McMaster University Osteoarthritis Index and Lysholm knee score between the two groups 3, 12 and 24 months after surgery (P > 0.05). (4) There was no significant difference in the ratio of lower limb force line between the two groups before surgery, after intraoperative correction and 24 months after surgery (P > 0.05). (5) It is indicated that in the early and middle stages of high tibial osteotomy, osteoporosis has no significant effect on the postoperative efficacy and lower limb force line. In conclusion, high tibial osteotomy has a definite curative effect in the early and middle stages of osteoporotic medial compartment knee osteoarthritis, which can significantly relieve knee pain and improve knee function, and is a good choice for the treatment of osteoporotic medial compartment knee osteoarthritis. However, more studies are needed to confirm whether osteoporosis will affect the long-term outcome after high tibial osteotomy.  Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of a new multi-dimensional cross locking plate in the treatment of subtrochanteric nonunion Wu Taoguang, Nie Shaobo, Chen Hua, Zhu Zhengguo, Qi Lin, Tang Peifu 2023, 27 (9):  1330-1334.  doi: 10.12307/2023.220 Abstract ( 561 )   PDF (1651KB) ( 48 )   Save BACKGROUND: New multi-dimensional cross locking plate (MDC-LP-II), as an additional plate with retaining intramedullary nail, can achieve more fixations of locking screws and the number of cortical layers in a limited space, but its mechanical stability in models of nonunions after intramedullary nailing of subtrochanteric fractures is uncertain.   OBJECTIVE: To compare biomechanical differences between MDC-LP-II and conventional locking compression plate as an additional plate in the treatment of postoperative nonunion after intramedullary nailing of subtrochanteric fractures. METHODS:  Ten artificial femoral models were used to establish the nonunion structure after intramedullary nailing of the subtrochanteric fracture, which were randomly divided into two groups (n=5 per group). After fixation of the nonunion ends with MDC-LP-II and locking compression plate, static torsional failure tests were performed, starting at 0 N·m and loading at 6(°)/min, with continuous recording of the torsional angle-torque curve until the complete destruction of the specimen structure. The torsional rigidity, ultimate torque at yield, and angle at failure of both were recorded and calculated.   RESULTS AND CONCLUSION: The torsional rigidity was (3.56±0.19) N·m/(°) for MDC-LP-II and (1.69±0.41) N·m/(°) for locking compression plate. The torsional rigidity was elevated by 1.87 N·m/(°) for MDC-LP-II compared with locking compression plate, which was 2.11 times (P < 0.001). When yielding occurred for MDC-LP-II and locking compression plate, the ultimate torque was (73.58±3.28) N·m and (59.88±6.74) N·m respectively, with MDC-LP-II increasing 13.7 N·m more than locking compression plate, which was 1.23 times that of the locking compression plate (P < 0.05). When the specimens were thoroughly destroyed, the destruction angle was (22.50±1.58)° for MDC-LP-II and (31.00±2.85)° for locking compression plate, and was significantly smaller for MDC-LP-II than for locking compression plate (P < 0.001). Due to the stronger torsional rigidity of MDC-LP-II, which is less prone to deformation, and the better biomechanical stability as an additional plate than locking compression plate, MDC-LP-II is the reliable option for the clinical treatment of nonunions after intramedullary nailing of subtrochanteric fractures. Figures and Tables | References | Related Articles | Metrics

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Differences in human dynamic stability during walking under different cognitive loads Liu Xinyue, Xing Xinyang, Huo Hongfeng 2023, 27 (9):  1335-1339.  doi: 10.12307/2023.215 Abstract ( 615 )   PDF (2076KB) ( 111 )   Save BACKGROUND: Maintaining postural stability during walking is critical for the prevention of falls, and how dynamic stability alters during cognitive dual-task walking remains controversial.  OBJECTIVE: To explore the influence of cognitive load factors on posture control performance of dual-task research paradigm by comparing the differences of dynamic stability during walking under four different cognitive loads, and to provide theoretical basis for dynamic stability rehabilitation training.  METHODS: The Motion three-dimensional motion capture system was used to collect the kinematic data of 16 male college students during walking under different cognitive loads (zero load, one load, double load and triple load), and the dynamic stability margin was calculated indirectly through the kinematic data. Among them, cognitive single-task walking refers to walking + zero times cognitive load; cognitive dual-task walking refers to walking + one, two, and three times cognitive load. Univariate repeated measure analysis of variance was used to compare the differences of gait parameters and dynamic stability under different cognitive loads.   RESULTS AND CONCLUSION: (1) Compared with zero load, walking speed and dynamic stability margin of other cognitive loads were decreased (P < 0.05). (2) Walking speed and step length of double cognitive load were lower than those of one cognitive load (P < 0.05). The step length of double cognitive load was lower than that of zero cognitive load (P < 0.05). (3) Step width parameters had no statistical significance when walking under different cognitive loads (P > 0.05). (4) It is indicated that with the increase of cognitive load, young adults responded to the intervention of cognitive task mainly by decreasing stride speed and stride length and changing gait pattern. During dual-task walking, the intervention of cognitive task did not affect step width parameters, and it is not recommended to use step width parameters as an effective indicator to evaluate the performance of dual-task posture control when evaluating the effectiveness of dual-task rehabilitation training program. When the cognitive load did not exceed the total attention resources of the human body, the intervention of cognitive task increased the dynamic stability of the left and right directions during walking. For young people, different cognitive loads have little influence on postural control, and the setting of cognitive load can be appropriately reduced when implementing dual-task rehabilitation intervention.  Figures and Tables | References | Related Articles | Metrics

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Effect of mechanical tension stress on arterial vessels after limb osteotomy in rabbits Tang Huiyu, Hou Biao, Xia Xiaodan, Xiang Wei, Xie Songlin 2023, 27 (9):  1422-1426.  doi: 10.12307/2023.216 Abstract ( 430 )   PDF (2045KB) ( 45 )   Save BACKGROUND: Limb lengthening by tensile stress has become an effective measure in the treatment of fracture and limb amputation, but the underlying mechanism of how mechanical tensile stress affects limb arteries and vessels has not been clarified.   OBJECTIVE: To investigate the effect of slow steady unidirectional mechanical tension stress on limb artery. METHODS:  Totally 75 adult New Zealand rabbits were randomly divided into model control group (the hind limb was amputated and not prolonged), experimental group (the hind limb was amputated and lengthened) and blank group (no limb treatment), with 25 rabbits in each group. The prolonged speed of the experimental group was 0.5 mm/time, twice a day, for 10 days. Saphenous artery specimens were collected at 8, 10, 12, 16, and 19 days (i.e., 3, 5, 7, 11, and 14 days from the start of distraction osteogenesis) after Ilizarov external fixation. The length of saphenous artery was observed and compared. At the same time, X-ray examination was conducted to detect the osteotomy of the affected limb. Arterial structure and inflammatory response were observed by hematoxylin-eosin staining.   RESULTS AND CONCLUSION: (1) In terms of vascular length: Since the 5th day of Ilizarov external fixation stent pulling, the length of saphenous artery in the experimental group was significantly increased compared with the model control group (P < 0.01). (2) In terms of X-ray examination, at 16 days after osteotomy (i.e., 1 day after the extension ends), the end of osteotomy in the experimental group was extended by about 10 mm, and no callus was formed in the gap. (3) Hematoxylin-eosin staining showed that at 8, 10, 12, 16, and 19 days after external fixation, the arterial tissue structure of the experimental group was intact, without intima vascular injury, smooth muscle cell necrosis or inflammatory cell infiltration. (4) These results indicate that slow and steady unidirectional mechanical stretch stress can prolong the limb arteries and keep the arterial vascular structure stable while lengthening the length of tibial osteotomy end, suggesting that the potential mechanism of stretch stress promoting limb lengthening lies in the stimulation of arterial vascular growth. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis and structural optimization design of 3D printed forearm braces Peng Zhixin, Yan Wengang, Wang Kun, Zhang Zhenjiang 2023, 27 (9):  1340-1345.  doi: 10.12307/2023.208 Abstract ( 682 )   PDF (1686KB) ( 94 )   Save BACKGROUND: The use of 3D printing technology to make personalized braces for patients is widespread, but there is a lack of biomechanical verification of the protective effect of braces on fracture sites.  OBJECTIVE: To combine reverse modeling, finite element analysis and topology optimization, propose a feasible method of 3D printing forearm bracing, and to verify the effectiveness of the brace through finite element analysis. METHODS:  Reverse modeling was used to construct a male volunteer forearm model by medical image processing software Mimics. Parametric design software Grasshopper was used to process the forearm data collected by Rodin 4D and to establish the brace model. Based on the biomechanical properties of the forearm, finite element analysis was carried out on the whole model of the forearm wearing the brace. The topology optimization and drilling were carried out on the brace according to the finite element analysis results. Finally, the brace was printed with a 3D printer.  RESULTS AND CONCLUSION: (1) Under the pressure load of 100 N, the stress and displacement at fracture point were 1.53 MPa and 0.27 mm, respectively, while the stress and displacement at fracture point of the forearm under the protection of brace were 0.19 MPa and 0.005 mm, respectively. (2) Topology optimization was carried out on the premise of ensuring the mechanical properties of the brace. By comparing the stiffness results of the optimized brace, 40% volume reduction was selected as the optimization result. According to the optimization results, Grasshopper plug-in was used to drill holes and reduce materials for the support. (3) By comparing the strength analysis of the brace designed by the hollow out of different samples, the Tyson polygon was selected as the punching sample. (4) This article proposes the feasibility of using digital design and 3D printing technology for the forearm brace, and establishes a complete forearm brace design, verification and manufacturing system. Figures and Tables | References | Related Articles | Metrics

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Dynamic analysis of structural changes in the lower cervical intervertebral foramen during rotation-traction manipulation by virtual reality technology Liu Guangwei, Feng Minshan, Zhu Liguo, Yin Xunlu, Chen Zhuoxian 2023, 27 (9):  1346-1351.  doi: 10.12307/2023.252 Abstract ( 620 )   PDF (1987KB) ( 71 )   Save BACKGROUND: Cervical spondylotic radiculopathy is a common clinical disease. Rotation-traction manipulation is an effective means to treat cervical spondylotic radiculopathy. The measurement of intervertebral foramen is an important reference standard in clinic.   OBJECTIVE: To analyze the effects of different states of rotation-traction manipulation on the structural changes of lower cervical intervertebral foramen, and to explore the biomechanical mechanism of rotation-traction manipulation. METHODS:  Cervical spine specimens were implanted with screws to facilitate positioning during CT imaging. Firstly, MTS material machine was used to simulate the rotation manipulation with different positioning angles on fresh cervical specimens. The motion trajectory of Marker points was obtained by motion capture technology. Then, the cervical specimens were scanned by thin-layer spiral CT. The three-dimensional cervical solid reconstruction was carried out by using Mimics software. According to the motion trajectory of cervical vertebra under the process of rotation-traction manipulation, the multi-mode medical image three-dimensional registration was carried out by Autodesk Maya software to realize dynamic virtual reality simulation, and then the dynamic image processing was carried out. Finally, ImageJ software and Adobe Photoshop software were used to measure the longitudinal diameter and area of lower cervical intervertebral foramen before and after rotation-traction manipulation.   RESULTS AND CONCLUSION: (1) Positioning traction was helpful to open the lower cervical intervertebral foramen in advance. The traction effect was slightly worse than neutral traction, but positioning traction had better safety. (2) When the pulling force was within 150 N, the smaller the pulling force of rotation-traction manipulation, the smaller the increase of the longitudinal diameter and area of the lower cervical intervertebral foramen. After the pulling force exceeded 150 N, the increase of longitudinal diameter and area of cervical intervertebral foramen had little effect. (3) Rotation-traction manipulation may help to loosen the adhesion around the intervertebral foramen by increasing the lower cervical intervertebral foramen, so as to alleviate the symptoms of nerve root stimulation. Figures and Tables | Related Articles | Metrics

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Influence of different bone mineral densities on cage subsidence after stand-alone oblique lateral interbody fusion: three-dimensional finite element analysis Wu Tianliang, Tao Xiuxia, Xu Hongguang 2023, 27 (9):  1352-1358.  doi: 10.12307/2023.212 Abstract ( 950 )   PDF (3404KB) ( 36 )   Save BACKGROUND: The clinical application of stand-alone oblique lateral interbody fusion is greatly affected by the bone mineral density of patients, but there is no relevant report on the specific bone mineral density at home and abroad. OBJECTIVE: To compare the biomechanical performance of an oblique lateral interbody fusion cage among different bone density models. METHODS:  Based on the CT data of healthy adult male volunteers, there were L3-S1 normal control finite element model (M0 group), the normal bone mineral density (T value>-1.0 SD) L4-5 stand-alone oblique lateral interbody fusion finite element model (M1 group), osteopenia (-2.5 SD<T value<-1.0 SD) L4-5 stand-alone oblique lateral interbody fusion finite element model (M2 group) and osteoporosis (T value≤-2.5 SD) L4-5 stand-alone oblique lateral interbody fusion finite element model (M3 group). A motion torque of 10 N•m was applied on the surface of the L3 vertebra to simulate the biomechanical properties of the lumbar spine under six working conditions of the human body and to evaluate the range of motion of the L4-5 segments and the stress distribution of the bony endplate and cage.  RESULTS AND CONCLUSION: (1) Under the same working conditions, compared with the M0 group, range of motion of the L4-5 segments of the M1, M2, and M3 groups all decreased, and the M3 group had the largest reduction. (2) Under the conditions of flexion, extension, and lateral bending, compared with the M0 group, the bony stress of the M1, M2, and M3 groups all increased significantly. Under the left and right rotation, compared with the M0 group, the bony endplate stress of the M1, M2, and M3 groups increased to different degrees. Under the same conditions, compared with the M1 group, the bony endplate stress in the M2 group was not significantly decreased, and the bony endplate stress in the M3 group was significantly increased. (3) Compared with the M1 group under the same working conditions, the cage stress in the M2 group was not significantly decreased, and the cage stress in the M3 group was increased significantly. (4) The results suggest that there is a risk of cage subsidence in patients with osteoporosis who undergo stand-alone oblique lateral interbody fusion surgery. For patients with bone mineral density T value>-2.5 SD, stand-alone oblique lateral interbody fusion surgery can improve biomechanical stability. Figures and Tables | References | Related Articles | Metrics

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Finite element biomechanical analysis of minimally invasive treatment of cervical spondylotic myelopathy and accurate exercise rehabilitation Liu Jinyu, Zhang Hanshuo, Cui Hongpeng, Pan Lingzhi, Zhao Boran, Li Fei, Ding Yu 2023, 27 (9):  1359-1364.  doi: 10.12307/2023.211 Abstract ( 481 )   PDF (1457KB) ( 54 )   Save BACKGROUND: Endoscopic fenestration and decompression of cervical lamina lead to changes in bony structure of cervical vertebrae, which in turn leads to biomechanical changes of responsible segments. In clinical rehabilitation, it is urgent to understand the biomechanical changes caused by structural changes so as to establish an accurate exercise rehabilitation program. OBJECTIVE: To establish a three-dimensional solid finite element model for the treatment of cervical spondylotic myelopathy by using the finite element reverse engineering technology, and to establish the static biomechanical analysis of cervical physiological activities, and to formulate the strategy of postoperative accurate exercise rehabilitation training.  METHODS: The thin slice plain scan data of cervical vertebrae of volunteers before and after two operations were obtained and imported into Mimics 20.0 software, respectively. Using the preoperative CT data, the finite element model M of C4-5 segment bone tissue was established. The fenestration model M1 of unilateral C4-5 lamina was established by using CT data after the first operation. The fenestration model M2 of bilateral C4-5 lamina was established by using CT data after the second operation. Three kinds of bone models were introduced into 3-matic for surface construction. A 75 N axial downward pressure was applied on the upper surface of the C4 vertebral body, and the intervertebral disc force and vertebral body displacement were recorded under different working conditions.    RESULTS AND CONCLUSION: (1) Compared with model M, the stress in intervertebral disc b and d regions of model M1 increased by 10%-12% during the right bending activity, and there was no significant difference in other physiological activities. The stress in b and d regions of model M2 increased by 10%-13% when the right bend was active, and the stress in a and c regions increased by 9%-11% when the left bend was active, and there was no significant difference in other physiological activities. (2) Compared with model M, the displacement of model M1 increased by about 15% under the right bending physiological activity, and increased by about 13% in other directions. Under the physiological activities of left and right lateral bending, the displacement of model M2 increased by about 17%, and increased by about 14% in other directions. (3) It is concluded that full endoscopic fenestration discectomy for cervical spondylotic myelopathy has little effects on the biomechanical stability of the spine as a whole. An accurate exercise rehabilitation program was made according to the biomechanical changes caused by the changes of bone structure after operation. For the patients after unilateral full endoscopic fenestration discectomy, they should focus on the training of the cervical semispinalis muscle and the cephalic semispinalis muscle on the operative side. For patients after bilateral full endoscopic fenestration discectomy, it is necessary to train muscle tissues such as bilateral cervical semispinalis muscle and cephalic semispinalis muscle, so as to increase the muscle strength of the back of the cervical vertebra, and make the cervical vertebra better on the central axis through muscle strength, so as to achieve the purpose of stabilizing the cervical vertebra. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of transarticular screw fixation of adolescent thoracic vertebra He Yujie, Kang Zhijie, Xue Mingming, Jin Feng, Li Zhijun, Wang Xing, Xu Yangyang, Gao Mingjie, Li Jiawei, Li Xiaohe, Wang Haiyan 2023, 27 (9):  1365-1370.  doi: 10.12307/2022.803 Abstract ( 666 )   PDF (2431KB) ( 75 )   Save BACKGROUND: Facet screw fixation is currently accepted as an internal fixation method. It has been extensively studied and applied in the cervical spine and lumbar spine.  OBJECTIVE: To quantitatively analyze and compare biomechanical properties of transarticular screw fixation and traditional pedicle screw fixation in adolescents using finite element method to explore the feasibility of the former in thoracic internal fixation. METHODS: The finite element models of total thoracic vertebral pedicle screw fixation (Model A) and transarticular screw fixation (Model B) were established in 14-year-old adolescents. The original data of continuous scan thoracic vertebral tomography images were imported into Mimics 21.0 in DICOM format. T1-T12 were reconstructed and then imported into 3-Matic to establish preliminary geometric models of discs, facet joints, screws and titanium rods, and then processed with denoising, surfacing, smoothing and so on. The models were imported into Hypermesh software to carry on the grid. After attribute assignment, materials were imported into Ansys 19.2 to show the finite element model. Boundary and load condition were set. The motion range and stress of pedicles, intervertebral discs, screws, and titanium rods were observed, and whether the two had the same force and biomechanical stability were analyzed. RESULTS AND CONCLUSION: (1) The range of motion of facet joints in all segments of pedicle screws was greater than that of facet screws in all six working conditions (flexion, extension, left rotation, right rotation, left flexion, right flexion). The maximum motion was located at T11/12 segment in the left flexion state (Model A: 0.691°; Model B: 0.563°). (2) There was no significant difference in the stress value of the pedicle between the two groups in flexion, extension, lateral flexion and left rotation (P > 0.05). In right-rotation state, the segments with significant differences (P < 0.05) were located at T3 and T6-T9, respectively, and the stress values of the model in Model A were higher than those in Model B. (3) There was no significant difference in the stress value of the superior articular process between Model A and B in flexion, extension, and lateral flexion motion (P > 0.05). In left-rotation and right-rotation states, the segments with significant differences (P < 0.05) were located at T10 and T8, respectively, and the stress values of the superior facet in Model B were higher than those in Model A. (4) The average stress value of T1-2 intervertebral disc in Model B was greater than that in Model A only in flexion forward, flexion right and rotation right, but was smaller than that in Model A under other conditions. In the overall stress cloud of titanium screw and rod, the average stress value of Model A was greater than that in Model B. (5) It is concluded that the biomechanical properties of small articular screws are similar to those of traditional pedicle screws, and posterior transarticular screw fixation in the thoracic spine can be used as an alternative fixation method. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element model analysis of intramedullary nailing fixation design for large femoral defects in Beagle dogs Wen Xinghua, Ding Huanwen, Cheng Kai, Yan Xiaonan, Peng Yuanhao, Wang Yuning, Liu Kang, Zhang Huiwu 2023, 27 (9):  1371-1376.  doi: 10.12307/2023.209 Abstract ( 478 )   PDF (1779KB) ( 146 )   Save BACKGROUND: Large bone defects occur from time to time, but at present, how to design the prosthesis is still judged by doctors’ subjective experience. The appearance of finite element analysis is expected to change this situation, provide the technical support for clinicians to carry out surgery, and improve the recovery rate of the surgery. OBJECTIVE: To investigate the effects of implant and intramedullary nail design project on repair of large bone defects in Beagle dogs by finite element analysis. METHODS: The 3D model of the normal left femur was established based on the CT image data of Beagle dogs. Large bone defect three-dimensional finite element model was set up, from the thickness and quantity of locking nail, the length of the implants and the distance from the center of cross section to locking nail. Four groups of 12 different experimental models (three models per group) were established. Through the finite element analysis, we studied the mechanical and structural characteristics of intramedullary nails after operation, compared biomechanical effects of each model, and obtained the best design scheme. RESULTS AND CONCLUSION: (1) In the first group, when the locking nail diameter was 2.7 mm, the maximum stress of intramedullary nails was the smallest compared with the other two groups. (2) In the second group, when the number of nails was four, the maximum stress of intramedullary nails was the smallest compared with the other two groups. (3) In the third group, when the length of the implant was 20 mm, the maximum stress of the intramedullary nail was the smallest compared with the other two groups. (4) In the fourth group, when the distance from the nail to the center of the cross section was 30 mm, the maximum stress of the intramedullary nail was the smallest compared with the other two groups. (5) These results verify that after the size of the intramedullary nail is determined, the diameter of the locking nail should be about half of the diameter of the intramedullary nail, and the number of the nail should be four, with two nails on both the upper and lower sides being the best. The length of the implant should be as short as possible, and the distance of the nail from the center of the cross section should be as far as possible. Figures and Tables | References | Related Articles | Metrics

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Comparison of 12-month follow-up results of primary total hip arthroplasty between modified direct anterior approach and direct anterior approach Ke Yuqi, Chen Changjian, Wu Hao, Zheng Lianjie 2023, 27 (9):  1377-1382.  doi: 10.12307/2023.213 Abstract ( 350 )   PDF (1729KB) ( 49 )   Save BACKGROUND: Direct anterior total hip arthroplasty can lead to increased muscle tension and contusion, especially in male patients with high body mass index and strong physique. Then, inflammatory reaction and early postoperative complications occurred.  OBJECTIVE: To explore the difference in early curative effect of modified direct anterior approach and direct anterior approach in total hip arthroplasty.  METHODS: The clinical data of 68 patients undergoing direct anterior approach for total hip arthroplasty admitted to the Second Affiliated Hospital of Dalian Medical University from June 2019 to August 2020 were collected and randomly divided into the modified group (modified direct anterior approach) and the traditional group (direct anterior approach) (n=34). Blood routine, creatine kinase, C-reactive protein, hemoglobin content and ultrasonic thickness of hip-related muscles were detected before operation and 2 days after operation. The hip flexion and abduction muscle strength were evaluated at 2 days and 1 month after the operation. The visual analogue scale score and Harris score of the hip joint were evaluated preoperatively, 2 days, 1, 6, and 12 months postoperatively.  RESULTS AND CONCLUSION: (1) Within 12 months of follow-up, no periprosthetic infection, periprosthetic osteolysis, prosthesis loosening or periprosthetic fracture occurred in 68 patients. (2) The changes in creatine kinase, tensor fascia lata thickness, vastus lateralis muscle thickness, and vastus intermedius thickness before and after surgery in the modified direct anterior approach group were all lower than those in the direct anterior approach group (P < 0.05). There was no significant difference in hip flexion and abductor strength ratings at 2 days and 1 month after operation between the two groups (P > 0.05). (3) Before surgery and at 2 days, 1, 6, and 12 months after surgery, there was no significant difference between the two groups in the visual analogue scale score and Harris score of the hip joint (P > 0.05). Among the 34 patients in the direct anterior approach group, 14 patients had mild iliac crest pain after surgery, and the pain disappeared 1 month after surgery. (4) The results conclude that compared with the traditional direct anterior approach, the modified direct anterior approach is helpful to reduce the injury of soft tissue such as tensor fascia lata. Although the iliac crest pain is increased, it does not affect the early pain score and rehabilitation function training of patients. The modified approach is especially suitable for patients with strong physique and high soft tissue tension.  Figures and Tables | References | Related Articles | Metrics

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Effect of tendon manipulation with equal emphasis on muscles and bones on accelerating the functional rehabilitation of quadriceps femoris after total knee arthroplasty Zhang Lichuang, Gao Huali, Wang Jingchao, Lin Huijun, Wu Chonggui, Ma Yinghui, Huang Yunfei, Fang Xue, Zhai Weitao 2023, 27 (9):  1383-1389.  doi: 10.12307/2023.237 Abstract ( 558 )   PDF (1496KB) ( 60 )   Save BACKGROUND: After total knee arthroplasty, the quadriceps femoris muscle strength of patients has a certain decline. If the injured quadriceps femoris cannot be effectively rehabilitated for a long time, it may cause a continuous decline in quadriceps femoris muscle strength and even lower limb muscle atrophy.  OBJECTIVE: To explore the effect of tendon manipulation with equal emphasis on muscles and bones on the accelerated rehabilitation of quadriceps femoris after total knee arthroplasty. METHODS:  Totally 80 patients undergoing total knee arthroplasty in the Guanghua Hospital, Shanghai University of Traditional Chinese Medicine were randomly divided into control group and treatment group (n=40 per group). The control group was given routine rehabilitation after total knee arthroplasty, including ankle pump training and quadriceps isometric contraction training. Rehabilitation training was conducted on the 1st to 14th days after operation. The treatment group was given routine rehabilitation combined with tendon manipulation with equal emphasis on muscles and bones to enhance the precise exercise of quadriceps femoris. Rehabilitation training was conducted on the 1st to 14th days after operation. The surface electromyography index, visual analogus scale score, tenderness threshold, hospital for special surgery knee score, the scores of Osteoarthritis Index questionnaire of Western Ontario and McMaster University, and hospital anxiety and depression scale were compared between the two groups.  RESULTS AND CONCLUSION: (1) After 7 and 14 days of manipulation intervention, the median frequency of surface electromyography of lateral femoral muscle, hospital for special surgery knee score, and knee tenderness threshold were higher in the treatment group than those in the control group (P < 0.05). Visual analogus scale score, Osteoarthritis Index questionnaire of Western Ontario and McMaster University, and hospital anxiety and depression scale were lower in the treatment group than those in the control group (P < 0.05). (2) There were no adverse events caused by manipulation or no surgical complications during manual rehabilitation. (3) The results show that the tendon manipulation with equal emphasis on muscles and bones can accelerate the functional rehabilitation of quadriceps femoris after total knee arthroplasty, which is safe and effective. Figures and Tables | References | Related Articles | Metrics

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Femoral neck system combined with platelet-rich plasma in the treatment of femoral neck fracture Zheng Hongrui, Zhang Wenjie, Wang Yunhua, He Bin, Shen Yajun, Fan Lei 2023, 27 (9):  1390-1395.  doi: 10.12307/2023.214 Abstract ( 459 )   PDF (2024KB) ( 64 )   Save BACKGROUND: For young patients with femoral neck fracture, the primary purpose of treatment is to achieve anatomical reduction and fixation to promote fracture healing. However, current studies have shown that after the occurrence of femoral neck fracture, the incidence of nonunion was 10%-30%; the incidence of femoral head necrosis was 15%-30%. Therefore, the risk to these patients is substantial.   OBJECTIVE: To study the clinical efficacy of platelet-rich plasma combined with femoral neck system in the treatment of femoral neck fracture in young patients. METHODS:  The clinical data of 52 patients (aged 18-55 years) with femoral neck fracture treated in Second Affiliated Hospital of Nanjing Medical University from January 2020 to January 2021 were included. Among them, 18 patients were treated with closed reduction and internal fixation with three cannulated screws (group A); 18 patients were treated with closed reduction and femoral neck system internal fixation (group B); 16 patients were treated with closed reduction and femoral neck system internal fixation combined with platelet-rich plasma (group C). The quality of fracture reduction was evaluated by anterior and lateral X-ray of femoral neck. Fracture healing at 6 months and 1 year after operation was evaluated by Fernandez-Esteve callus score. Hip joint function at 6 months and 1 year after operation was evaluated by Harris hip score. The incidence of femoral neck shortening was compared and analyzed between the two groups.   RESULTS AND CONCLUSION: (1) All the 52 cases completed the operation successfully and no complications such as infection, re-fracture, or deep venous thrombosis of lower extremities occurred. They were followed up for at least one year. (2) The postoperative fracture healing in group C was better than that in groups A and B (P < 0.05). Harris hip score in group C was higher than that in groups A and B at 6 months and 1 year after operation (P < 0.05). At 6 months after operation, the Fernandez-Esteve callus score in group C was higher than that in groups A and B (P < 0.05). The incidence of femoral neck shortening in group C was lower than that in group A after operation (P < 0.05). (3) The surgical treatment of femoral neck fracture with femoral neck system combined with platelet-rich plasma is helpful to improve the therapeutic effect, promote fracture healing, reduce the occurrence of femoral neck shortening and improve the prognosis of patients. Figures and Tables | References | Related Articles | Metrics

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Application of compressed sensing technology in two-dimensional magnetic resonance imaging of the ankle joint Du Xueting, Zhang Xiaodong, Chen Yanjun, Wang Mei, Chen Wubiao, Huang Wenhua 2023, 27 (9):  1396-1402.  doi: 10.12307/2023.205 Abstract ( 560 )   PDF (1327KB) ( 68 )   Save BACKGROUND: At present, there are few reports on the application of compressed sensing technology in ankle MRI.  OBJECTIVE: To investigate the effect of different acceleration factors in compressed sensing (CS) on image quality and scanning time of conventional 2D-MRI of the ankle joint.  METHODS: Totally 24 healthy volunteers (38 ankles) underwent conventional 2D-TSE sequence scanning at 3.0T MR. Based on SENSE parallel imaging (S group) and compressed sensing technique (CS group), sequence images of T1WI-TRA (S1.3, CS1.3, CS1.9, CS2.7), PDWI-Dixon-SAG (S1.8, CS1.8, CS2.6, CS3.2) and PDWI-SPAIR-COR (S1.3, CS1.3, CS1.6, CS2.0) were obtained separately. Other scan parameters of each sequence remained consistent. The tendon, cartilage, ligament and muscle structures of the ankle joint images were subjectively scored by 5 points. The standard deviation of background noise and signal intensity of bone, cartilage, ligament, tendon, muscle, effusion and fat structures were measured, and the signal-to-noise ratio and contrast-to-noise ratio were calculated. The subjective score and objective evaluation of different acceleration factor images were statistically analyzed. SENSE group was used as the standard reference for the image quality of each sequence.  RESULTS AND CONCLUSION: (1) When acceleration factor was the same, there were no statistically significant differences in subjective score, signal-to-noise ratio and contrast-to-noise ratio between the S group and the CS group (P > 0.05). (2) The acceleration factor of CS (TRA), CS (SAG) and CS (COR) sequences at CS1.9, CS2.6 and CS1.6 showed no significant difference in the image quality of cartilage, tendon, ligament and other main observed structures of the ankle joint (P > 0.05), and the scanning time was 1 minute and 32 seconds, 1 minute and 42 seconds, 1 minute and 48 seconds, respectively. When the acceleration factor of CS (TRA), CS (SAG) and CS (COR) sequences increased to CS2.7, CS3.2 and CS2.0, respectively, the subjective scores of all anatomical structures were still greater than 3, but signal-to-noise ratio and contrast-to-noise ratio of each sequence decreased significantly (P < 0.05). (3) These findings confirm that when acceleration factor is the same, compared with CS group, the image quality obtained by CS group is generally higher than that of S group. When acceleration factor increases, the scanning time of CS sequence decreases gradually, and the image quality also decreases. On a 3.0T MR, CS technology recommended CS1.9, CS2.6, and CS1.6 accelerators for conventional 2D sequences T1WI-TRA, PDWI-Dixon-SAG, and PDWI-SPAIR-COR, respectively, reducing the overall time by about 27% (1 minute and 53 seconds). Figures and Tables | References | Related Articles | Metrics

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Early symptomatic intervertebral disc pseudocysts after discectomy detected on MRI You Zhengqiu, Zhang Zhongzu, Wang Qunbo 2023, 27 (9):  1403-1409.  doi: 10.12307/2023.210 Abstract ( 466 )   PDF (5139KB) ( 104 )   Save BACKGROUND: Postoperative symptomatic intervertebral disc pseudocyst is a cystic lesion in the area of intervertebral disc surgery. It is usually found in patients undergoing MRI examination in the early postoperative period. At present, there is insufficient data on its clinical characteristics and pathogenesis, and its treatment method is still controversial.  OBJECTIVE: To investigate the clinical characteristics, pathogenesis and treatment strategy of symptomatic intervertebral disc pseudocyst after discectomy. METHODS:  Seven patients with symptomatic intervertebral disc pseudocysts after intervertebral discectomy in the Yongchuan Hospital Affiliated to Chongqing Medical University from January 2019 to September 2021 were enrolled in this study. There were 5 males and 2 females, at the age of 35-60 years. Clinical features and treatments were retrospectively analyzed. RESULTS AND CONCLUSION: (1) Among seven patients, five patients underwent percutaneous endoscopic lumbar discectomy and two underwent posterior microscopic endoscopic discectomy. Their symptoms were significantly relieved after surgery. However, the symptoms recurred after the operation. The postoperative MRI showed low signal on T1WI and high signal on T2WI in the original operation area, and it communicated with the intervertebral disc, which was diagnosed as symptomatic intervertebral disc pseudocyst. The average time for MRI to find the pseudocyst was about 32 days. (2) For seven patients with symptomatic intervertebral disc pseudocysts, four patients received analgesia and detumescence, bed rest and other symptomatic treatments; one patient received percutaneous endoscopic lumbar discectomy; two patients received microscopic endoscopic discectomy. Waist and leg pains were significantly relieved. At 1 month after operation, MRI showed the original pseudocyst was significantly reduced. (3) The results indicate that symptomatic intervertebral disc pseudocyst usually occurs in the early postoperative period. MRI can be the first choice for examination. When conservative treatment fails, interventional or surgical treatment can be performed and the outcome can be good. Figures and Tables | References | Related Articles | Metrics

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Arthroscopy-assisted locking hollow screw fixation and open reduction plate internal fixation in the treatment of Schatzker II-III tibial plateau fractures: early CT evaluation Zheng Bo, Zhang Xiuli, Zhou Hao, He Zebi, Zhou Jin, Zhou Weiyun, Li Peng 2023, 27 (9):  1410-1416.  doi: 10.12307/2023.225 Abstract ( 617 )   PDF (1607KB) ( 69 )   Save BACKGROUND: Schatzker II-III tibial plateau fractures are one of the most common fractures in clinical practice. The traditional open reduction and internal fixation scheme can cause great surgical trauma, often causing great troubles to clinicians and patients. OBJECTIVE: To discuss the early imaging and clinical results of the treatment of Schatzker II-III tibial plateau fractures with arthroscopy-assisted locking hollow screws and traditional open reduction plate internal fixation. METHODS:  118 patients with Schatzker II-III tibial plateau fractures who met the criteria for surgical treatment in Qingbaijiang District People’s Hospital of Chengdu from January 1, 2015 to January 1, 2020 were retrospectively collected and randomly assigned to two groups. The 52 cases of the locking hollow screw group were treated with locking hollow screw fixation assisted by arthroscopy. The 66 cases of the traditional group were treated with open reduction steel plate internal fixation. The intraoperative blood loss, incision length, cost, length of hospital stay, and visual analogue scale pain score before operation, 1 day and 1 week after operation were recorded and compared between the two groups. Before and 1 day after the operation, the knee joint was scanned by CT to record the maximum settlement distance of the tibial plateau articular surface. Range of motion, Hospital for Special Surgery knee score, Knee Society Score (clinical score and functional score), and complications during the last follow-up (2 years after surgery) were recorded. RESULTS AND CONCLUSION: (1) The intraoperative blood loss, incision length, cost, and length of hospital stay were significantly better in the locking hollow screw group than those in the traditional group (P < 0.05). The surgical time in the traditional group was significantly shorter than that in the locking hollow screw group (P < 0.05). (2) There was no significant difference in visual analogue scale scores between the two groups before and 1 week after surgery (P > 0.05). At 1 day after surgery, the visual analogue scale score of the locking hollow screw group was significantly shorter than that of the traditional group (P < 0.05). (3) There was no significant difference in the fracture separation distance measured by CT before operation between the two groups (P > 0.05). At 1 day after operation, the fracture separation distance in the locking hollow screw group was significantly lower than that in the traditional group (P < 0.05). (4) At 2 years postoperatively, the range of flexion in the locking hollow screw group was significantly higher than that in the traditional group (P < 0.05). There was no significant difference in range of knee extension, hospital for special surgery knee score, and Knee Society Score (clinical score and functional score) between the two groups (P > 0.05). (5) It is indicated that compared with open reduction and internal fixation, arthroscopy-assisted locking hollow screw fixation in the treatment of Schatzker II-III tibial plateau fractures has advantages in blood loss, incision length, pain, cost, hospital stay, and degree of reduction. However, there was no significant difference in functional score and the operation time was longer.  Figures and Tables | References | Related Articles | Metrics

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Respiratory training improves morphological changes of the multifidus muscle in patients with chronic nonspecific lower back pain assessed by musculoskeletal ultrasound Li Chao, Zhang Peipei, Xu Mengting, Li Linlin, Ding Jiangtao, Liu Xihua, Bi Hongyan 2023, 27 (9):  1417-1421.  doi: 10.12307/2023.206 Abstract ( 532 )   PDF (1252KB) ( 71 )   Save BACKGROUND: Studies have confirmed that lumbar spine stabilization training can improve muscle morphology of the multifidus muscle in patients with chronic low back pain. There is no clinical study on whether respiratory training affects the multifidus muscle morphology in patients with chronic lower back pain.   OBJECTIVE: To investigate the effect of respiratory training on the changes of muscle thickness and cross-sectional area of lumbar stable muscle (multifidus muscle) in patients with chronic nonspecific lower back pain. METHODS:  Totally 96 patients with chronic nonspecific lower back pain who met the inclusion criteria were randomly divided into trial group (n=32), respiratory training control group (n=32) and core training control group (n=32). The respiratory training and core training control groups received respiratory training and core stabilization training, respectively. The trial group received respiratory training combined with core stabilization training. The treatment was performed once a day, 20 minutes every time, 5 days per week, for 10 consecutive weeks. Before and after treatment, musculoskeletal ultrasound was used to observe and record the thickness and cross-sectional area of the lumbar stabilizing muscle (multifidus muscle) in the three groups. The morphology of the multifidus muscle was evaluated before and after treatment in the three groups.  RESULTS AND CONCLUSION: (1) After treatment, there was no significant difference in bilateral L5 multifidus muscle thickness sum between the respiratory training control group and the core training control group, but the multifidus muscle thickness sum was significantly thicker in the trial group than that in the other two groups. After treatment, there were significant differences in cross-sectional area sum of bilateral L5 multifidus muscle among groups (trial group >  respiratory training control group > core training control group) (P < 0.001). (2) Musculoskeletal ultrasound results of the morphological changes of the multifidus muscle in the three groups before and after treatment confirmed that respiratory training could improve the thickness and cross-sectional area of the lumbar multifidus muscle. Musculoskeletal ultrasound technology, as a new curative effect observation tool, can be used as an effective means for the evaluation and adjuvant therapy in patients with chronic nonspecific lower back pain. Figures and Tables | References | Related Articles | Metrics

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Targeting of non-coding RNAs in the pathogenesis of the osteonecrosis of the femoral head Pan Zhongjie, Qin Zhihong, Zheng Tiejun, Ding Xiaofei, Liao Shijie 2023, 27 (9):  1441-1447.  doi: 10.12307/2023.227 Abstract ( 549 )   PDF (1571KB) ( 46 )   Save BACKGROUND: At present, non-coding RNAs have been proven to play an important role in a variety of orthopedic disease. Therefore, non-coding RNAs may bring new ideas for understanding the etiology, pathogenesis and treatment of this disease. OBJECTIVE: To explore the methods and ideas of early diagnosis and treatment of the femoral head necrosis, review the research progress on non-coding RNAs in the femoral head necrosis, and put forward the existing problems and solutions.  METHODS:  The keywords of “osteonecrosis of the femoral head, non-coding RNAs, miRNA, lncRNA, circRNA” were used to search articles published between January 2000 and November 2021 on CNKI, Wanfang, VIP, PubMed, and Medline databases. Finally, 67 articles were included.  RESULTS AND CONCLUSION: (1) The types of non-coding RNAs are very rich, accounting for about 98% of all transcription products and 90% of the functions of all RNAs. According to their functions, they can be divided into housekeeping non-coding RNAs, such as tRNA, rRNA, and snoRNA and regulatory non-coding RNAs, such as miRNA, lncRNA, circRNA, and siRNA. (2) At present, the research on miRNAs and steroid-induced osteonecrosis of the femoral head is the most popular focus, while the related studies on exosomal lncRNAs and circRNAs and necrosis of the femoral head have not been reported. (3) The expression of most non-coding RNAs is down-regulated in the occurrence of steroid-induced osteonecrosis of the femoral head, and most non-coding RNAs promote the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells and the generation of osteogenic markers by negatively regulating their related target genes, can also promote the formation of vascular endothelial cells and inhibit the occurrence and progression of avascular necrosis of femoral head. (4) Non-coding RNAs carried by exosomes can also play a role in the femoral head necrosis, but there is little literature at present, and the difference between non-coding RNAs carried by exosomes is not clear at present, which can be gradually improved in future studies. (5) The use of non-coding RNAs analogues and inhibitors can effectively inhibit the occurrence and development of non-traumatic femoral head necrosis, which can provide a new strategy for the early diagnosis and treatment of non-traumatic femoral head necrosis. Figures and Tables | References | Related Articles | Metrics

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Femoral neck anteversion measurement assessment: how to establish a unified method and standard Cai Zhihao, Xie Zhaoyong 2023, 27 (9):  1448-1454.  doi: 10.12307/2022.980 Abstract ( 552 )   PDF (2017KB) ( 61 )   Save BACKGROUND: Femoral neck anteversion is widely used in clinical practice such as total hip replacement and congenital dislocation of hip. Accurate assessment of femoral neck anteversion plays an important role in disease assessment, treatment selection and prognosis evaluation. Femoral anteversion can be assessed in a variety of ways, including the use of clinical physical measurements, physical measurements, radiography, CT, magnetic resonance imaging, ultrasound, 3D printing model measurement (model method), intraoperative Kirschner wire measurement, C Arm, self-made instrument measurement and computer-aided design and medical image processing technology.  OBJECTIVE: To seek a unified method and standard to evaluate the femoral neck anteversion by elaborating on the above measurement methods and the differences between different methods. METHODS: The CNKI and Wanfang databases were retrieved with the key words of “femoral neck anteversion, measurement, evaluation, method”, and the PubMed database was retrieved with the key words of “femoral neck anteversion”. The literature was searched for methods to assess femoral neck anteversion. After excluding irrelevant and duplicate articles, 43 articles that met the criteria were included for review.  RESULTS AND CONCLUSION: At present, the measurement methods of femoral neck anteversion are mainly concentrated in the field of imaging examination, and CT examination method is mostly studied in imaging examination methods. CT has several advantages over other measurement methods. At the same time, both 3D printing technology and artificial intelligence technology need the support of CT image data. CT will play an important role in a unified method for the assessment of femoral neck anteversion in the future.  Figures and Tables | References | Related Articles | Metrics

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3D printed porous tantalum metal in the treatment of developmental dysplasia of the hip: current status and application prospect He Yinhao, Li Xiaosheng, Chen Hongwen, Chen Tiezhu 2023, 27 (9):  1455-1461.  doi: 10.12307/2023.240 Abstract ( 628 )   PDF (1290KB) ( 123 )   Save BACKGROUND: Patients with developmental dysplasia of the hip often have extensive distortion of anatomical structures such as shallow acetabulum and straight and narrow femoral canal. Especially in the face of developmental dysplasia of the hip patients with high dislocation, the implementation of surgical treatment is very challenging. In recent years, the effect and prognosis of individualized treatment of developmental dysplasia of the hip with 3D printed porous tantalum metal are good. It can be used for preoperative diagnosis, preoperative surgical planning, intraoperative establishment of 3D navigation template, determination of preoperative acetabular severity and postoperative acetabular reconstruction and correction evaluation. It has a good development prospect.   OBJECTIVE: To investigate the latest research progress of 3D printed porous tantalum metal in the treatment of developmental dysplasia of the hip. METHODS:  The research data on individualized treatment of developmental dysplasia of the hip by 3D printed porous tantalum metal were searched on the databases of CNKI, PubMed, MDPI, BMC Biotechnology, Web of Science, and Springer link by computer. Retrieval time was from 1970 to 2022. According to the inclusion and exclusion criteria, 58 articles were selected for review.   RESULTS AND CONCLUSION: (1) Porous tantalum metal has biological and biomechanical properties such as biocompatibility, bone integration and bone inductance, which can effectively promote the growth of new bone, new blood vessels and nerves. (2) 3D printed porous tantalum is a combined application of 3D printing molding technology and natural metal materials and porous tantalum. Currently, the effectiveness of this program is mainly evaluated in patients with developmental dysplasia of the hip and hip bone defects. (3) Good preoperative planning of 3D printed porous tantalum metal can effectively improve the postoperative outcomes of developmental dysplasia of the hip and hip bone defects, and prepare for the preoperative individualized planning of prosthetic implants, effectively avoid intraoperative obstacles and fully solve patient-specific malformations, and directly affect the surgical results. The application prospect is good. (4) Currently, animal models and some articles have verified the short-term efficacy of 3D-printed porous tantalum metal in the individualized treatment of developmental dysplasia of the hip, but medium and long-term follow-up results are lacking. Figures and Tables | References | Related Articles | Metrics

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Application of trunk surface morphometry in vertebral column defects Hu Xijian, Zhao Bin, Chai Huo, Liu Haifeng 2023, 27 (9):  1462-1468.  doi: 10.12307/2022.999 Abstract ( 490 )   PDF (1346KB) ( 117 )   Save BACKGROUND: With the progress of optical technology, the detection accuracy of existing trunk surface morphology measurement methods is constantly improving. At the same time, with the intelligence of software technology, various new detection technologies and methods have emerged.  OBJECTIVE: To review various methods and research progress of the application of trunk surface morphometry in vertebral column defects in recent years, and summarize the limitations and development trend of trunk surface morphometry.  METHODS: The first author searched the literature published from 1980 to 2021 on PubMed, Web of Science, CNKI, and Wanfang databases. The key words were “vertebral column defects, spinal deformation, scoliosis, trunk surface, surface topography, TS, AIS, screening”. After excluding repetitive and poor-quality studies, a total of 72 articles were included for analysis. RESULTS AND CONCLUSION: (1) As a non-radiation detection method, the safety of trunk surface morphometry is higher than that of radiological examination, but its accuracy is still controversial because this method is an indirect way to infer the degree of spinal curvature. At present, it cannot replace the special status of radiological examination in the diagnosis and treatment of abnormal spinal curvature diseases. (2) At present, the measurement of trunk surface morphology is divided into three categories: one is the physical examination based on Adam’s test and trunk rotation angle measurement. It has been used in the screening of scoliosis for a long time. To improve the accuracy of the examination, a variety of examinations need to be used together, and the detection efficiency is low. The second is the two-dimensional image measurement method represented by the Trunk Aesthetic Clinical Evaluation and posterior trunk symmetry index, which is often used for the regular monitoring of patients with abnormal spinal curvature. The third is three-dimensional imaging detection represented by Moire image, structured light and Formetric system. In recent years, after breaking through the technical bottleneck, it has got rid of its inefficient and harsh measurement conditions. The measurement accuracy is higher than two-dimensional image measurement. It is widely used in the clinical work of spinal deformity. (3) In recent years, more efficient spinal deformity screening methods developed by relying on new information technologies such as artificial intelligence and big data have also been reported from time to time. When improving the existing trunk surface morphology measurement, optimizing the existing trunk surface morphology measurement or creating a new measurement index can further improve the accuracy and effectiveness of the trunk surface morphology measurement and expand its scope of use under the conditions of meeting the requirements of direct measurement, using clear and accurate anatomical landmarks, simplifying the measurement scheme and clarifying the normal threshold of the index.  Figures and Tables | References | Related Articles | Metrics

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Hormonal osteonecrosis and oxidative stress Dang Yi, Du Chengyan, Yao Honglin, Yuan Nenghua, Cao Jin, Xiong Shan, Zhang Dingmei, Wang Xin 2023, 27 (9):  1469-1476.  doi: 10.12307/2022.958 Abstract ( 590 )   PDF (1526KB) ( 113 )   Save BACKGROUND: The exact mechanism of glucocorticoid induced osteonecrosis is still unclear, and oxidative stress is one of the important mechanisms.  OBJECTIVE: To summarize the relationship between hormonal osteonecrosis and oxidative stress, and to understand the pathogenesis of oxidative stress in hormonal osteonecrosis by reviewing the currently known relevant literature.  METHODS: CNKI, Wanfang, VIP, CBM and PubMed databases were searched for articles regarding research progress of hormonal osteonecrosis and oxidative stress. After preliminarily screened by reading abstracts, a total of 96 articles were finally included for review.  RESULTS AND CONCLUSION: (1) Reactive oxygen species closely links the signal network formed by mesenchymal stem cells, osteocytes, osteoblasts, osteoclasts, and blood vessels to inhibit their osteogenesis and angiogenesis, thus playing an important role in steroid-induced femoral head necrosis. (2) The article explains separately the role of reactive oxygen species in bone metabolism, which mainly regulates cell proliferation, apoptosis and differentiation in bone metabolism through Wnt/β-catenin, MAPK, nuclear factor-κB and PI3K/AKT signaling pathways, thus mediating bone formation and resorption imbalance induced by glucocorticoid. (3) Due to the complex mechanism of hormone osteonecrosis at present, the specific mechanism and process are not clear. In addition, due to the current technical limitations, antioxidant strategies have not had a significant impact on the disease. (4) The mechanism of oxidative stress in steroid-induced osteonecrosis of the femoral head should be further studied based on existing mechanisms. Furthermore, different signaling pathways involved in reactive oxygen species regulation were further analyzed to provide therapeutic targets for clinical treatment of osteonecrosis.  Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of the efficacy and safety of 3D printed porous titanium alloy fusion cage in anterior cervical discectomy and fusion Wang Yanjin, Zhou Yingjie, Chai Xubin, Zhuo Hanjie 2023, 27 (9):  1434-1440.  doi: 10.12307/2023.263 Abstract ( 528 )   PDF (1273KB) ( 77 )   Save OBJECTIVE: To systematically evaluate the clinical efficacy and safety of 3D printed cages in anterior cervical discectomy and fusion. METHODS:  PubMed, Embase, The Cochrane Library, CBM, CNKI, Wanfang, and VIP databases were searched to collect the clinical controlled trial articles on 3D printed fusion cage (3D Cage) placed in anterior cervical discectomy and fusion surgery from database establishment to April 2022. Two independent investigators performed literature screening, data extraction and quality evaluation according to the inclusion and exclusion criteria. Meta-analysis was performed on the outcome measures using RevMan 5.3 software.   RESULTS: (1) A total of 11 relevant articles were included, containing 2 articles of randomized controlled trials with moderate risk of bias and 9 articles of high-quality retrospective study. A total of 691 patients were involved, 338 cases in the test group (3D cage implantation) and 353 cases in the control group (other implant implantation). (2) Meta-analysis results showed that there was no significant difference in the fusion rate (RR=1.03, 95%CI: 0.98 to 1.07, P=0.23) between the two groups. The operation time (MD=-11.84, 95%CI: -17.12 to -6.57, P < 0.000 1), intraoperative blood loss (MD=-10.60, 95%CI: -16.86 to -4.33, P=0.000 9), complications (RR=0.55, 95%CI: 0.35 to 0.88, P=0.01), C2-7 Cobb angle (MD=4.14, 95%CI: 3.42 to 4.85, P < 0.000 01), intervertebral space height (MD=0.48, 95%CI: 0.25 to 0.70, P < 0.000 01) and cervical JOA score under analysis (SMD=0.55, 95%CI: 0.29 to 0.82, P < 0.000 1; SMD = 1.09, 95%CI: 0.73 to 1.46, P < 0.000 01) were superior in the test group to those in the control group. CONCLUSION: The fusion rate of 3D Cage was not inferior to other implants. 3D Cage could shorten operation time, reduce intraoperative blood loss and reduce the occurrence of complications; it could promote the sagittal balance of cervical vertebra and the recovery of neurological function. Figures and Tables | References | Related Articles | Metrics

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Systematical evaluation of bone fusion rate after interbody fusion in patients with osteoporosis and lumbar degenerative disease treated with teriparatide Jiang Xiaocheng, Shi Lu, Wang Yinbin, Li Qiujiang, Xi Chuangzhen, Ma Zefeng, Cai Lijun 2023, 27 (9):  1427-1433.  doi: 10.12307/2022.990 Abstract ( 571 )   PDF (1665KB) ( 110 )   Save OBJECTIVE: To systematically review the changes of bone fusion rate after interbody fusion in patients with osteoporosis and lumbar degenerative disease treated with teriparatide. METHODS: A comprehensive search of PubMed, Embase, Cochrane library, Home-ClinicalTrials (US clinical trial database), CNKI, Wanfang, VIP, Chinese Biomedical Literature Service System and Chinese clinical trial database was performed with “teriparatide, spinal fusion, spondylodesis, randomized controlled trial, randomized, placebo” as English search terms and “teriparatide, spinal fusion, lumbar fusion, interbody fusion” as Chinese search terms. The search time was from database establishment to November 16, 2021. All randomized controlled trials of teriparatide after lumbar fusion in patients with osteoporosis and lumbar degeneration were collected. The methodological quality of the literature was analyzed using the Cochrane Review Manual. Primary outcome measures were the rate of bone fusion, the number of patients with pedicle screw loosening, and the rate of pedicle screw loosening. Secondary outcome measure was the Oswestry Disability Index score for low back pain at 12-month follow-up. Meta-analysis was performed using RevMan 5.3 and Stata 16.0 software.  RESULTS: (1) A total of 9 high-quality research articles were included, including 536 patients. (2) Meta-analysis results showed that bone fusion rate was significantly increased in the teriparatide group compared with the control group at 6-month follow-up [RR=1.96, 95%CI(1.38-2.80), Z=3.73, P=0.000 2 < 0.05], but there was no significant difference in bone fusion rate between teriparatide group and control group at 12-month follow-up [RR=1.02, 95%CI(0.88-1.17), Z=0.23, P=0.82 > 0.05], suggesting that teriparatide can improve postoperative bone fusion rate and shorten bone fusion time in osteoporotic patients with lumbar degenerative diseases. (3) At a follow-up time of 12 months, the loosening rate of pedicle screws in the teriparatide group was significantly lower than that in the control group (P < 0.05). (4) There was no significant difference in the number of pedicle screw loosening between the teriparatide group and the risedronate group [RR=0.99, 95%CI(0.58-1.70), Z=0.02, P=0.98 > 0.05], but the number of pedicle screw loosening could be significantly reduced in the teriparatide group compared with the risedronate group [RR=0.50, 95%CI(0.32-0.78), Z=3.05, P=0.002 < 0.05].  CONCLUSION: (1) Teriparatide can promote bone fusion and shorten bone fusion time. (2) Teriparatide can reduce the incidence of pedicle screw loosening. (3) The effect of teriparatide on postoperative low back pain Oswestry Disability Index score cannot be clarified. Figures and Tables | References | Related Articles | Metrics