Table of Content

08 May 2023, Volume 27 Issue 13 Previous Issue   

For Selected:

Download Citations EndNote Reference Manager ProCite BibTeX RefWorks

Toggle Thumbnails

Select

Finite element analysis of lumbar vertebra biomechanics after oblique lateral interbody fusion combined with bilateral cortical bone trajectory screw fixation Yan Laijun, Ge Haiya, Zhou Bin, Mi Daguo, Wang Pengxiang, Li Nan 2023, 27 (13):  1969-1974.  doi: 10.12307/2023.271 Abstract ( 485 )   PDF (1938KB) ( 36 )   Save BACKGROUND: Cortical bone trajectory screw is a new type of spinal minimally invasive internal fixation technology. Compared with traditional pedicle screws, it has the characteristics of less trauma and strong pullout resistance, and has strong biomechanical properties for patients with osteoporosis. However, studies on the application of cortical bone trajectory screws combined with oblique lateral interbody fusion and fixation are still rare.   OBJECTIVE: To evaluate the effect of oblique lateral interbody fusion combined with various fixation methods on stress distribution and range of motion of cage and L4-5 lower endplate by constructing three kinds of finite element models including oblique lateral interbody fusion (OLIF stand-alone) model, OLIF combined with bilateral pedicle screw (OLIF+BPS) model and OLIF combined with cortical bone trajectory screw (OLIF+CBT) model. METHODS: The CT images of adult lumbar spine were used to establish the three kinds of OLIF finite element models: OLIF stand alone, OLIF+BPS, and OLIF+CBT. Ansys workbench was used to simulate the application of six different motion loads of human body flexion and extension, left and right bending, and left and right rotation to calculate stress distribution and the changes in the range of motion of the lumbar spine of the cage and endplate of the three lumbar spine surgery models and to compare the effects of three surgical options on the biomechanical effects of the lumbar spine.   RESULTS AND CONCLUSION: (1) The OLIF stand-alone model, OLIF+BPS model and OLIF+CBT model were constructed successfully. (2) In terms of range of motion, OLIF+CBT model presented no obvious difference with that of OLIF stand-alone model in flexion and extension, left and right lateral bending, and left and right rotation motions. (3) In flexion, extension, and lateral bending conditions, the maximum stress of cage of OLIF+CBT model was smaller than that of OLIF stand-alone model and slightly greater than that of OLIF+BPS model. When it came to rotating condition, the maximum stress of cage in OLIF+CBT model was bigger than that of two other models. (4) The maximum stress of the lower end plate of OLIF+CBT model was smaller than that of OLIF stand-alone model but slightly greater than that of OLIF+BPS model at various conditions. (4) It is concluded that OLIF combined with CBT fixation provides a good stable support for the vertebral body of the fusion segment on the premise of ensuring the mobility of the lumbar spine, and has a relatively good biomechanical effect. Figures and Tables | References | Related Articles | Metrics

Select

Biomechanical characteristics of integrated expandable repositionable cage through lateral anterior approach Zhang Hong, Wu Aimin, Li Junwei, Cai Xinyi, Ren Yanan, Du Chengfei 2023, 27 (13):  1975-1980.  doi: 10.12307/2023.272 Abstract ( 493 )   PDF (1835KB) ( 60 )   Save BACKGROUND: In vitro experiments have confirmed that although the integrated interbody cage can be implanted from the side, it does not have the ability to adjust the height of the intervertebral cage and adjust the reduction function of lumbar spondylolisthesis after implantation. Therefore, the present study designed a new lumbar surgical procedure: oblique lumbar interbody fusion with an integrated expandable repositionable cage fixation (OLIF+IERC), and studied the biomechanical performance of OLIF+IERC.   OBJECTIVE: To explore the biomechanical performance differences of the OLIF+IERC surgical model in this study, compared with the normal lumbar spine finite element model, OLIF stand-alone without fixation system (stand-alone OLIF) model, and OLIF with posterior bilateral pedicle screws fixation (OLIF+BPS) model. METHODS:  The established and validated normal model (L3-S1) was suitably modified to establish three kinds of OLIF surgical models: stand-alone OLIF, OLIF+BPS, and OLIF+IERC designed in this study. By applying a 500 N follower load and a moment load of 7.5 N·m in different directions (flexion, extension, lateral bending, and axial rotation) to each model, the various biomechanical indicators of the different models were compared.   RESULTS AND CONCLUSION: (1) For range of motion, maximum cage stress, and maximum endplate stress at L4-L5, OLIF+IERC was lower than other surgical models in axial rotation; stand-alone OLIF was highest in all motion postures; OLIF+BPS was lowest in flexion, extension, and lateral bending. (2) Taken together, the biomechanical stability, resistance to cage subsidence, and disc height reduction of OLIF+IERC were superior to stand-alone OLIF in all motion postures and superior to OLIF+BPS in motion posture of axial rotation. (3) This study suggests that OLIF+IERC may be considered as a surgical procedure for future surgical treatment of patients with degenerative disease of the lumbar spine. This study provides a valuable reference for the treatment of lumbar degenerative diseases. Figures and Tables | References | Related Articles | Metrics

Select

Biomechanical stability and finite element analysis of endoscopic LOVE decompression technique and endoscopic unilateral laminotomy for bilateral decompression technique for lumbar spinal stenosis Zhang Hanshuo, Ding Yu, Jiang Qiang, Lu Zhengcao, Lian Shilin, Li Tusheng 2023, 27 (13):  1981-1986.  doi: 10.12307/2023.238 Abstract ( 573 )   PDF (1975KB) ( 45 )   Save BACKGROUND: Endoscopic LOVE decompression and endoscopic unilateral laminotomy for bilateral decompression, as cutting-edge and highly precise techniques for posterior spinal endoscopic treatment of lumbar spinal stenosis, have good clinical efficacy. However, there are few reports on biomechanical and finite element analysis.  OBJECTIVE: To study the influence of endoscopic LOVE decompression and endoscopic unilateral laminotomy for bilateral decompression on the biomechanics of endoscopic treatment of lumbar spinal stenosis, and verify the reliability and effectiveness of the two surgical methods in the treatment of lumbar spinal stenosis.  METHODS: The CT image of one volunteer was taken. The finite element model M0 of lumbar L4-L5 segment was established by Mimics, Geomagic, Solidworks and Ansys software. On this basis, an endoscopic LOVE decompression model M1 and an endoscopic unilateral laminotomy for bilateral decompression model M2 were established. The same stress was applied to the upper surface of L4 vertebral body of the three groups of models. The lower surface of L5 vertebral body was fixed and supported. The total range of motion and the Von Mises stress extreme value of the annulus fibrosus were analyzed under six physiological conditions of forward bending, extension, left bending, right bending, left rotation, and right rotation. RESULTS AND CONCLUSION: (1) Compared with model M0, the overall joint range of motion of model M1 increased by 8.24%, 12.17%, 0.77%, 1.60%, 1.86%, and 6.85% in forward bending, extension, left bending, left rotation, right bending, and right rotation, respectively; the overall joint range of motion of the model M2 increased by 8.24%, 12.17%, 0.77%, 1.60%, 2.17%, and 6.85% in forward bending, extension, left bending, left rotation, right bending, and right rotation, respectively. Compared with the model M1, the overall joint range of motion of the model M2 under the right bending slightly increased, and there was no obvious increase or trend change in the other working conditions. (2) Compared with model M0, the extreme values of Von Mises stress of the annulus fibrosus in model M1 under forward bending, extension, left bending, left rotation, right bending, and right rotation increased by 4.65%, 16.09%, 0.21%, 0.77%, 0.25%, 1.51%, respectively; the extreme values of Von Mises stress of the annulus fibrosus under forward bending, extension, left bending, left rotation, right bending, and right rotation of model M2 increased by 4.58%, 16.15%, 0.20%, 0.80%, 0.23%, and 1.52%, respectively. The variation trends of the extreme value of Von Mises stress of the fibrous annulus of model M1 and model M2 were not obvious under different working conditions. (3) These results confirm that responsibility segment is stable after endoscopic LOVE decompression and endoscopic unilateral laminotomy for bilateral decompression for treatment of lumbar spinal stenosis. Figures and Tables | References | Related Articles | Metrics

Select

Clinical efficacy and biomechanical analysis of the tripod percutaneous reconstruction technique in periacetabular lesions caused by metastatic cancer Lai Jieqing, Li Ruoyu, He Mincong, Lan Yun, Yang Xingfu, Zhou Nannan, Jiang Linheng, Lyu Zheng, Yi Chunzhi, Fang Bin 2023, 27 (13):  1987-1992.  doi: 10.12307/2023.282 Abstract ( 597 )   PDF (2128KB) ( 36 )   Save BACKGROUND: Previous reports have shown that percutaneous tripod acetabular support surgery can quickly improve the pain of pelvic metastases and restore the function of hip joint.   OBJECTIVE: To further explore the clinical efficacy and biomechanical mechanism of percutaneous tripod acetabular support surgery. METHODS: This study retrospectively included four patients with five acetabular metastases from the First Affiliated Hospital of Guangzhou University of Chinese Medicine, and used Eastern Cooperative Oncology Group (ECOG) and visual analogue scale scores to evaluate the efficacy. Three-dimensional finite element model of pelvis-proximal femur was constructed using three-dimensional finite element technology. The normal group was set as the normal acetabulum; the model group as the affected side acetabulum; and the treatment group as postoperative acetabulum on the affected side. The stress areas of the three groups were observed to analyze the biomechanical principles and mechanisms of percutaneous tripod acetabular support surgery.   RESULTS AND CONCLUSION: (1) Data analysis: Postoperative ECOG and visual analogue scale pain scores were significantly improved (P < 0.05) in four patients. Among the four patients, one case could walk freely; two cases changed from bed rest to walking with crutches and walkers, and one case still used walkers to walk. (2) Finite element analysis: Compared with the blank group, the local stress of the acetabulum in the two-legged standing position in the model group increased (P < 0.05) , indicating that the stability of the affected acetabulum was poor; the stress concentration was obvious, and the bearing stress effect was not good after the bone in the tumor area was destroyed. Compared with the model group, the stress in the acetabulum in the two-foot standing position in the treatment group decreased (P < 0.05), indicating that the tripod in the affected area of the acetabulum could bear the stress and relieve the stress concentration in the acetabulum and tumor area. Comparing the blank group and the treatment group, it could be seen that the stress concentration of the acetabulum was relieved after operation, and the support brought by the tripod structure was able to achieve the support stress effect of normal bone (P > 0.05). (3) It is concluded that tripod surgery is a new technique for providing safe and effective pain relief for acetabular metastases. This technique provides stable mechanical support for the acetabulum, but its long-term clinical efficacy still needs long-term follow-up evaluation. Figures and Tables | References | Related Articles | Metrics

Select

Finite element analysis of hollow screw fixation for sacroiliac dislocation Ye Haimin, Zou Huachun, Ding Linghua, You Murong 2023, 27 (13):  1993-1998.  doi: 10.12307/2023.235 Abstract ( 466 )   PDF (2411KB) ( 28 )   Save BACKGROUND: The sacroiliac joint plays an important role in stabilizing the pelvic ring, and its fracture or dislocation is challenging in surgery. Despite the continuous improvement of various screw placement methods, complications still exist such as screw misplacement and neurovascular injury. How to accurately place the screw into the sacrum, confirm the position of the screw, and ensure good stability is an urgent problem to be solved. OBJECTIVE: To analyze biomechanical differences of two different combinations of screw fixation for sacroiliac dislocation by finite element analysis.  METHODS: Human corpse specimens were used as data. The three-dimensional finite element model of the whole pelvis was constructed by the ABAQUS finite element analysis system. Finite element models of sacroiliac dislocation were established, and two combinations of screw fixation were performed. One is that S1 was treated with 2 screws of 6.0 mm in diameter + S2 was treated with 1 screw of 6.0 mm in diameter (named as S12 + S21 group), and the other is that S1 was treated with a screw of 7.3 mm in diameter + S2 was treated with a screw of 6.0 mm in diameter (named as S11 + S21 group). A vertical force of 600 N was applied to the end plate on S1, and the maximum stress of the pelvis, the maximum stress of the screw (fatigue resistance), the overall displacement value of the model and the deformation of the screw were analyzed.  RESULTS AND CONCLUSION: (1) Pelvis fixation with screws in the two groups could effectively restore the conduction direction of pelvic biomechanics. The pelvic stress was less than the double-segment screw fixation stress, and the maximum stress was located on the cortical bone at the fracture end. (2) The maximum displacement of the normal pelvis was 0.080 9 mm and the maximum stress of the pelvis was 9.39 MPa. The maximum displacement of the pelvis was 0.097 8 mm and the maximum stress was 11.59 MPa in the S12+S21 group. The maximum displacement of the pelvis was 0.111 8 mm and the maximum stress was 13.51 MPa in the S11+S21 group. (3) The maximum stress was 12.35 MPa and the deformation was 0.081 11 mm in the S12+S21 group. The maximum stress was 14.53 MPa and the deformation was 0.088 2 mm in the S11+S21 group. (4) These results demonstrate that compared with the normal pelvis, there is no substantial change in the stability of the two fixation methods at two levels. The fatigue resistance of the screws with three screws is better than that with two screws in the two levels. Therefore, three-screw fixation is the first choice, but if the S1 double screw fixation is performed unconditionally, the best fixation method is to select one screw at both levels for fixation. Figures and Tables | References | Related Articles | Metrics

Select

Finite element analysis of percutaneous reverse screw for treatment of superior pubic ramus fracture Lu Hui, Xu Ling, Jiang Daixiang, Wu Qimei, Liu Rong 2023, 27 (13):  1999-2004.  doi: 10.12307/2023.254 Abstract ( 404 )   PDF (3212KB) ( 25 )   Save BACKGROUND: Percutaneous screw fixation of pubic ramus is widely used in clinical practice, but the selection of screw insertion point is lacking in mechanical verification.   OBJECTIVE: To investigate the biomechanical characteristics of different insertion points of percutaneous reverse screw for superior pubic ramus fracture by finite element method. METHODS:  CT data of healthy volunteers were input into Mimics software for 3D reconstruction of the pelvis. 3-Matic software was used to divide the model of superior pubic ramus fracture, and percutaneous reverse screws with different insertion points were established to simulate the treatment of superior pubic ramus fracture. After material assignment by Mimics software, Ansys software was used to simulate the force of standing position with 600 N load on S1 vertebral endplate and to compare the mechanical stability.   RESULTS AND CONCLUSION: (1) For the fracture of superior pubic ramus in area I, if the insertion point was located in the upper part, the maximum stress on the whole model and screw was lower than that on the lower part. The insertion point was located at the upper part and the lower part, and the maximum stress of the screw was 4.57 MPa and 10.50 MPa. The upper part was significantly lower than the lower part, and the upper part was recommended as the insertion point above the midpoint of the pubic crest. (2) For the fracture of superior pubic ramus in area II, the effect of the insertion point on the upper or lower part was similar. (3) For fractures of superior pubic ramus in area III, it is recommended to select the insertion point below the midpoint of the pubic crest. Figures and Tables | References | Related Articles | Metrics

Select

Plantar pressure at different phases during gait cycle in diabetic patients and midsole structure design Cao Zijun, Wang Fang, Li Xuemei, Li Mingxin, He Yaoguang, Zhang Yu, Yang Tao, Liu Guoqing, Zhang Jianguo 2023, 27 (13):  2005-2010.  doi: 10.12307/2023.258 Abstract ( 635 )   PDF (1715KB) ( 63 )   Save BACKGROUND: High plantar pressure is one of the critical factors causing diabetic foot ulcers. Studying the plantar pressure in multi-phase during gait cycle of diabetic patients contributes to offloading footwear development.   OBJECTIVE: To analyze the plantar pressure distribution in diabetic patients at heel strike and push off, and design midsole to optimize offloading effect. METHODS:  Plantar pressure was tested to analyze the difference in plantar pressure at heel strike and push off between diabetics patients with diabetic peripheral neuropathy and without diabetic peripheral neuropathy and healthy subjects. Finite element model of foot was constructed. Ethylene vinyl acetate copolymer midsole and thermoplastic polyurethane diamond lattice structure midsole with different modulus were designed. Changes in plantar pressure and stress of soft tissue at heel strike and push off in diabetic peripheral neuropathy patient were analyzed to optimize the structure size of diabetes footwear.   RESULTS AND CONCLUSION: (1) The peak plantar pressure at push off in diabetic peripheral neuropathy group (22.2%)  was higher than healthy control group (P < 0.05). (2) Ethylene vinyl acetate copolymer midsole reduced the peak plantar pressure at heel strike and push off by 13.0% and 12.9%, reduced the peak stress of soft tissue at two phases by 18.2% and 11.1%. (3) The optimized diamond lattice structure reduced the peak plantar pressure at two phases by 41.6% and 48.4%, reduced the peak stress of soft tissue at two phases by 41.4% and 49.8%. (4) In conclusion, offloading at push off should be noticed in development of diabetic footwear. The diamond lattice structure midsole could archive better effect than ethylene vinyl acetate copolymer midsole. Figures and Tables | References | Related Articles | Metrics

Select

Finite element comparative analysis on treatment of lumbar disc herniation by the oblique wrench method and the combination of traction, pressing, and oblique pulling Lu Yu, Xiang Junyi, Yin Benjing, Bi Heng, Li Jizheng, Wei Jiajia, Jia Tao, Li Pengfei, Li Jubao 2023, 27 (13):  2011-2015.  doi: 10.12307/2023.276 Abstract ( 425 )   PDF (1491KB) ( 56 )   Save BACKGROUND: Traditional Chinese medicine manipulation for the treatment of lumbar intervertebral disc herniation has a long history, wide application and remarkable curative effect, and is favored by the majority of patients. However, there are various specific methods of use, and the advantages and disadvantages of various methods and the differences in efficacy are not yet clear.   OBJECTIVE: To compare the biomechanical mechanism and efficacy of the oblique wrench method and the combined manipulation of traction, pressing, and oblique pulling in the treatment of lumbar disc herniation using the three-dimensional finite element analysis. METHODS:  Based on the CT images of the lumbar spine in patients with lumbar disc herniation, three-dimensional finite element models of the L4-5 motor function unit in patients with lumbar disc herniation were established. The oblique wrench method and the combination of oblique wrench method and the combined manipulation of traction, pressing, and oblique pulling were simulated to analyze the influence of different methods on the stress, strain and displacement of each tissue of the lumbar motor unit, so as to compare the mechanical mechanism and evaluate the difference in efficacy.   RESULTS AND CONCLUSION: (1) The three-dimensional finite element model of the L4-5 segment was successfully established and its effectiveness was verified. (2) When the oblique wrench method was applied, the stress in the front of the intervertebral disc was largest, and the stress in the protruding position was smallest; the strain direction of the annulus fibrosus in the posterior right side was rightward and backward, and the strain direction of the annulus fibrosus in the posterior part of the left (protruding side) was rightward and anterior. The intervertebral disc moved forward and rightward, the left nerve root moved forward, and the right nerve root moved backward. (3) When the combination of traction, pressing, and oblique pulling was applied, the stress distribution, strain trend and displacement direction were similar to those of the oblique wrench method, but the stress, strain and displacement were larger. (4) It is indicated that the oblique wrench method and the combination of traction, pressing, and oblique pulling have a good effect on lumbar disc herniation patients, which can shrink and retract the herniated intervertebral disc, increase the distance between the disc and the nerve root, relieve the symptoms of nerve compression. The combined manipulation is more effective. Figures and Tables | References | Related Articles | Metrics

Select

Three-dimensional finite element analysis of the treatment of ulnar coronoid process fracture with modified threaded Kirschner wire Xiang Shijun, Sun Qiang, Su Yun, Dong Xinli, Jiang Jian 2023, 27 (13):  2016-2021.  doi: 10.12307/2023.234 Abstract ( 437 )   PDF (1734KB) ( 46 )   Save BACKGROUND: Effective surgical fixation should be performed for patients with ulnar coronoid fractures with unstable elbow joint. When the coronoid fracture fragment is large, there are more internal fixation materials, such as microplates, steel wires, screws, and anchors. However, when the fracture fragment is small, choosing the appropriate internal fixation device is a difficult problem.  OBJECTIVE: To explore the stability of modified threaded Kirschner wire in the treatment of ulnar coronoid process fracture using finite element analysis. METHODS:  Thin layer 128-row CT was applied to scan the elbow of one healthy male volunteer. Ulnar coronoid process Regan-Morrey II type fracture model was established using the software such as Mimics 21.0. The models of ordinary Kirschner wire (1.2 mm) and modified threaded Kirschner wire (1.2 mm) were established by Unigraphics NX 10.0 software. The above three kinds of model data were imported into ANSYS Workbench software to generate the ulnar coronoid process Regan-Morrey II type fracture model of ordinary Kirschner wire fixation (ordinary wire group) and the ulnar coronoid process Regan-Morrey II type fracture model of modified threaded Kirschner wire fixation (threaded wire group). The anti-pull-out simulation test, anti-horizontal displacement simulation test and anti-rotational displacement simulation test were carried out for both groups of models. The displacement and stress changes of fracture blocks were recorded, and the variation curves were plotted and Mises stress nephogram was obtained.  RESULTS AND CONCLUSION: (1) In the anti-pull-out simulation test, the maximum displacement and the maximum stress of the ordinary wire group were 3.96 mm and 93.2 N, respectively. The maximum displacement and the maximum stress of threaded wire group were 0.20 mm and 177.6 N, respectively. The stress distribution of the threaded wire group was slightly more concentrated than that of the ordinary wire group. (2) In the anti-horizontal displacement simulation test, the maximum displacement and the maximum stress of the ordinary wire group were 0.55 mm and 199.2 N, respectively. The maximum displacement and maximum stress of the threaded wire group were 0.05 mm and 573.7 N, respectively. The stress distribution of the threaded wire group was slightly more concentrated than that of the ordinary wire group. (3) In the anti-rotational displacement simulation test, the maximum displacement and the maximum stress of the ordinary wire group were 3.75 mm and 332.2 N, respectively. The maximum displacement and the maximum stress of the threaded wire group were 0.25 mm and 225.6 N, respectively. The stress distribution of the threaded wire group was slightly more concentrated than that of the ordinary wire group. (4) The experiment proves that the modified threaded Kirschner wire has better stability in fixation of ulnar coronoid process fracture.  Figures and Tables | References | Related Articles | Metrics

Select

Comparison of finite element model establishment and validity verification of total cervical vertebrae between human and adult rhesus monkeys Wang Xing, Li Kun, Ma Yuan, Zhang Shaojie, Wang Chaoqun, Gao Mingjie, Zheng Bingwu, Chen Jie, Li Xiaohe, Zhang Zhifeng, Zheng Leigang, Shi Jun, Li Zhijun 2023, 27 (13):  2022-2027.  doi: 10.12307/2023.255 Abstract ( 579 )   PDF (5450KB) ( 38 )   Save BACKGROUND: There is a high similarity of the cervical vertebrae between rhesus monkeys and human, both in terms of the number of cervical vertebrae and the anatomical structure of cervical vertebrae, especially the uncinate joints, which are unique to the cervical vertebrae, so they can be used as an ideal animal experimental model. However, there are few reports on the mechanical comparative study between the two.   OBJECTIVE: To establish the finite element model of adult human cervical vertebra and adult rhesus monkey cervical vertebra, to compare the characteristics of stress and displacement of the uncinate joint between human and rhesus monkey cervical vertebra under six working conditions by means of finite element analysis, and to provide theoretical basis for clinical vertebral replacement. METHODS:  A 40-year-old adult volunteer and a 7-year-old adult male rhesus monkey were scanned by spiral CT. The original cervical vertebra CT data were introduced into Mimics 21.0 to establish a preliminary three-dimensional model. Through the optimization, assignment, assembly and other tissue grids of each segment of cervical vertebra, intervertebral disc, ligament and so on, the cervical vertebra finite element model was constructed by Abaqus, and 75 N additional load and 1 N·m external force couple moment were loaded on the model. Comparative mechanical analysis was carried out under six working conditions of flexion, extension, lateral area and rotation, in order to find the mechanical change trend and difference between them.   RESULTS AND CONCLUSION: (1) Both human and rhesus monkey cervical vertebrae had the unique structure of uncinate joint of cervical vertebrae. Through finite element modeling, the stress and displacement changes of the uncinate joint between them were basically consistent, and the stress and displacement concentration points were all at C5. There was a significant difference between them. (2) However, the cervical vertebra of rhesus monkey can be used as the best candidate animal for clinical cervical vertebra animal model, and provide theoretical basis for artificial cervical vertebra replacement. Figures and Tables | References | Related Articles | Metrics

Select

Acetabular wear after femoral head replacement: cause and management Wang Shangzeng, Wang Zhen, You Mingcan, Ma Shang, Shen Jintao 2023, 27 (13):  2028-2032.  doi: 10.12307/2023.273 Abstract ( 536 )   PDF (1444KB) ( 51 )   Save BACKGROUND: The incidence of different types of acetabular wear after femoral head replacement varies between different studies. With the increase of clinical artificial femoral head replacement cases, its complications also appear gradually.   OBJECTIVE: To investigate the causes and management strategies of acetabular wear after femoral head replacement. METHODS:  From June 2012 to October 2019, 56 failed cases of acetabular wear after femoral head replacement (56 hips) were admitted to the Department of Joint Medicine of Henan Province Hospital of TCM and received the total hip joint revision surgery. All patients were suffered hip pain with limited movement. Harris score was 33.71±1.85 and VAS score was 6.91±0.67 preoperatively. All cases were followed up regularly 3, 12, and 24 months postoperatively, once every year thereafter. The results of preoperative and postoperative follow-up were analyzed.   RESULTS AND CONCLUSION: (1) 56 patients were followed up for 24-72 months, mean (47.52±15.80) months. X-ray films showed that all prostheses were no loosening and had good position as well as normal alignment. There was no infection or other complications. (2) The Harris score at each time point of postoperative follow-up was significantly higher than that before surgery (P < 0.05), and the visual analogy scale score was significantly lower than that before surgery (P < 0.05). There was no significant difference in Harris score or visual analogy scale score at 24 and 12 months after operation. (3) It is concluded that the non-infective complication after femoral head replacement is mainly acetabular cartilage wear; pain is a major symptom. In the clinic, if the cartilage damage or degeneration is obvious or the life expectancy is long, artificial femoral head replacement should be used with caution. If the acetabular cartilage is worn and painful after surgery, the solution is to give the patient a first-stage total hip revision. It would rebuild the hip joint and restore the normal function of the hip joint. Figures and Tables | References | Related Articles | Metrics

Select

Mid- and long-term follow-up of valgus knees with total knee arthroplasty via subvastus approach Liu Hongwen, Yin Li, Xu Wenhao, Li Jiao, Luo Fenqi, Liu Shaojiang, Xu Jie 2023, 27 (13):  2033-2037.  doi: 10.12307/2023.312 Abstract ( 511 )   PDF (3311KB) ( 46 )   Save BACKGROUND: The subvastus approach is the most minimally invasive surgical method for total knee arthroplasty. The knee joint function recovers quickly after surgery, but the long-term efficacy is unclear.   OBJECTIVE: To evaluate the mid- and long-term prosthesis position and knee function of valgus knees with total knee arthroplasty via subvastus approach. METHODS:  A retrospective investigation was conducted among 50 patients (55 knees) with valgus knees in the Department of Orthopedics, Fujian Provincial Hospital from January 2009 to January 2018. Total knee arthroplasty was performed via subvastus approach, femoral distal resection with 3°to 5°of valgus, and the routinely resurfaced patella. The operation time, blood loss, incision length, grounding time, time up and downstairs, and hospital stay were recorded. Visual analogue scale, Knee Society Score, hospital for special surgery, range of motion, femorotibial angle, hip-knee-ankle angle, condylar-hip angle, and plateau-ankle angle were counted to assess postoperative efficacy and prosthesis position.   RESULTS AND CONCLUSION: (1) Follow-up time was 5.7-11.1 years. (2) The operation time was (67.2±6.2) minutes; blood loss was (317.3±109.6) mL; incision length was (11.5±1.2) cm; grounding time was (1.1±0.5) days; time of up and down stairs was (2.3±0.9) days; hospital stay was (4.9±1.2) days. (3) Compared with preoperative data, visual analogue scale scores decreased significantly. Range of motion, Knee Society Score, and hospital for special surgery score increased significantly at the last follow-up. Femorotibial angle / hip-knee-ankle angle decreased significantly. Condylar-hip angle and plateau-ankle angle decreased significantly (P < 0.001). (4) No postoperative complications such as common peroneal nerve palsy, infection or deep venous embolism occurred. During the follow-up, the prosthesis was in a good position and no revision cases were performed. (5) It is indicated that total knee arthroplasty via subvastus approach for valgus knees can get satisfactory mid- and long-term prosthesis position, lower limb alignment, and functional recovery. Figures and Tables | References | Related Articles | Metrics

Select

Comparison of two techniques in locating tibial prosthesis during total knee arthroplasty of varus knee Huang Huida, Huang Yongming, Zhou Junde, Liu Wenbo, Lin Yuewei, Su Haitao 2023, 27 (13):  2038-2043.  doi: 10.12307/2023.274 Abstract ( 526 )   PDF (1185KB) ( 23 )   Save BACKGROUND: The Akagi line and range-of-motion (ROM) technique are widely used for locating the tibial prosthesis during total knee arthroplasty; however, there is still a lack of relevant research on the size and source of the difference between the two positioning methods.   OBJECTIVE: To compare the differences of Akagi line and ROM technique in varus knee during total knee arthroplasty, and to discuss the causes of this difference. METHODS:  Totally 70 patients with varus knee who underwent total knee arthroplasty in the Department of Orthopedics, Guangdong Hospital of Traditional Chinese Medicine from July to December 2021 were enrolled in this study. All operations were performed with the posterior cruciate-stabilizing total knee prostheses. The femorotibial angle, lateral distal femoral angle, medial proximal tibial angle, and joint line convergence angle were measured before operation. Its difference from normal was calculated. The angle α between Akagi line and ROM technique was measured during operation. The angles that measured preoperatively and α were statistically tested by using correlation analysis and multiple linear regression analysis.   RESULTS AND CONCLUSION: (1) Before operation, Δ mechanical femoral-tibial angle was (10.90±4.82)°; Δ anatomic tibiofemoral angle was (10.81±4.34)°; Δ mechanical lateral distal femoral angle was (-3.26±2.68)°; Δ anatomic lateral distal femoral angle was (-3.00±2.30)°; Δ mechanical medial proximal tibial angle was (2.39±3.05)°; Δ anatomic medial proximal tibial angle was (2.98±3.31)°; Δ joint line convergence angle was (4.71±2.52)°; the α that measured during operation was (2.39±2.50)°. (2) Totally 53 cases selected Akagi line and 13 cases selected ROM technique for locating the tibial prosthesis finally. (3) Statistical analysis results showed that Δ mechanical medial proximal tibial angle and Δ anatomic medial proximal tibial angle had a significant positive effect on α (P < 0.01), and the regression equations were α=0.658±0.432×Δ mechanical medial proximal tibial angle and α=0.013±0.346×Δ anatomic medial proximal tibial angle respectively. (4) The results suggest that there is a difference between Akagi line and ROM technique when locating the tibial prosthesis for patients with varus knee undergoing total knee arthroplasty, and this difference (α) is positively correlated with the degree of proximal tibial varus deformity. Figures and Tables | References | Related Articles | Metrics

Select

Deep vein thrombosis distribution and risk factors after total knee arthroplasty during enhanced recovery after surgery Wu Qian, Liu Lingfeng, Li Lisong, Lu Yingjie, Zhou Liyu, Xu Wu, Huang Lixin, Jiang Dinghua 2023, 27 (13):  2044-2050.  doi: 10.12307/2023.292 Abstract ( 541 )   PDF (1328KB) ( 52 )   Save BACKGROUND: Deep vein thrombosis is one of the common complications after total knee arthroplasty. In recent years, enhanced recovery after surgery has developed rapidly. However, there is still a lack of large sample studies on the occurrence and risk factors of thrombosis after total knee arthroplasty in China.   OBJECTIVE: To explore the occurrence of deep vein thrombosis in the lower extremities after total knee arthroplasty during enhanced recovery after surgery, and to further explore the risk factors for postoperative deep vein thrombosis. METHODS:  A total of 1 260 patients who underwent unilateral total knee arthroplasty for knee osteoarthritis in the First Affiliated Hospital of Soochow University from May 2016 to December 2021 were retrospectively analyzed. According to the results of postoperative venous ultrasound of the lower limbs, the patients were assigned into thrombosis group (n=140) and non-thrombosis group (n=1 120). The differences of various indicators between the two groups were compared by univariate analysis. Finally, the possible meaningful indicators were taken as independent variables into the binary multivariate logistic regression analysis.   RESULTS AND CONCLUSION:  (1) 140 patients suffered from postoperative deep vein thrombosis, of which the incidence of proximal thrombosis was 1.67%, and the incidence of distal thrombosis was 9.44%. In the proximal type, 38.10% of the thrombus involved only one vein, and 61.90% of the patients involved two or more veins. Of the distal type, 79.83% involved a single vein and 20.17% involved two or more veins. (2) Univariate analysis results showed that the proportion of patients with a history of hypertension, a history of deep vein thrombosis and a history of drinking alcohol in the thrombotic group were significantly higher than those of the non-thrombosis group (P < 0.05). (3) Binary multivariate logistic regression analysis showed that a history of preoperative hypertension (OR=1.686, P=0.012, 95%CI=1.123-2.531), a history of deep vein thrombosis (OR=4.794, P < 0.001, 95%CI=2.124-10.820), and a history of alcohol consumption (OR=10.733, P < 0.001, 95%CI=6.942-16.594) were risk factors for the development of deep vein thrombosis after total knee arthroplasty. (4) The results show that although the incidence of proximal thrombosis is not high during the enhanced recovery after surgery, given that it often involves two or more veins, attention should be paid to the evaluation of thrombosis treatment in such patients. Preoperative history of hypertension, previous history of varicose veins, and the presence of alcohol consumption are independent risk factors for the development of deep vein thrombosis in the lower limbs after total knee arthroplasty, so surgeons should focus on the patient's general condition and perform preoperative optimization. Figures and Tables | References | Related Articles | Metrics

Select

Feasibility of three-dimensional printing technology combined with computer-aided design in total knee arthroplasty for severe knee osteoarthritis Wu Di, Si Lina, Wu Lizhu, Wang Jianhua, Luo Jinwei, Chang Qiankun, Lyu Yongming, Du Yuanliang 2023, 27 (13):  2051-2057.  doi: 10.12307/2023.280 Abstract ( 1644 )   PDF (1674KB) ( 40 )   Save BACKGROUND: There are research reports on 3D printing technology and computer-aided design technology assisted total knee arthroplasty. It is not known whether their combination assisted total knee arthroplasty for treatment of knee osteoarthritis can achieve better results.   OBJECTIVE: To explore the application value of 3D printing technology combined with computer-aided design technology in total knee arthroplasty for severe knee osteoarthritis. METHODS: Totally 93 patients with severe knee osteoarthritis were prospectively selected in Affiliated Hospital of Chengde Medical College from October 2018 to October 2020. They were randomly divided into a control group (n=46) and an observation group (n=47), and underwent traditional artificial total knee arthroplasty and 3D printing technology + computer-aided design technology under the guidance of total knee arthroplasty. Pain degree, stress-related indicators, knee recovery rate, and complications were collected in both groups.   RESULTS AND CONCLUSION: (1) The pain visual analogue scale score of the observation group at 7 and 14 days after operation was lower than that of the control group (P < 0.05); the levels of D-dimer and fibrinogen degradation products at 1 day after operation were lower in the observation group than those of the control group (P < 0.05); the level of hemoglobin was higher in the observation group than that of the control group (P < 0.05). (2) There was no significant difference between the two groups in hospital for special surgery knee score 6 months after operation (P > 0.05). The range of motion of the knee joint in the observation group was larger than that in the control group (P < 0.05); the angle of the lower limb force line was smaller in the observation group than that in the control group (P < 0.05). (3) At 6 months after operation, 1 case affected medial tibial plateau bone loss (total incidence of complications 2%) in the observation group. There were medial tibial plateau bone loss in 1 case, prosthesis loosening in 1 case, and incision infection in 2 cases (total incidence of complications 9%) in the control group. There was no significant difference in the incidence of complications between the two groups (P > 0.05). (4) It is indicated that compared with traditional total knee arthroplasty, 3D printing technology combined with computer-aided design technology in total knee arthroplasty for severe knee osteoarthritis can relieve pain, improve knee function, and reduce stress response. Figures and Tables | References | Related Articles | Metrics

Select

Biplanar osteotomy and bone transport combined with intramedullary nailing for large segmental tibial bone defects Cheng Kang, Wang Bin, Tu Zhenxing, Lyu Zichen, Wang Zixin, Xu Ao 2023, 27 (13):  2058-2063.  doi: 10.12307/2023.223 Abstract ( 527 )   PDF (1951KB) ( 77 )   Save BACKGROUND: The traditional Ilizarov bone transfer technique is used to treat large segmental bone defects of long bones. Although the curative effect is good, due to factors such as the length of wearing external fixation, bone bending deformity, retraction of the extension zone, and refracture, it affects the clinical effect of bone transfer. Biplanar osteotomy and bone transport combined with intramedullary nailing has many advantages.  OBJECTIVE: To analyze the effect of biplanar osteotomy and bone transport combined with intramedullary nailing in the treatment of large segmental tibial bone defects. METHODS:  A retrospective analysis was performed on eight patients with large segmental tibial bone defects who were admitted from July 2016 to June 2020, including seven males and one female, with an average age of 39.3 years (33-50 years old). Causes of injury: five cases were injured by traffic accident and three cases were injured by heavy objects. After debridement, the skin defect ranged from 6.5 cm×1.3 cm to 23.1 cm×9.7 cm, with an average of 10.01 cm×5.51 cm. The length of the tibial defect was 6.8-12.1 cm (averagely 9.2 cm). All patients were treated with biplanar osteotomy and bone transport combined with intramedullary nailing for the treatment of large segmental tibial bone defects. In two patients, the bone defect was located in the middle of the tibia. After biplanar osteotomy was performed at the proximal and distal ends of the tibia, intramedullary nails were placed and fixed with locking nails at the distal and proximal ends. The bone fragments at both ends were transported to the middle. In six patients, the bone defect was located at the distal end of the tibia, and a biplanar osteotomy was performed at the proximal end of the tibia. An intramedullary nail was placed and fixed with locking nails at the distal and proximal ends. The proximal two bone fragments were transported anterogradely. The bone migration time, the mineralization time of the traction zone, the healing index, the external fixation time, the external fixation index and the complications of the patients were recorded. Bone healing and limb function were evaluated using the Association for the Study and Application of the Methods of Ilizarov score.  RESULTS AND CONCLUSION: (1) All eight patients were followed up after operation, and the follow-up time ranged from 19 to 33 months. All patients achieved bone union, and no infection or recurrence occurred during treatment. (2) Bone migration time was 36-62 days, with an average of 50.2 days. Solidification time in the traction area was 267-512 days, with an average of 366.9 days. Healing index was 1.18-1.41 months/cm, with an average of 1.31 months/cm. External fixation time was 5.5-12.5 months, with an average of 8.3 months. External fixation index was 0.73-0.99 months/cm, with an average of 0.86 months/cm. (3) There were three patients with nonunion of the butt joint. (4) According to the Association for the Study and Application of the Methods of Ilizarov score, five patients (62%) were excellent, and three patients (38%) were poor. Functional results were excellent in six cases (75%) and good in two cases (25%). (5) It is concluded that biplanar osteotomy and bone transport combined with intramedullary nailing can significantly shorten the external fixation time, reduce the probability of complications such as needle tract infection, poor alignment, and refracture in the extension area. This is an effective method for the treatment of large segmental tibial bone defects.  Figures and Tables | References | Related Articles | Metrics

Select

All-arthroscopic repair of anterior talofibular ligament with suture anchors versus InternalBrace for chronic lateral ankle instability Zeng Guanglong, Xie Qingxiang, Li Yongcong, Su Boyuan 2023, 27 (13):  2064-2070.  doi: 10.12307/2023.395 Abstract ( 871 )   PDF (1752KB) ( 39 )   Save BACKGROUND: Anterior talofibular ligament is the most easily injured or even broken of ankle sprain. Patients who fail to receive conservative treatment after injury are often afraid of walking at night, resulting in persistent ankle swelling, painful, slack or stiff and functional decline that it is so-called chronic lateral ankle instability. InternalBrace repair is closer to the biomechanical structure of anterior talofibular ligament and become stronger lateral stability of ankle that it is helpful for chronic lateral ankle instability patients who need early recovery of activity.   OBJECTIVE: To investigate feasibility and safety of all-arthroscopic repair of anterior talofibular ligament with suture anchors versus InternalBrace for chronic lateral ankle instability by prospective controlled study, analyze and compare its clinical efficacy, and provide patients with better and more satisfactory total arthroscopic treatment. METHODS:  From January 2019 to December 2021, 72 patients with chronic lateral ankle instability induced by IIII degree injury of anterior talofibular ligament in Dongguan Hospital of Traditional Chinese Medicine were selected. Arthroscopic ankle surgery was performed. They were randomly divided into two groups according to a prospective random number table, including 36 cases repaired with InternalBrace (InternalBrace group) and 36 cases repaired with suture anchors (suture anchor group). Intraoperative blood loss, operation time, “back to sport” time, the tilt angle of talus and the anterior displacement distance of talus in last follow-up, visual analogy scale score, American Orthopaedic Foot and Ankle Society Score (AOFAS score), Kofoed ankle function score, Japanese Society for Surgery of the Foot (JSSF) scale and Tegner score were compared between the two groups. Complications such as recurrence, rejection and wound infection of lateral ankle instability were counted.   RESULTS AND CONCLUSION:  (1) 72 patients were followed up for 6 to 18 months. (2) The AOFAS score, Kofoed ankle function score, JSSF scale and Tegner score, the tilt angle of talus and the anterior displacement distance of talus in last follow-up of InternalBrace group were significantly better than those of the suture anchor group (P < 0.05), and the excellent rates both were 100%. (3) There were no complications such as recurrence of lateral ankle instability, rejection or wound infection in the two groups after surgery. (4) There was no significant difference in the intraoperative blood loss, operation time and visual analogy scale score between the two groups at the last follow-up (P > 0.05). (5) It is indicated that all-arthroscopic repair of anterior talofibular ligament with InternalBrace for chronic lateral ankle instability is beneficial for sufficient strength and ankle stability. Satisfactory ankle function recovery can lead to better outcomes and faster return to sports. Figures and Tables | References | Related Articles | Metrics

Select

Correlation of anterior cruciate ligament injury with patella alta and femoral trochlear dysplasia in adults evaluated by magnetic resonance imaging Zeng Weipeng, Lin Jianping, Zhou Gang, Mao Hanru 2023, 27 (13):  2071-2075.  doi: 10.12307/2023.275 Abstract ( 609 )   PDF (1957KB) ( 29 )   Save BACKGROUND: Anterior cruciate ligament injury is a common sports injury in young people. Anatomical factors of the knee joint may be related to its injury, but few scholars have used MRI to evaluate the relationship of anterior cruciate ligament injury with patella alta and femoral trochlear dysplasia.   OBJECTIVE: To explore whether there is a correlation of anterior cruciate ligament injury with patella alta and femoral trochlear dysplasia in adults. METHODS:  From August 2017 to August 2021, 90 adult patients (case group) with complete anterior cruciate ligament tear were retrospectively analyzed. According to age and gender, 91 patients with knee pain were matched as the control group. The length of the patellar tendon and patella was measured and the Insall-Salvati index was calculated according to the MRI image of the knee. According to Dejour classification, the femoral trochlear dysplasia was classified into types A, B, C or D.   RESULTS AND CONCLUSION: (1) There was no significant difference in patellar length between the two groups (P > 0.05), but there was statistically significant difference in the length of patellar tendon and Insall-Salvati index (P < 0.05). (2) Compared with the control group, patients in the case group had a longer length of patellar tendon (P < 0.05) and higher Insall-Salvati index (P < 0.05). (3) The rate of femoral trochlear dysplasia in the case group (14%) was significantly higher than that of the control group (4%, P < 0.05). (4) Among the 13 patients with trochlear dysplasia in the case group, 9 were type A, 2 were type B, 1 was type C, and 1 was type D. (5) It is concluded that compared with healthy people, patients with anterior cruciate ligament injury have longer length of patellar tendon, higher Insall-Salvati index and higher rate of trochlear dysplasia. Therefore, in clinical practice, doctors should pay attention to these variants that may be risk factors for anterior cruciate ligament tears, and remind people with patella alta and trochlear dysplasia that they are more likely to damage the anterior cruciate ligament during exercise. Figures and Tables | References | Related Articles | Metrics

Select

Significance of X-ray measurement of the anatomical relationship between adult lateral tibial plateau and lateral femoral condyle in fracture reduction Fang Run, Ning Rende, Liu Yulong, Bi Chenghao, Zhou Daobin 2023, 27 (13):  2076-2080.  doi: 10.12307/2023.311 Abstract ( 391 )   PDF (1381KB) ( 30 )   Save BACKGROUND: There is no unified clinical reference standard for the recovery of the plateau width during the operation of tibial plateau fracture, and there are few studies on its effect on the postoperative knee function at home and abroad.   OBJECTIVE: To explore the anatomical relationship between adult lateral tibial plateau and lateral femoral condyle and its clinical significance about width reduction in Schatzker II tibial plateau fractures. METHODS:  The X-ray films of knee joint of 148 normal adults (208 knees) in normal neutral position (normal knee group) and X-ray films of Schatzker II tibial plateau fractures of 58 cases (58 knees) (fracture group) from December 2019 to June 2021 in the Third Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The lateral-most margins of the tibial plateau articular surface were defined as point A; the lateral femoral condyle articular surface was defined as point B; the lateral femoral epicondyle was defined as point C; the horizontal distances of A-B and A-C were measured separately; medial and lateral measurements to point A were recorded as (-) and (+). The A-C distance was recorded in the same way. They were grouped by sex and side factors, and the comparison between the groups was performed to find the anatomical relationship between the adult lateral tibial plateau and lateral femoral condyle. The Hospital for Special Surgery scale was performed for one year after surgery of Schatzker II tibial plateau fractures. After reduction, point A on the inside of point C was defined as group A and point A on the outside of point C was defined as group B; the knee function of group A and group B was compared.   RESULTS AND CONCLUSION: (1) There was no significant difference in the mean A-B distance of the normal knee group between males and females (t=-1.86, P > 0.05). There was no significant difference in the mean A-C distance of the normal knee group between males and females (t=0.70, P > 0.05). There was no significant difference in the mean A-B distance of the normal knee group between the left side and the right side (t=-0.67,P > 0.05). There was no significant difference in the mean A-C distance of the normal knee group between the left side and the right side (t=1.09, P > 0.05). (2) The mean A-B distance of the normal knee group was (-3.60±0.84) mm and the mean preoperative A-B distance of the fracture group was (-5.28±1.16) mm; there was significant difference between groups (t=10.28, P < 0.05). The mean A-C distance of the normal knee group was (1.80±1.26) mm and the mean preoperative A-C distance of the fracture group was (1.09±2.18) mm; there were significant differences between groups (t=2.37, P < 0.05). (3) The mean Hospital for Special Surgery scale for one year after surgery was (83.05±2.04) points of group A and (75.97±1.91) points of group B; there were significant differences between groups (t=13.25, P < 0.05). (4) It is concluded that the anatomical position relationship between the lateral tibial plateau and the lateral femoral condyle in adults is relatively constant, and poor intraoperative reduction of the width of the tibial plateau is an important influencing factor of decreased knee function after surgery. Figures and Tables | References | Related Articles | Metrics

Select

Bone mineral density difference in bilateral femoral necks measured by dual-energy X-ray absorptiometry and its influencing factors Yin Yuping, Liu Jiachen, Guo Ningning, Li Chuangquan, Liu Xiuwen, Zhang Shukang, Lin Xueqing, Tang Wei, Chen Shaoxiong, Liu Xingguang, Wu Guixia, Li Long, Liu Jing, Zhang Hong 2023, 27 (13):  2081-2086.  doi: 10.12307/2023.236 Abstract ( 764 )   PDF (1221KB) ( 34 )   Save BACKGROUND: Coping with osteoporosis is an important part of China's response to population aging. Early prevention, early detection and early intervention of osteoporosis were considered to play a very important role in improving prognosis. OBJECTIVE: To analyze the relevant factors affecting the difference in bone mineral density of bilateral proximal femur and to explore the methods to improve the diagnostic performance of dual-energy X-ray absorptiometry. METHODS:  The clinical data of 207 subjects who underwent dual-energy X-ray absorptiometry bone mineral density examination in Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January to July 2021 were retrospectively analyzed. After grouping, differences between groups and related factors leading to differences were analyzed. Multivariate Logistic Regression Equation was utilized for correction. Receiver operating characteristic curve was used to predict performance.  RESULTS AND CONCLUSION: (1) There was no significant correlation between the differences in the bone mineral density of the bilateral femoral necks (higher than the least significant change) and left-right handedness, sleep orientation preference (all P > 0.05). (2) For postmenopausal women and men over the age of 50 years, when the left femoral neck T value was -0.9 or -1.0 (the difference between the bone mineral density value and the bone mineral density value when the T value was -1.1 was greater than the least significant change), the right-side examination could significantly improve the diagnosis rate of osteopenia (P < 0.001). Multivariate logistic regression analysis showed that it was an independent influencing factor after correcting traditional factors, OR=0.001, 95%CI (0.000-0.326), P=0.03; receiver operating characteristic curve predicted its efficacy in altering the diagnosis: area under the curve=0.765, 95%CI (0.536-0.993), P=0.018. (3) It is concluded that for postmenopausal women and men over 50 years old, when the T value of the left femoral neck was -0.9 or -1.0 (the difference between the bone mineral density value and the bone mineral density value when the T value was -1.1 was greater than the least significant change), the dual-energy X-ray absorptiometry bone density test of the lumbar spine and bilateral proximal femur could significantly improve the diagnosis rate of bone loss compared with the lumbar and left side examination.  Figures and Tables | References | Related Articles | Metrics

Select

Establishment and validation of a prognostic model for the recurrence risk after percutaneous endoscopic lumbar discectomy Li Xin, Luo Mingran, Li Gen, Cheng Lin, Pan Bin, Yuan Feng 2023, 27 (13):  2087-2092.  doi: 10.12307/2023.224 Abstract ( 522 )   PDF (1606KB) ( 38 )   Save BACKGROUND: Recurrent lumbar disc herniation is an adverse event after percutaneous endoscopic lumbar discectomy. Accurately predicting the risk of recurrent lumbar disc herniation after surgery remains a major challenge for spine surgeons. OBJECTIVE: To investigate the risk factors for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy, and to develop and validate an effective predictive model. METHODS:  Clinical data from 365 patients with lumbar disc herniation who underwent percutaneous endoscopic lumbar discectomy at the Affiliated Hospital of Xuzhou Medical University from January 1, 2017 to January 1, 2020 were retrospectively collected. Predictors significantly associated with postoperative lumbar disc herniation recurrence were screened according to least absolute shrinkage and selection operator (LASSO) regression analysis, and a prediction model was established, followed by internal validation of the model using the enhanced Bootstrap validation method. The performance of the model was evaluated using receiver operating characteristic curve and calibration curves. Finally, the clinical utility of the model was analyzed using decision curves and clinical impact curves.  RESULTS AND CONCLUSION: (1) Among the 365 patients included in this study, there were 33 recurrences (9.0%) after percutaneous endoscopic lumbar discectomy. (2) Six factors that were significantly associated with recurrence after percutaneous endoscopic lumbar discectomy were selected by LASSO regression, including age, operative segment, Modic changes, Pfirrmann classification, smoking history, and intense physical work. (3) The bias-corrected curve of the model fitted well with the apparent curve, with an area under the receiver operating characteristic curve of 0.909 and 95% confidence interval of (0.860-0.958). (4) The model has good clinical utility and is useful for clinicians to identify high-risk patients preoperatively and to individualize treatment. Figures and Tables | References | Related Articles | Metrics

Select

Partial peroneus longus tendon reconstruction in the treatment of posterolateral complex injury of the knee joint Liu Xiuqi, Chen Fang, Zhong Hehe, Xiong Huazhang, Lyu Guoqing, Wu Shuhong, Liu Yi 2023, 27 (13):  2093-2098.  doi: 10.12307/2023.226 Abstract ( 422 )   PDF (1851KB) ( 29 )   Save BACKGROUND: Posterolateral knee complex injury can lead to external rotation of the tibia, affecting lower extremity function and quality of life. The reconstruction with partial peroneus longus tendon can restore the stability of the lateral knee joint, but its mechanism is less reported. OBJECTIVE: To observe the effect of partial peroneus longus tendon reconstruction in the treatment of posterolateral knee complex injury.  METHODS:  From January 2017 to January 2021, 56 patients with posterolateral knee complex injury were treated in Affiliated Hospital of Zunyi Medical University. They were randomly divided into control group and observation group (n=28 per group). Patients in the control group were treated with autogenous hamstring tendon and bone-patellar tendon-bone reconstruction under arthroscopy, while patients in the observation group were treated with partial peroneus longus tendon reconstruction. Knee stability, knee function, and quadriceps femoris muscle strength were evaluated and compared in both groups before and after surgery. General indexes, complications and ankle function were compared between the two groups after surgery.   RESULTS AND CONCLUSION: (1) Length of hospital stay and postoperative visual analogue scale score were lower in the observation group than those in the control group (P < 0.05). Medical cost was less in the observation group than that in the control group (P < 0.05). (2) Hospital for Special Surgery knee score and Lysholm score were higher in the observation group than those in the control group at 1 and 2 months after surgery (P < 0.05). (3) The peak torque and total work of quadriceps femoris were lower in the observation group than those in the control group at 7 days after surgery (P < 0.05). (4) The complication rate of observation group was lower than that of control group after surgery (P < 0.05). (5) Baird-Jackson ankle scoring system at 2 months after surgery showed that motion range, pain score, running ability score, walking ability score, and ankle stability score were higher in the observation group than those in the control group (P < 0.05). (6) It is concluded that application of reconstruction with partial peroneus longus tendon in patients with posterolateral knee complex injuries can effectively improve the knee stability and function, alleviate the pain, promote the recovery of its quadriceps femoris muscle strength and shorten the length of hospital stay. Figures and Tables | References | Related Articles | Metrics

Select

Knee rotation and patellar instability Guo Zonglei , Wang Yehua, Liu Guangluan 2023, 27 (13):  2099-2103.  doi: 10.12307/2023.281 Abstract ( 675 )   PDF (1140KB) ( 29 )   Save BACKGROUND: Patellar instability is associated with a series of anatomical abnormalities of tibia, femur and soft tissue. The relationship between patellar instability and knee rotation is not well established.   OBJECTIVE: To analyze the influential factors of knee rotation on patellar instability and the correlation between them. METHODS:  A total of 96 patients with knee osteoarthritis admitted to the Affiliated Hospital of Xuzhou Medical University from September 2018 to November 2021 were included. The image data of knee joint three-dimensional CT and patella (merchant position) X-ray film were collected. The correlation between knee rotation and patellar instability was analyzed by measuring the imaging parameters such as proximal tibia rotation, distal femur rotation, knee rotation, patellar tilt angle, and lateral patellar displacement distance.   RESULTS AND CONCLUSION: (1) Pearson’s correlation analysis showed that knee rotation was moderately correlated with patellar tilt angle (R=0.440, P < 0.001) and lateral patellar displacement distance (R=0.453, P < 0.001). With the increase of knee external rotation, both patellar tilt angle and lateral patellar displacement distance increased. Proximal tibial rotation was strongly correlated with patellar tilt angle (R=0.578, P < 0.001) and lateral patellar displacement distance (R=0.654, P < 0.001). With the increased external rotation of proximal tibia, the patellar tilt angle and lateral patellar displacement distance increased. There was no correlation of distal femoral rotation with patellar tilt angle and lateral patellar displacement distance. (2) These findings indicate that in imaging findings, the lateral patellar displacement distance is less affected by knee rotation than the patellar tilt angle. The proximal tibial rotation was strongly correlated with knee rotation. The rotation of the knee joint was mainly affected by the proximal tibial rotation, while the distal femur rotation was not correlated with the rotation of the knee joint. Figures and Tables | References | Related Articles | Metrics

Select

Application and progress of finite element analysis in the treatment of thoracolumbar fractures with pedicle screw fixation Zheng Xiaobo, Yang Sheng, Wang Fengyun 2023, 27 (13):  2104-2109.  doi: 10.12307/2023.245 Abstract ( 494 )   PDF (1115KB) ( 39 )   Save BACKGROUND: Pedicle screw fixation is widely used in the treatment of thoracolumbar fractures because of its simplicity and easy operation. It has always been a research hotspot to find a method that can preoperatively simulate and evaluate the safety of posterior pedicle screw fixation in the treatment of thoracolumbar fractures. Finite element analysis is currently a common method for evaluating long-segment and short-segment pedicle screw fixation models and analyzing their safety.   OBJECTIVE: It is hoped that a suitable, safe and effective finite element model of thoracolumbar fractures can be found by analyzing the existing finite element studies of pedicle screw fixation for thoracolumbar fractures. METHODS:  In the PubMed database, “finite element analysis, pedicle screw, thoracolumbar fractures” were used as the key words to carry out the relevant literature search. In the CNKI database, the relevant literature search was carried out with the key words of “finite element analysis, pedicle screw, thoracolumbar fractures”. The articles that were not closely related to the topic were excluded by quickly browsing the article titles and abstracts. Finally, 57 articles were screened out for intensive reading and writing.   RESULTS AND CONCLUSION: So far, there is no established standard for simulating thoracolumbar fractures through three-dimensional finite element models. The models of previous related studies are relatively simplified and out of touch with clinical practice, so they cannot accurately display the real situation of injured vertebrae, and the repeatability is poor. The finite element model of moderate and severe fractures based on the load sharing classification scoring system is more in line with the actual situation, because the quantitative assessment of the degree of vertebral body injury, the extent and displacement of the fracture fragments, and the correction of the kyphosis of the injured vertebra can all be determined by the finite element method. The method is well simulated. Therefore, the finite element study of pedicle fixation for thoracolumbar fractures based on this fracture model is also closer to clinical practice. Figures and Tables | References | Related Articles | Metrics

Select

Current status of 3D printing medical applications and center construction Yang Lian, Feng Haiyang, Xu Yuanjing 2023, 27 (13):  2110-2115.  doi: 10.12307/2023.294 Abstract ( 681 )   PDF (1374KB) ( 94 )   Save BACKGROUND: As the informational technology raising, 3D printing is applied widely in digital medicine. The importance of research and application of medical 3D printing focuses on the following perspectives: (1) printing organ pathology models and guid plate to aid in preoperative planning and adjuvant therapy; (2) creating custom prosthesis or implant scaffolds; and (3) creating personalized orthoses and braces; (4) fabricating viable tissues or organoids.   OBJECTIVE: This paper described the application and advantages of 3D printing in digital medical industry, and summarized the current construction situations for 3D printing digital medical center in domestic and foreign market, as well as the registration approval of 3D printing medical devices, to provide experiences for the development of 3D printing digital medical industry. METHODS:  Databases of Wanfang, CNKI and PubMed were searched for relevant articles published from January 2010 to February 2022 with the key words of “3D printing technology, 3D printed orthoses, 3D bioprinting, medical applications, medical center” in Chinese or English. A few classic early articles were included. By reading the titles and abstracts, repetitive studies, low-quality or irrelevant articles were excluded. Finally, 60 articles were included for review.   RESULTS AND CONCLUSION: 3D printing technology and clinical medicine are tightly combined, and the cross-innovation of “medicine-industrial integration” has been realized through interdisciplinary innovative applications, and many scientific research innovations have been achieved. The construction of the 3D printing digital medical center will systematically train medical-engineering personnel for the hospital, and provide services such as image processing and cloud service system construction, and medical device printing, which also integrates digital medical technology and pushes the application of 3D printing to a new height in clinical practice. Figures and Tables | References | Related Articles | Metrics

Select

Methods, technologies and future of Chinese medicine modulation of cellular autophagy in the treatment of spinal cord injury Wang Yaxin, Lin Yican, Guo Yinuo, Zhang Bo, Ma Yuying, He Xiaoping 2023, 27 (13):  2116-2123.  doi: 10.12307/2023.232 Abstract ( 490 )   PDF (1704KB) ( 90 )   Save BACKGROUND: Traditional Chinese medicine therapies such as traditional Chinese medicine and acupuncture have shown good effects on the treatment of spinal cord injury by modulating autophagy, and gradually occupy an important position in the treatment of spinal cord injury. OBJECTIVE: To summarize the research progress addressing the regulation of cellular autophagy for treating spinal cord injury using Chinese medicine. METHODS: The PubMed database was searched with “spinal cord injury, autophagy, traditional Chinese medicine, signal” as the main search terms. CNKI database was searched with “spinal cord injury, autophagy, traditional Chinese medicine, signal pathway” as the main search terms. The search period was from January 2014 to January 2022. Irrelevant and repetitive articles were excluded and 72 articles that met the criteria were included in the review. RESULTS AND CONCLUSION: (1) Regarding the traditional Chinese medicine mechanism and treatment of spinal cord injury, a series of symptoms in the early stage of spinal cord injury are often caused by the damage of the Directing Vessel, which is strongly associated with the production of qi stagnation and blood stasis after the damage, so the treatment can be carried out to activate blood circulation and remove blood stasis and the Directing Vessel. (2) The traditional Chinese medicine theory of autophagy is mainly associated with “yin and yang” and “qi and blood”. According to different diseases, the identification of internal organs is mainly based on the spleen, liver, and kidney. (3) Numerous experimental studies have confirmed that traditional Chinese medicine and acupuncture can modulate the expression of cellular autophagy proteins and signaling pathways and can effectively suppress the inflammatory response after spinal cord injury, which is conducive to reducing the inflammatory response after spinal cord injury and protecting spinal cord neurons, and improving motor and neuronal damage after injury. (4) Autophagy regulation by traditional Chinese medicine for spinal cord injury is a current research hotspot. Nevertheless, most of the studies are at the stage of theory, and the specific action mechanisms of some methods are not yet clear. (5) The research concerning autophagy is less in the field of traditional Chinese medicine compared with western medicine. In particular, the scientific research on the treatment of spinal cord injury by regulating autophagy should be strengthened. (6) In the future, it is hoped that researchers will formulate typical traditional Chinese medicine, combine with acupuncture and western medicine, and take targeted experimental studies to find effective traditional Chinese medicine methods or even combined Chinese and western therapies for the treatment of spinal cord injury.  Figures and Tables | References | Related Articles | Metrics

Select

Advantage of supramalleolar osteotomy for asymmetric ankle arthritis: a system evaluation Shang Wei, Fu Panfeng, Kang Zhe, Zhu Shaobo 2023, 27 (13):  2124-2132.  doi: 10.12307/2023.260 Abstract ( 443 )   PDF (1819KB) ( 38 )   Save OBJECTIVE: For asymmetric ankle arthritis with varus and valgus deformity, supramalleolar osteotomy can correct the negative gravity line, restore the coordination of the joint, and regulate the pressure in the ankle joint. This study was designed to evaluate supramalleolar osteotomy in treating asymmetric ankle arthritis by evidence-based medicine.   METHODS: Databases of Wanfang Data, China National Knowledge Infrastructure (CNKI), PubMed, EMbase and Medline were searched from their establishment to December 30, 2021 to collect the randomized controlled trials and non-randomized controlled trials about supramalleolar osteotomy for the treatment of the asymmetric ankle arthritis. The established inclusion and exclusion criteria were strictly followed to screen articles that met the inclusion criteria and extract data. Data were meta-analyzed using Stata 12.0 software. RESULTS:  A total of 14 studies (884 patients) were included. Among them, there were 546 patients with varus deformity and 338 patients with valgus deformity. Meta-analysis results showed: (1) in 884 patients, American Foot and Ankle Surgeons ankle and hindfoot score, visual analogue scale pain score, talus inclination angle, tibial lateral articular surface angle, and Takakura rank score were better after operation than those before operation (P < 0.05). The distal tibial articular surface angle was not significantly different before and after operation (P > 0.05). (2) American Foot and Ankle Surgeons ankle and hindfoot score, visual analogue scale pain score, talus inclination angle, tibial lateral articular surface angle, and Takakura rank were better after operation than those before operation in the varus group (P < 0.05). American Foot and Ankle Surgeons ankle and hindfoot score, visual analogue scale pain score, distal tibial articular surface angle, and Takakura rank were better after operation than those before operation in the valgus group (P < 0.05). (3) There was no significant difference in American Foot and Ankle Surgeons ankle and hindfoot score, visual analogue scale pain score, and tibial lateral articular surface angle between the varus group and the valgus group after surgery (P > 0.05), but there were significant differences in distal tibial articular surface angle, talus inclination angle, and Takakura rank (P < 0.05).   CONCLUSION: The American Foot and Ankle Surgeons ankle and hindfoot score, distal tibial articular surface angle, and Takakura rank were improved by supramalleolar osteotomy in the treatment of asymmetric ankle arthritis. The tibial lateral articular surface angle and talus inclination angle for varus deformity were improved. There is no significant improvement in tibial lateral articular surface angle and talus inclination angle for valgus deformity. The need for combined fibular osteotomy is still lack of more subgroup evidence to support. Figures and Tables | References | Related Articles | Metrics