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28 June 2023, Volume 27 Issue 18 Previous Issue   

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Comparative finite element analysis of the cervical articular process after resection of different ranges of the uncinate processes Hao Yunteng, Shi Jun, Liu Yuhang, Li Kun, Ma Yuan, Zhang Shaojie, Wang Chaoqun, Chen Jie, Zhang Zhifeng, Zheng Leigang, Wang Xing, Li Zhijun 2023, 27 (18):  2789-2796.  doi: 10.12307/2023.303 Abstract ( 594 )   PDF (3294KB) ( 326 )   Save BACKGROUND: Uncinate processes hyperplasia often leads to cervical spondylosis. Uncinate process resection without internal fixation is of great significance, but there are still many problems.   OBJECTIVE: To establish a three-dimensional finite element model of the whole cervical vertebrae (C0-T1), and to explore the characteristics and laws of stress change after excising different ranges of the uncinate process, so as to provide a theoretical basis for the surgical treatment of clinical cervical spondylosis. METHODS:  Raw data were obtained from spiral CT thin-section scans of 40-year-old male normal adult volunteers. Mimics, GeomagicStudio, Hypermesh, Abaqus and other software technologies were used to establish (C0-T1) full cervical three-dimensional finite element model. Models of 50% unilateral uncinate processes excision, 100% unilateral uncinate processes excision and 100% bilateral uncinate processes excision were constructed on the C5 vertebral body. After loading the same torque, six working conditions of flexion, extension, lateral flexion and rotation were assigned to observe changes of stress and displacement of the cervical facet joint in different states after the resection of the uncinate process.   RESULTS AND CONCLUSION: (1) By constructing the finite element model of the normal cervical vertebrae and the uncinate process in different ranges, after loading the same torque, the stress concentration area of the cervical articular process was now moved up from C6 in the normal group to C5 in the different ranges of uncinate process excision groups. The stress of the nodal process increased with the increase of the vertebral sequence. (2) The stress concentration areas were located at C5 and C6, and the overall shape was sharp. The degree of resection of the uncinate process reduced the stability of the cervical spine, and the degree of reduction increased with the extent of resection. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element analysis of a new height adjustable cervical fusion cage Huang Dingan, Liu Chen 2023, 27 (18):  2797-2803.  doi: 10.12307/2023.380 Abstract ( 507 )   PDF (5448KB) ( 192 )   Save BACKGROUND: The core of anterior decompression is to relieve the compression of spinal cord and nerve and restore the intervertebral height and physiological curvature of cervical spine. However, the cage currently used in the clinic cannot satisfy the individualized needs, resulting in the destruction of the endplate of the fusion segment and the subsidence or displacement of the cage. In this study, a height adjustable cervical fusion cage was designed, which can be implanted into the intervertebral space to fit with the upper and lower end plates of the intervertebral space.   OBJECTIVE: To evaluate the mechanical characteristics of the new height adjustable cervical fusion cage by three-dimensional finite element analysis, and to provide corresponding theoretical basis for clinical application and further improvement. METHODS:  The three-dimensional finite element models of anterior cervical discectomy and fusion were established and the models were divided into normal group, lower cage implantation height group, moderate cage implantation height group and higher cage implantation height group. 50 N preload and 1.0 N·M motion additional bending moment were applied under six working conditions of flexion and extension, left and right lateral flexion and left and right rotation. The corresponding peak Von Mises stress of vertebral body, peak Von Mises stress of cage, intervertebral disc stress and C3-C7 vertebral motion range were observed.   RESULTS AND CONCLUSION: (1) The peak Von Mises stress of fusion cage and the peak Von Mises stress of C3-C7 vertebral body in the group with moderate cage implantation height were lower than those in the group with lower cage implantation height and the group with higher cage implantation height. (2) The stress difference of C4/5 intervertebral disc was obvious after implantation of different height cages. (3) The overall intervertebral relative activity of C3-C7 decreased the most in the higher cage implantation height group, followed by the moderate cage implantation height group, and the overall intervertebral activity decreased least in the lower cage implantation height group. (4) It is suggested that the appropriate implantation height of the cage can make the cervical spine achieve immediate stability, and minimize the stress on the cage and cervical vertebra, so as to effectively avoid the cervical cage subsidence. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of different fibular support methods to reconstruct the poor medial column of humeral proximal fractures Liu Yan, Ge Hongqing, Chen Wenzhi, Liang Zeqian, Li Junye, He Jielong 2023, 27 (18):  2804-2808.  doi: 10.12307/2023.298 Abstract ( 535 )   PDF (1928KB) ( 234 )   Save BACKGROUND: The method of fibular allograft to reconstruct the poor medial column of humeral proximal fractures has gradually been widely used in clinic, while the best support site in the intramedullary cavity is still controversial, and it is necessary to study its stability through biomechanical approach.   OBJECTIVE: To explore the biomechanical stability of the fibula in the center of the medullary cavity, anterolateral, anteromedial, posterolateral, and posteromedial positions using a finite element analysis method. METHODS:  The proximal humeral CT data of an osteoporosis female patient were obtained, modeled by Mimics 19.0 software and Geomagic Wrap software, and osteotomized in Soildworks 2017 software according to 5 mm below the anatomical neck of the humerus to establish a poor medial column support proximal humeral fracture model. The position of the fibula in the medullary cavity was divided into five groups. The fibula was located in center of the medullary cavity named F-C group; the fibula in anteromedial side of the medullary cavity named F-AL group; the fibula in anteromedial side of the medullary cavity named F-AM group; the fibula in posterolateral side of the medullary cavity named F-PL group; the fibula in posteromedial side of the medullary cavity named F-PM group. The data were imported into Ansys 2019 software to simulate the biomechanical stability of different grouping models under indirect violence.   RESULTS AND CONCLUSION: (1) Under axial load of 600 N, humeral stress: F-PL group (49.706 MPa)  < F-C group (57.980 MPa) < F-AL group (58.519 MPa) < F-PM group (61.868 MPa) < F -AM group (63.886 MPa); internal fixation stress: F-AM group (106.310 MPa) < F-PM group (110.030 MPa) < F-C group (111.940 MPa) < F-PL group (114.320 MPa) < F-AL group (122.98 MPa). (2) Under 600 N axial loads, humeral deformation: F-PM group (0.352 mm) < F-PL group (0.416 mm) < F-C group (0.431 mm) < F-AM group (0.549 mm) < F-AL group (0.574 mm); internal fixation deformation: F-PM group (0.127 mm) < F-PL group (0.187 mm) < F-C group (0.191 mm) < F-AM group (0.272 mm) < F-AL group (0.290 mm). (3) Relative displacement of the fracture: F-PM group (0.048 mm) was approximately 0.54 times as large as the F-PL group (0.088 mm) and F-AM group (0.088 mm), and the F-C and F-AL groups were 0.067 mm and 0.103 mm. (4) The results of the study showed that the F-PM group had the least displacement and more distributed stresses, indicating that the biomechanical stability of placing the fibula on posteromedial side of the medullary cavity was better than that of placing the fibula in the center of the medullary cavity, and the biomechanical stability of placing the fibula on the lateral side of the medullary cavity was the worst. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of stress changes after elastic fixation between metatarsal bones for correction of hallux valgus deformity Yang Jun, Kong Weifeng, Yuan Xiaoqing, Jin Rongzhong, Li Guijun 2023, 27 (18):  2809-2813.  doi: 10.12307/2023.291 Abstract ( 436 )   PDF (2424KB) ( 280 )   Save BACKGROUND: Although the elastic fixation between the first and second metatarsal bones can achieve satisfactory clinical effects in the treatment of hallux valgus, the reported risk of complications of stress fracture of the second metatarsal bone is higher. In the previous study of the research group, good clinical results were obtained using this elastic fixation in the treatment of hallux valgus.   OBJECTIVE: To further verify the safety and reliability of the technique by establishing a finite element model of hallux valgus surgery for the fixation of the first and second metatarsal bones, and perform mechanical loading analysis. METHODS: Based on the CT image of a female hallux valgus patient as modeling data, relevant operations were carried out to establish a three-dimensional model of hallux valgus using the software Mimics 19.0, Geomagic Studio, Hypermesh 12.0, and ANSYS 19.0. The hallux valgus model was divided into three kinds of surgical models according to surgical sites: from the base of the distal segment of the first metatarsal to the base of the distal segment of the second metatarsal (group A), the middle segment (group B), and the proximal base (group C) of the second metatarsal. The three groups of surgical models were subjected to horizontal mechanical loading to gradually reduce the intermetatarsal angle for mechanical test analysis. To simulate the stress mode of the human body when standing, the vertical loading mechanics were gradually performed on the upper segment of the tibia and fibula, and the mechanics and deformation of the whole foot and the first and second metatarsal bones were observed.   RESULTS AND CONCLUSION: (1) In terms of stress, when the horizontal force applied to the angle between the first and second metatarsal bones was 50, 100, 200, and 300 N, the maximum stress at the overall action point of the metatarsal bones occurred in group B. The maximum stress of the first metatarsal occurred in the model of group A. The maximum stress of the second metatarsal occurred in the model of group C. The minimum stress of the second metatarsal occurred in the B model. (2) In terms of deformation, the lateral displacement of the first metatarsal was the largest in model A, followed by group B, the smallest in group C. The difference between the models in each group was small for vertical application. (3) The results showed that models of group A and group B had better orthopedic ability and were less likely to cause stress fracture of the second metatarsal. This study provides mechanical data for the clinical implementation of the first and second metatarsal elastic fixation to correct hallux valgus surgery without osteotomy. Figures and Tables | References | Related Articles | Metrics

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Constructing digital model of knee joint and surrounding soft tissue surface by three-dimensional image registration technology Zhang Xiaohui, Zhang Mingjun, Wang Jianping, Qu Haijun, Chai Le, Li Yu, Zhang Xinmin 2023, 27 (18):  2814-2819.  doi: 10.12307/2023.315 Abstract ( 608 )   PDF (1833KB) ( 2370 )   Save BACKGROUND: With the development of modern industry, modern national defense and modern medical rehabilitation industry, bionic design and manufacturing technology is booming. This technology often takes various organisms and their tissues as research objects, imitating their geometric shapes, mechanical properties and other indicators, and then achieves reverse design and manufacture of various synthetic products, in which the effective bionics of geometric shapes, especially surface modeling technology, is a key part of it.   OBJECTIVE: Taking the human knee joint as an example, this paper discussed the practical application technology of surface modeling, and established a digital model of the geometric anatomy of the human knee joint. It provided support for the research on the biomechanical properties of the knee joint, and at the same time provided an effective teaching and research model for the complex surface modeling of the bionic mechanism. METHODS:  Using knee CT scan images and magnetic resonance imaging images, the point cloud data and approximation curves of bone tissue and soft tissue contours were obtained through medical image processing technology, respectively, and the knee joint entity models of bone tissue and soft tissue were reconstructed respectively. Finally, based on the 3D image registration technology, each soft tissue group was assembled on the bone tissue entity model to form the overall knee joint 3D model.   RESULTS AND CONCLUSION: Through 3D medical imaging technology, a digital anatomical digital model of knee joint with complex geometric surfaces including various bone tissues and ligaments, meniscus, tendons and other major soft tissues was constructed. Figures and Tables | References | Related Articles | Metrics

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In vitro biomechanical characteristics of the effect of Rotation-Traction Manipulation on lower cervical vertebral displacement Feng Minshan, Han Changxiao, Liang Dongzhu, Zhao Weidong, Yin Xunlu, Liu Guangwei, Zhu Liguo 2023, 27 (18):  2820-2823.  doi: 10.12307/2023.358 Abstract ( 544 )   PDF (1624KB) ( 408 )   Save BACKGROUND: It is helpful to evaluate vertebral displacement for revealing the manipulative biomechanical mechanisms. However, there is, at present, no study to analyze the vertebral displacement of Rotation-Traction Manipulation.   OBJECTIVE: To observe the displacement of the lower cervical vertebrae during Rotation-Traction Manipulation and the effect of different thrust forces on the vertebral displacement. METHODS:  Seven healthy adult male cervical spine specimens were selected and the pre-traction and different thrust forces (50, 150, 250 N) were simulated on the specimens by using the MTS machine and fixture. The kinematic measurements of different positions of C4-C7 vertebrae (right transverse process, vertebral body midpoint, left transverse process) were performed by using the motion capture system to determine vertebral body displacement under pre-traction and different thrust forces.   RESULTS AND CONCLUSION: (1) During pre-traction, the longitudinal displacement of the right transverse process and midpoint of the vertebral gradually decreased from C4 to C7 (P < 0.05), and the longitudinal displacement of the right transverse process of C4 was significantly greater than that of the left transverse process (P < 0.05). (2) During thrust, the longitudinal displacement of the right transverse process and midpoint of the vertebral gradually decreased from C4 to C7 (P < 0.05), and the longitudinal displacement of the right transverse process of C4 was significantly greater than that of the left transverse process for 150 N and 250 N thrust forces (P < 0.05). (3) Comparison of different thrust forces: The longitudinal displacement of each segment and position of the vertebral body in the 50 N group was significantly smaller than that in the 150 N and 250 N groups (P < 0.05). The differences in longitudinal displacement of each segment and position of the vertebral body between the 150 N and 250 N groups were not statistically significant (P > 0.05). (4) The results show that the Rotation-Traction Manipulation can adjust the lower cervical vertebrae displacement, with the largest displacement of the C4 transverse process on the rotational side, and positive displacement with increasing thrust force. Figures and Tables | References | Related Articles | Metrics

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Effect of partial posterior root tear of medial meniscus on biomechanics of the knee joint during gait cycle Xu Zhi, Li Yuwan, Jin Ying, Liu Yi 2023, 27 (18):  2824-2830.  doi: 10.12307/2023.293 Abstract ( 508 )   PDF (7670KB) ( 69 )   Save BACKGROUND: At present, most of biomechanical studies on medial meniscus posterior root tearing to accelerate knee joint degeneration are limited to testing the complete tear model of the posterior root of the medial meniscus on the basis of static simulation design. However, the biomechanical behavior of medial meniscus posterior root tear in the full gait cycle is not clear.  OBJECTIVE: To compare the biomechanical differences between the normal knee joint model and the medial meniscus posterior root partial tear model in the complete gait cycle using dynamic finite element analysis method. METHODS: Based on the CT scan data of the right knee joint of healthy adults, the finite element model of healthy knee joint including bone, meniscus and articular cartilage was established, and the posterior root tear model of medial meniscus of knee joint was further established on the basis of healthy model. The standard gait load of ISO was applied to the two models for simulation test. The differences of stress, displacement and contact area of the corresponding parts of the two models were compared.   RESULTS AND CONCLUSION: (1) Under the complete gait cycle, the stress distribution of the posterior root of the medial meniscus in the healthy model was uniform, while the pathological model showed stress concentration in the injured area. The maximum stress of the former appeared at the inner edge of the lateral meniscus at 30% time, with a value of 29.68 MPa. The latter maximum stress appeared at the inner edge of the lateral meniscus at 50% time, with a value of 30.34 MPa. (2) During the complete gait cycle, the stress distribution of tibial cartilage in healthy and pathological models was roughly the same. The maximum stress of the two models appeared at 50% and 20% around the gait, respectively, and the values were 5.11 MPa and 6.85 MPa, respectively. (3) The difference between the medial intercompartment group and the lateral intercompartment group was greater than that in the lateral intercompartment group. The average stress of the medial tibial plateau of the pathological model was 9.3% higher than that of the normal model, and the maximum value of 5.73 MPa appeared in the middle of the support phase. The peak contact area of femur and tibia appeared at 40% time, and the average contact area of femoral cartilage in each phase of the pathological model decreased by 14.6% compared with the normal model. (4) The results show that alterations in the biomechanical properties of the knee joint after a partial tear of the medial meniscus posterior root increase the risk of osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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Effect of elastin degradation of patellar tendon on the quasi-static tensile mechanical properties Liu Xiaoyun, Deng Yuping, Li Feifei, Zhao Dongliang, Yang Yang, Huang Tao, Tan Wenchang, Wu Yaobin, Huang Wenhua, Li Yanbing 2023, 27 (18):  2831-2836.  doi: 10.12307/2023.317 Abstract ( 679 )   PDF (2624KB) ( 347 )   Save BACKGROUND: Patellar tendon is an important structure to maintain the stability of the knee joint and exhibits unique nonlinear mechanical properties under tension, but the effect of elastin on the mechanical behavior of the patellar tendon under tensile loading is still unclear.   OBJECTIVE: To study the effect of elastin on the mechanical properties of patellar tendon through targeted enzyme treatment of elastin. METHODS:  (1) Thirty fresh porcine patellar tendons, weighing 40–50 mg, were evenly divided into five different elastase concentrations (0, 1, 5, 10, 20 U/mL) or incubated in elastase solutions for five different times (0, 1, 4, 6, 12 hours), and finally the elastin content was detected. (2) Patellar tendon was treated in PBS or 5 U/mL elastase for 8 hours, then Verhoeff Van Gieson (VVG) staining and Masson staining were performed. (3) Twenty fresh porcine patellar tendons were randomly divided into PBS control group and elastase-treated group. After 9 points were marked on the sample surface, the longitudinal tensile test and stress relaxation test were carried out. The displacement of the marked points was calculated by optical non-contact method for subsequent strain analysis and stress calculation. The samples were incubated in PBS or 5 U/mL elastase for 8 hours, and the same mechanical test was performed again.   RESULTS AND CONCLUSION: (1) Incubating in 5 U/mL elastase for 8 hours could meet the requirements of this experiment. (2) Compared with pre-treatment, tissue tensile stress was significantly reduced in the PBS and elastase-treated groups, which were both decreased by about 40% (P < 0.001, P < 0.01). Compared with pre-treatment, the relaxation percentage after treatment increased significantly, with a difference of about 12% (P < 0.05). On the normalized average stress-time curve, the stress of elastase-treated treatment group decreased more than that of PBS group, with a difference of about 16% (P < 0.0001). (3) The above results showed that elastin played an important role in the tensile mechanical properties and viscoelastic properties of patellar tendon, further supplementing the understanding of the multiscale tendon structure-function relationships, which would be beneficial to the development and improvement of microstructure constitutive model in the future to simulate patellar tendon lesions and surgical intervention. Figures and Tables | References | Related Articles | Metrics

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Efficacy of 3D printed microporous titanium fusion device applied to anterior cervical decompression graft fusion and its effects on cervical spine anatomy and stress hormones Jiang Chengming, Jiang Sainan, Tang Ye, Jiang Lin 2023, 27 (18):  2837-2841.  doi: 10.12307/2023.394 Abstract ( 564 )   PDF (1518KB) ( 242 )   Save BACKGROUND: 3D printed intervertebral fusion has elastic modulus closer to cancellous bone and vertebral cortical bone, and further analysis of the effect of its clinical application is an important guideline for the reasonable selection of fusion device for cervical spine surgery.   OBJECTIVE: To investigate the effectiveness of 3D printed microporous titanium fusion in anterior cervical decompression graft fusion and its effects on cervical spine anatomy and stress hormones. METHODS: Totally 90 patients with cervical spondylotic myelopathy in The First Hospital of Changsha from March 2016 to September 2021 were selected, including 46 males and 44 females, aged (46.85±9.74) years old. They were divided into two groups by the random number table method. Patients in the control group (n=45) received anterior cervical decompression graft fusion with a polyetheretherketone interbody fusion and autogenous bone. Patients in the observation group (n=45) received anterior cervical decompression graft fusion with a 3D printed microporous titanium fusion. One week after the operation, the Japanese Orthopaedic Association Spinal Cord Function Scale was used to evaluate the curative effect. At 3 days and 3 months after the operation, cervical spine X-ray films were taken to record the anatomical indexes of the neck. At 1 and 3 days after operation, venous blood was collected to detect the levels of norepinephrine and cortisol. At 3 months after the operation, the neck disability index and the daily living ability scale were used to evaluate the limb function status of the patients.   RESULTS AND CONCLUSION: (1) There was no significant difference in the excellent and good rate of clinical efficacy between the two groups (P > 0.05). (2) The height of the fused segment, Cobb angle of the fused segment, and T1 tilt angle of the observation group were higher than those of the control group at 3 months after surgery (P < 0.001). The cortisol and norepinephrine levels of the observation group were lower than those of the control group at 1 and 3 days after surgery (P < 0.001). (3) The cervical dysfunction index of the observation group was lower than that of the control group at 3 months after surgery (P < 0.001). Activity of daily living of the observation group was higher than that of the control group at 3 months after surgery (P < 0.001). (4) It can be seen that 3D printed microporous titanium alloy fusion device applied to anterior cervical decompression and implant fusion achieved good results, which can reduce the stress of the body and improve limb function and have more advantages in maintaining cervical spine anatomy. Figures and Tables | References | Related Articles | Metrics

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Study on the distribution of calcaneal fracture line based on three-dimensional fracture map technology Jiang Daixiang, Lu Hui, Ma Ling, Zhang Hua, Liu Dingxi, Sheng Zhaoyou, Wu Qimei, Liu Rong 2023, 27 (18):  2842-2847.  doi: 10.12307/2023.217 Abstract ( 751 )   PDF (2235KB) ( 350 )   Save BACKGROUND: Calcaneal fractures are extremely complex in terms of anatomy, biomechanics, and injury mechanisms, and are difficult to treat. The existing fracture classification systems are diverse, and the clinical selection is not uniform. In recent years, fracture mapping technology has become more and more perfect, and clinical research has gradually increased, providing new research ideas for fracture characteristics and injury mechanisms of fractures in various parts of the body.   OBJECTIVE: To draw a calcaneal fracture line map and convert it into a heat map to analyze the characteristics of calcaneal fractures. METHODS: The case data of 68 patients (74 feet) with calcaneal fractures were retrospectively studied. The CT scan data of the right calcaneus of a 34-year-old healthy male were selected for three-dimensional reconstruction and used as a template for drawing fracture lines. CT scan data of foot and ankle of 68 patients were imported into Mimics 20.0 software to reconstruct a three-dimensional fracture model. The fracture model was imported into 3-matic 12.0 software to simulate fracture reduction and to fit with the standard template. The fracture line was traced on the standard template. A fracture line map was created and converted into a heat map to analyze the fracture characteristics.   RESULTS AND CONCLUSION: (1) Most of the patients with calcaneal fractures were 44-55 years old, of which 85.3% were male and 14.7% were female. (2) Three arc-shaped high-incidence areas were clearly visible on the map of calcaneal fractures. A belt: the annular high-incidence area of the lateral wall; B belt: covering the entire angle of Gissane and running towards the junction of the lateral tubercle and the bottom; C belt: from the middle of the posterior talar articular surface runs posteriorly and medially, and extends anteriorly by the tubercle in the medial wall. (3) The results show that the fracture map can directly display the characteristics of calcaneal fractures, and can provide references for further classification of calcaneus, internal fixation design, nail placement strategy, and finite element analysis validation. Figures and Tables | References | Related Articles | Metrics

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Comparison of cementless and cemented femoral prosthesis for unicompartmental knee arthroplasty in the treatment of osteoarthritis Shi Sifeng, Lin Qiang, Zhou Bing, Chen Xiangyang, Lu Wenhai 2023, 27 (18):  2848-2853.  doi: 10.12307/2023.377 Abstract ( 493 )   PDF (10734KB) ( 121 )   Save BACKGROUND: The application of cementless unicompartmental knee arthroplasty is becoming increasingly popular, but its clinical result is still controversial.   OBJECTIVE: To compare the clinical result of the cementless and the cemented femoral prosthesis in unicompartmental knee arthroplasty in the treatment of anteromedial knee osteoarthritis. METHODS:  From January 2020 to January 2021, 62 patients with medial compartmental osteoarthritis of the knee were enrolled in the Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, and randomly allocated to 2 groups, including 31 cases in the cemented group and 31 cases in the cementless group. Patients were all treated with unicompartmental knee arthroplasty. The postoperative visual analogue scale score, range of motion of the knee, Hospital for Special Surgery score and patient satisfaction were recorded for statistical evaluation.   RESULTS AND CONCLUSION: (1) There was no significant difference in knee range of motion at 1, 3, and 6 months after surgery, excellent and good rate of Hospital for Special Surgery score and patient satisfaction at 6 months after surgery between the two groups (P > 0.05). (2) The visual analogue scale score of the cemented group was better than that of the cementless group at 1 and 3 months at rest (P < 0.05); the visual analogue scale score on activity was better in the cemented group than that of the cementless group at 3 months (P < 0.05). (3) There was no postoperative infection or deep vein thrombosis. There were two patients with delayed wound healing, and wound healed after dressing change. (4) It is suggested that cementless femoral prosthesis for unicompartmental knee arthroplasty was safe and effective in the treatment of medial osteoarthritis. Compared with cemented femoral prostheses, although pain relief was less in the early postoperative period, two prostheses have the same effect on postoperative knee range of motion and clinical function of the knee. For elderly patients with osteoporosis, the authors recommend the cemented unicompartmental knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Significance of changes in posterior tibial slope plateau after unicompartmental knee arthroplasty Hu Zhenghao, Chen Wang, Feng Shuo, Zhang Leshu, Chen Xiangyang 2023, 27 (18):  2854-2860.  doi: 10.12307/2023.283 Abstract ( 510 )   PDF (1674KB) ( 349 )   Save BACKGROUND: Previous studies have tended to study the optimal posterior tibial slope of tibial plateau after unicompartmental knee arthroplasty, ignoring the comparison with the preoperative angle to explore the impact of the degree of change on the clinical efficacy.   OBJECTIVE: To investigate the changes of posterior tibial slope and their influence on short-term efficacy after unicompartmental knee arthroplasty. METHODS:  Totally 65 patients (67 knees) who underwent Oxford unicompartmental knee arthroplasty for medial osteoarthritis in Affiliated Hospital of Xuzhou Medical University from January 2016 to June 2021 were selected as the research subjects. The groups were divided according to the difference between postoperative minus preoperative posterior tibial slope. Positive value was increased posterior slope; negative value was decreased posterior slope. Group A: posterior slope decreased > 2°, Group B: posterior slope changed ≤ 2°, Group C: posterior slope increased > 2°. The hospital for special surgery knee score, Oxford knee score, range of motion, and forgotten joint score were recorded and compared in three groups.   RESULTS AND CONCLUSION: (1) A total of 65 patients (67 knees) were included in this study. According to the change of the average posterior tibial slope, they were divided into three groups, with 13 knees in group A, 38 knees in group B, and 16 knees in group C. (2) There was no significant difference in baseline data such as age, gender and prosthesis size among the three groups (P > 0.05). (3) Compared with the knee range of motion at the last follow-up after operation, the knee range of motion in group C was significantly greater than that in group A (P=0.014) and group B (P=0.032). (4) The Oxford knee score of group B at last follow-up was significantly lower than that of group C (P=0.004). (5) In the last follow-up, artificial joint amnesia index in the group B was significantly better than that in the group A (P=0.012). (6) It is indicated that patients with a change in posterior tibial slope of ≤ 2° after unicompartmental knee arthroplasty can obtain better short-term clinical efficacy. Within unicompartmental knee arthroplasty, individualized and precise osteotomy on the tibial side should be emphasized. Figures and Tables | References | Related Articles | Metrics

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Correlation between hand feeling and torque of screw insertion in lumbar pedicle system Jiang Guozheng, Feng Ningning, Yu Xing, Zhao He, Yang Yongdong, Qu Yi, Wang Fengxian 2023, 27 (18):  2861-2865.  doi: 10.12307/2023.314 Abstract ( 670 )   PDF (1337KB) ( 203 )   Save BACKGROUND: Screw loosening is a common complication of lumbar transpedicle screw fixation in patients with osteoporosis. It is a difficult problem for clinicians to accurately choose the right time to strengthen pedicle screw fixation.   OBJECTIVE: To investigate the correlation between hand feel and screw torque in the process of lumbar pedicle screw insertion, and initially screen the visual simulation score of hand feeling and the range of torque for bone cement reinforcement. METHODS: A total of 34 patients with degenerative diseases of lumbar spine who underwent lumbar internal fixation fusion in Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine from January to December 2020 were included. During the operation, the operator’s hand feeling, visual simulation score of hand feeling and the maximum screw torque value were recorded, and the screw loosening was evaluated periodically after the operation. All 188 screws were divided into groups with small, average, large and laborious hand resistance according to hand feeling. Hand score and torque value among the four groups were compared, and the correlation between torque value and hand feeling was analyzed.   RESULTS AND CONCLUSION: (1) The hand feeling resistance group of screw insertion was reinforced with bone cement. The feeling score and torque value of this group were significantly lower than those in the other three groups (P ≤ 0.001, P ≤ 0.05), and the torque value was strongly positively correlated with the feeling of screw insertion. (2) The results showed that hand feeling score and torque value of pedicle screw could assist the surgeon to judge the stability of screw. When hand feeling score ≤ 3 and torque value ≤ 1.3 N·m, the possibility of screw loosening after operation was greater, and bone cement fixation was recommended. Figures and Tables | References | Related Articles | Metrics

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Insertion of distal interlocking of femoral intramedullary nails with vernier device Liu Xu, Chen Hao, Kong Xiangru, Jiang Wei 2023, 27 (18):  2866-2870.  doi: 10.12307/2023.307 Abstract ( 552 )   PDF (2028KB) ( 234 )   Save BACKGROUND: Intramedullary nail is the “gold standard” for the treatment of femoral shaft fractures, but the placement of distal locking of the femoral intramedullary nail has always been a difficult problem.   OBJECTIVE: To compare the effectiveness between unarmed and vernier device support groups for distal interlocking screws in femoral nails. METHODS: Totally 63 patients with femoral shaft and trochanteric fractures (64 sides) were enrolled from Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital from 2017 to 2021. They were randomly divided into two groups. In the vernier device support group (32 cases), unarmed femoral intramedullary nail placement and internal fixation were conducted with vernier device support. In the unarmed group (32 cases), unarmed femoral intramedullary nail distal locking screw placement and internal fixation were conducted. The operation time and X-ray count for a perfect circle image, the time and the number of fluoroscopy when the nail was successfully placed, and the total time of the locking nail insertion were compared between unarmed and vernier device support groups.   RESULTS AND CONCLUSION: The operation time and X-ray count for a perfect circle image of the vernier device support group were less than those in the unarmed group (P < 0.001). The time and the number of fluoroscopy when the nail was successfully placed of the vernier device support group were less than those in the unarmed group (P < 0.001). The total time of the locking nail insertion of the vernier device support group was less than that in the unarmed group (P < 0.001). The results show that, compared with the unarmed nail placement, the vernier device support placement has faster locking speed, less indirect radiation, no direct radiation exposure, and no need for a specially designed device. It is a locking nail technology worthy of promotion. Figures and Tables | References | Related Articles | Metrics

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Instrument-assisted soft tissue mobilization combined with physiotherapy scoliosis specific exercises for adolescent idiopathic scoliosis type RigoA: Improving trunk rotation angle and reducing back pain Sun Xiaolei, Zhang Xiaohui, Lin Jiasheng, Liao Bagen 2023, 27 (18):  2871-2877.  doi: 10.12307/2023.378 Abstract ( 755 )   PDF (2390KB) ( 483 )   Save BACKGROUND: Exercise therapy for adolescent idiopathic scoliosis has been recognized by The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment, but there are fewer clinical studies on specific physiotherapy combined with exercise therapy for specific subtypes of adolescent idiopathic scoliosis.   OBJECTIVE: To analyze the clinical effect of instrument-assisted soft tissue mobilization combined with physiotherapy scoliosis specific exercises on adolescent patients with idiopathic scoliosis type RigoA. METHODS:  Eighteen adolescent idiopathic scoliosis RigoA patients admitted to The Fifth Hospital of Harbin City between December 2020 and December 2021 were selected, including 6 males and 12 females, at the age of 10-16 years. The patients were randomly divided into trial group (n=10) and control group (n=8). The trial group underwent Instrument-Assisted Soft Tissue Mobilization combined with Physiotherapy Scoliosis Specific Exercises and the control group only received Instrument Assisted Soft Tissue Mobilization. The frequency of treatment was once a week.   RESULTS AND CONCLUSION:  (1) After 24 weeks of treatment, the Cobb angle and thoracic curvature of the trial group were lower than those before treatment (P < 0.05), while the Cobb angle and thoracic curvature of the control group had no significant changes compared with those before treatment (P > 0.05). The Cobb angle and thoracic curvature were lower in the trial group than those of the control group (P < 0.05). (2) After 24 weeks of treatment, the axial trunk rotation angle of the trial group was lower than that before treatment (P < 0.05). There was no significant change in the axial trunk rotation angle in the control group compared with that before treatment (P > 0.05). The axial trunk rotation angle of the trial group was lower than that of the control group (P < 0.05). (3) The visual analog scale scores of the first treatment and 10 and 24 weeks after treatment in both groups were lower than those before treatment (P < 0.05). The visual analog scale score of the trial group after 24 weeks of treatment was lower than that of the control group (P < 0.05). (4) After 24 weeks of treatment, the vital capacity of the trial group was higher than that before treatment (P < 0.05). There was no significant change in the vital capacity of the control group compared with that before treatment (P > 0.05). The vital capacity of the trial group was higher than that of the control group (P < 0.05). (5) These results indicate that the combination of Instrument-Assisted Soft Tissue Mobilization and Physiotherapy Scoliosis Specific Exercises proved to be effective in reducing the axial trunk rotation angle of scoliosis, reducing back pain and increasing vital capacity, and controlling the development of the scoliosis curve in adolescent idiopathic scoliosis RigoA patients. Figures and Tables | References | Related Articles | Metrics

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Stability of anterior cruciate ligament reconstructed by double-loop titanium plate suspension under arthroscopy Wu Mingjie, Li Liang, Zhang Xiaoqiang, Luo Zhiping, Wu Jiachang, Sang Hongxun 2023, 27 (18):  2878-2883.  doi: 10.12307/2023.397 Abstract ( 1136 )   PDF (2278KB) ( 284 )   Save BACKGROUND: Most patients with anterior cruciate ligament fracture need surgical reconstruction of knee stability, but there are still controversies in the location of bone canal, graft selection and fixation method during reconstruction.   OBJECTIVE: To investigate the safety and efficacy of double suspension titanium plate for anterior cruciate ligament reconstruction. METHODS: The clinical data of 65 patients undergoing arthroscopic anterior cruciate ligament reconstruction with autogenous tendon from January 2019 to May 2021 were retrospectively analyzed. They were divided into two groups. In the double suspension group (n=30), only the semitendinosus tendon was obtained from the autologous tendon transplantation, and the anterior cruciate ligament was reconstructed by the whole-internal technique double-loop titanium plate suspension. In the conventional surgery group (n=35), the semitendinosus and gracilis tendons were obtained from autologous graft tendon, and fixed with tibial sheath and tibial absorbable conical screws. Operation duration, length and diameter of grafted tendon after braiding were compared between the two groups. Postoperative visual analogue scale score, knee stability (KT2000), knee function score: International Knee Documentation Committee score, Lysholm score, Tegner score; perioperative complications and other indicators were analyzed.   RESULTS AND CONCLUSION: (1) There were no statistically significant differences in surgical duration, perioperative visual analogue scale score, knee function score and stability between the two groups (P > 0.05). (2) Graft length and diameter after tendon braiding were longer in the conventional surgery group than those in the double suspension group (P < 0.05). (3) These results suggested that reconstruction of anterior cruciate ligament by double-loop titanium plate suspension under arthroscopy can achieve the same function and stability of knee joint as that of the conventional surgery group, and the function of gracilis muscle and more tibial bone mass are retained in the double suspension group, which is safe and effective in clinical application. Figures and Tables | References | Related Articles | Metrics

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Safety of interbody fusion with one-hole split endoscope for L4/5 spondylolisthesis evaluated by three-dimensional CT Liu Changzhen, Sun Ning, Zhu Kai, Liu Xin, Dou Yongfeng, Wang Jianye, Bi Jingwei, Zhu Tengyue, Sun Zhaozhong 2023, 27 (18):  2884-2891.  doi: 10.12307/2023.346 Abstract ( 515 )   PDF (5191KB) ( 267 )   Save BACKGROUND: A novel one-hole split endoscope technique has been used in the treatment of lumbar spondylolisthesis, but there is no literature on the safety, feasibility and effectiveness of this technique. OBJECTIVE: The relationship between bone markers and L4, L5 nerves and intervertebral space position is observed by lumbar CT three-dimensional reconstruction to evaluate the safety of intervertebral fusion with one-hole split endoscopic L4/5 spondylolisthesis.  METHODS:  Totally 26 patients with grade I L4/5 spondylolisthesis (spondylolisthesis group) and 26 volunteers (normal group) underwent lumbar CT scanning. Data were input into Mimics 17.0 software to measure the following parameters: (1) vertical distance. a, b: The intersection of the medial edge of the articular surface at the coronal position of the upper endplate of L5 and the upper articular process of L5 (N) to the highest point of the posterior edge of the mastoid process (R) and the tip of the superior articular process of L5 (S); c: point of intersection between L4 inferior articular process tip (X) and N on sagittal plane and L4 inferior endplate (M). (2) Horizontal distance. d: intersection point between R and N and lower edge of  L4 outlet nerve root (N1); e: intersection point of transverse section from R to M with lower edge of L4 outlet nerve root (M1); f: intersection point of N to N cross section and lateral edge of nerve tissue (N2); g: N1 to N2; h: M1 to M2; i: N2 to M1; j: Posterior edge of articular surface (R1) in sagittal position of superior articular process from M1 to L5. (3) Nine patients underwent a one-hole split splinterbody endoscopic interbody fusion with bone grafting. The outcomes were evaluated by visual analogue scale for lumbar and leg pain, Japanese Orthopaedic Association Evaluation score, Oswestry Disability Index, and 36-item Short-Form scale. RESULTS AND CONCLUSION: (1) There was no significant difference between b and c in the spondylolission group (P > 0.05), indicating that only equal amounts of upper and lower articular processes and/or laminae were removed to expose the L4/5 disc. (2) There were statistically significant differences in d and e between the two groups (P < 0.05), so surgery should be planned according to pathological changes. (3) There were no significant differences in f, g and i between the two groups (P > 0.05), indicating that the degenerative spondylolisthesis did not change the position relationship between walking and outlet nerve, and it was safe to implant the fusion device in the constant transverse workspace of both groups. (4) Visual analogue scale score, Japanese Orthopaedic Association Evaluation score, Oswestry Disability Index and 36-item Short-Form scale score of nine patients with lumbar spondylolisthesis were significantly improved at the last follow-up compared with the data before operation and 6 months after operation (P < 0.05). (5) Safe fenestrating range: S down (11.78±2.34) mm to N, X up to L4 lower endplate to expose the upper and lower margins of the intervertebral disc. Opening the window outward to M1 would not damage L4 nerve; decompress inwards to prevent damage to N and its adjacent L5 nerves. Understanding the technical features of the novel one-hole split endoscope technique can help improve surgical safety and efficacy. Figures and Tables | References | Related Articles | Metrics

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Feasibility of vertebral CT value in differentiating fresh and old osteoporotic vertebral compression fractures Feng Ningning, Jiang Guozheng, Yu Xing, Zhao He, Yang Yongdong, Guan Jianbin, Ma Yukun, Wang Shuyang 2023, 27 (18):  2892-2896.  doi: 10.12307/2023.310 Abstract ( 817 )   PDF (1848KB) ( 667 )   Save BACKGROUND: The incidence of osteoporotic vertebral compression fracture is increasing year by year. Clinical differentiation of fresh or old fractures determines the choice of treatment for patients. It is of great clinical significance to find a simple and rapid method to identify the properties of osteoporotic vertebral compression fracture in hospitals without relevant examination facilities and in patients with contraindications to MRI and single photon emission computed tomography whole-body bone scanning.   OBJECTIVE: To analyze and compare the consistency between vertebral CT values (Hounsfield units value, HU) and MRI in differentiating fresh and old osteoporotic vertebral compression fractures and to explore the feasibility of using vertebral CT values to diagnose fresh osteoporotic vertebral compression fractures. METHODS:  A retrospective analysis was performed on 40 patients, aged 55-89 (74.63±9.71) years, diagnosed as osteoporotic vertebral compression fracture with complete MRI and CT examination in Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine from January 2018 to October 2021. The nature of vertebral fractures was determined based on MRI images: Diagnostic criteria of fresh osteoporotic vertebral compression fracture based on MRI were high signal intensity of bone marrow edema on fat-suppression images, whereas normal signal of MRI on the vertebral body with wedge-shaped was diagnosed as old osteoporotic vertebral compression fracture. The vertebral CT values of target vertebrae with its adjacent level were measured separately. The CT value of target vertebra significantly higher than adjacent vertebra was diagnosed as fresh osteoporotic vertebral compression fracture but similar CT value as old osteoporotic vertebral compression fracture. Wilcoxon rank-sum test was used to compare the consistency of fresh and old vertebral fractures determined by MRI and vertebral CT values.   RESULTS AND CONCLUSION: (1) A total of 55 vertebral bodies were involved in 40 patients; 42 fresh fractures and 13 old fractures were diagnosed via MRI. (2) The Hu of fresh fractured osteoporotic vertebral compression fracture vertebral body (139.99±49.69 HU) was significantly higher than that of normal adjacent vertebral body (60.44 ±34.74 HU) (P < 0.01). The Hu of old fractured vertebral body (55.65±31.31 HU) was 6.19 HU (1.09-14.51 HU) from that of normal adjacent vertebral body (55.07±29.47 HU), and there was no statistical difference (P > 0.05). (3) The vertebral body CT value was used to diagnose 41 fresh fractured vertebral bodies and 14 old fractured vertebral bodies. (4) Wilcoxon rank-sum test showed that MRI and CT were highly consistent in differentiating fresh and old fractures in osteoporotic vertebral compression fracture (Kappa value=0.951). (5) It is concluded that the CT has high consistency with MRI in differentiating fresh and old fracture of osteoporotic vertebral compression fracture. By comparing the CT values of the target and adjacent vertebrae, fresh or old fractures can be accurately distinguished, which can provide a simple examination method other than MRI for rapid clinical decision making. For fractures that are difficult to determine, the combination of vertebral CT values and MRI can markedly improve the diagnostic accuracy. Figures and Tables | References | Related Articles | Metrics

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Posterior vertebral structure and its influence on measurement of disc herniation volume Niu Cehao, Zhang Chunlin, Yan Xu, Fu Su, Feng Yang, Zhu Andi 2023, 27 (18):  2897-2902.  doi: 10.12307/2023.348 Abstract ( 651 )   PDF (2372KB) ( 81 )   Save BACKGROUND: Volume of disc herniation is an important measurement index for quantitative evaluation of disc herniation degree. Previously, the volume of cervical disc herniation that was completely absorbed after cervical microendoscopic laminoplasty was found unable to be confirmed by volume quantitative measurement. The reason was related to the fact that some tissues posterior to the vertebral body that could not be absorbed were included during measurement.   OBJECTIVE: To compare and analyze the effect of inclusion and removal of the posterior vertebral structure on the volume measurement of herniated lumbar intervertebral discs, and to preliminarily observe the early changes of the volume of herniated intervertebral discs after lumbar microendoscopic laminoplasty. METHODS:  Totally 98 patients with lumbar disc herniation (191 intervertebral discs) in First Affiliated Hospital of Zhengzhou University were enrolled. Lumbar spine MRI images of patients before and 1 week after lumbar microendoscopic laminoplasty were collected. The volumes were measured using PACS software. There were two measurement methods: one group included the posterior vertebral structure and the other group removed the posterior vertebral structure. The reduction rate, reduction ratio, unchanged ratio, enlargement ratio, and enlargement rate of the herniated lumbar intervertebral discs before and after the operation under the two measurement methods, and the absorption ratio and absorption rate of the herniated lumbar intervertebral disc under two measurement methods at 1 week after operation were compared.   RESULTS AND CONCLUSION: (1) In the inclusion group, 123 disc herniations with reduced volume after lumbar microendoscopic laminoplasty (reduction ratio of 64.4%, maximum reduction rate of 34.17%); 45 disc herniations were unchanged in volume, ratio of 23.6%; 23 disc herniations showed increase in volume, increase ratio of 12%, and maximum increase rate of 59.9%. In the exclusion group, 143 disc herniations were reduced in volume after lumbar microendoscopic laminoplasty (reduction ratio of 74.9%, maximum reduction rate of 51.47%), 28 disc herniations were shown unchanged in volume, constant ratio of 14.7%, and 20 disc herniations increased in volume, increase ratio of 10.5%, maximum increase rate of 60.26%. (2) The absorption ratio and absorption rate of herniated lumbar intervertebral disc were lower in the inclusion group than that in the exclusion group (P < 0.01). (3) It is concluded that the measurement method of disc herniation volume by exclusion of posterior vertebral structure is closer to the actual state with a high accuracy. Lumbar microendoscopic laminoplasty can induce the herniated lumbar disc to spontaneously absorb in the early stage postoperatively. Figures and Tables | References | Related Articles | Metrics

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Analysis and reconstruction of sagittal lumbo-pelvic parameters in the elderly with lumbar spinal stenosis Xiao Shipeng, Guo Chen, Li Shichun, Li Qinliang, Xu Yong, Xu Shuai 2023, 27 (18):  2903-2909.  doi: 10.12307/2023.308 Abstract ( 629 )   PDF (1710KB) ( 160 )   Save BACKGROUND: Lumbar spinal stenosis is the most common degenerative disease of the spine in the elderly, and its symptoms and postoperative efficacy are related to both local sequence and overall balance. However, the reasonable range of spinal-pelvic sagittal parameters in this population is unknown.   OBJECTIVE: To determine and validate the acceptable interval of sagittal lumbo-pelvic parameters for lumbar spinal stenosis patients. METHODS:  A total of 376 patients with lumbar spinal stenosis who were admitted to Peking University People's Hospital from June 2016 to December 2019 were selected. According to the scoring principle of propensity matching and the ratio of (2-3):1, they were divided into a derivation cohort group (n=276) and a validation cohort group (n=100). Imaging examinations were performed preoperatively and at the final postoperative follow-up to obtain sagittal spino-pelvic parameters, containing thoracolumbar kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt and sagittal vertical axis. | Pelvic incidence - lumbar lordosis |, pelvic tilt and sagittal vertical axis were seen as the main parameters. Quality-of-life was evaluated by the Oswestry disability index, which contained four quarters orderly: mild, sub-mild, sub-severe and severe dysfunction. The reasonable threshold of parameters corresponding to Oswestry disability index was determined by both linear regression and logistic regression. Cases in the validation cohort were used to verify the results concluded from derivation cohort.   RESULTS AND CONCLUSION: (1) Oswestry disability index got improvement in the final follow-up. At baseline, Oswestry disability index was positively correlated to | pelvic incidence - lumbar lordosis | (P=0.011) while at final Oswestry disability index was positively correlated to | pelvic incidence - lumbar lordosis | and pelvic tilt (P=0.029, P=0.008) but not correlated to sagittal vertical axis in the derivation cohort. (2) Mild, sub-mild, sub-severe and severe dysfunctions of Oswestry disability index were 15-35, 36-39, 40-43, and 44-50 preoperatively, but 0-4, 5-8, 9-12, and 13-40 in the final follow-up, respectively in the derivation cohort. Multiple regression analysis showed that the independent factor affecting preoperative Oswestry disability index was  | pelvic incidence - lumbar lordosis |, with Oswestry disability index =0.19×| pelvic incidence - lumbar lordosis |+36.9 and the mean threshold of preoperative | pelvic incidence - lumbar lordosis | was 10.7°. At final, pelvic tilt was the influencing factor of Oswestry disability index and | pelvic incidence - lumbar lordosis | was the influencing factor of pelvic tilt with Oswestry disability index =0.21× pelvic tilt +3.16 and pelvic tilt =0.60×| pelvic incidence - lumbar lordosis |+12.22. (3) The mean threshold of postoperative | pelvic incidence - lumbar lordosis | was 16.0° and pelvic tilt was 23.1° by both linear regression and logistic regression. (4) In validation cohort, Oswestry disability index in patients less than the threshold of | pelvic incidence - lumbar lordosis | was superior to cases with over-larged | pelvic incidence - lumbar lordosis | (P=0.046). (5) It is concluded that | pelvic incidence - lumbar lordosis |=16.0° was probably the reasonable sagittal range for lumbar spinal stenosis with posterior surgery and we should be tolerate to spino-pelvic matching for this population. Figures and Tables | References | Related Articles | Metrics

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Correlation of knee joint alignment correction between valgus stress and postoperative radiography after unicompartmental knee arthroplasty Li Shichao, Xie Guangyue, Sun Zhen, Han Peng, Hou Xiaohua, Sun Xiaowei, Zhang Qidong 2023, 27 (18):  2910-2914.  doi: 10.12307/2023.615 Abstract ( 782 )   PDF (2014KB) ( 221 )   Save BACKGROUND: Stress radiographs had a certain reference value for the correction of the lower limb alignment in unicompartmental knee arthroplasty, but the extent of tibiofemoral subluxation correction was still unclear. In addition, most medical centers did not pay enough attention to this examination.   OBJECTIVE: To clarify the correlation between the degree of correction of knee varus deformity and subluxation on the stress radiographs and the X-ray appearance after unicompartmental knee arthroplasty. METHODS:  We retrospectively analyzed the patients who undertook unicompartmental knee arthroplasty from January 2018 to January 2021. Totally 37 patients with 50 knees were included. The clinical outcome, and the radiographic assessment including the hip-knee-ankle angle, joint line convergence angle and coronal tibiofemoral subluxation value were assessed on pre- and post-operative full-length radiographs, as well as preoperative valgus stress radiographs. The correlations in-between these factors were analyzed.   RESULTS AND CONCLUSION: (1) Compared with preoperative radiographs, hip-knee-ankle angle, joint line convergence angle and coronal tibiofemoral subluxation were significantly corrected in valgus stress and postoperative radiographs (P < 0.05). (2) Pearson correlation analysis showed that the correction of joint line convergence angle on the valgus stress radiographs was positively correlated with the correction of hip-knee-ankle angle after unicompartmental knee arthroplasty (r=0.420, P < 0.05), while the correction of coronal tibiofemoral subluxation at valgus stress radiographs was also positively correlated with the correction of postoperative coronal tibiofemoral subluxation (r=0.754, P < 0.05). (3) Thus, unicompartmental knee arthroplasty can correct the varus deformity and coronal tibiofemoral joint subluxation of the knee joint, and the degree of correction can be effectively predicted by preoperative valgus stress radiographs. Figures and Tables | References | Related Articles | Metrics

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Construction and validation of a model for predicting postoperative severe complications of  intertrochanteric fracture in the elderly Weng Youlin, Cai Yu, Li Zutao, Guo Bin, Xu Jiangbo 2023, 27 (18):  2915-2920.  doi: 10.12307/2023.343 Abstract ( 529 )   PDF (1742KB) ( 174 )   Save BACKGROUND: Accurate perioperative risk prediction is very important. At present, there are few prediction models for severe complications of intertrochanteric fracture in the elderly, and the clinical decision-making of doctors and patients lacks basis. The purpose of this study is to develop a nomogram for severe complications of intertrochanteric fracture in the elderly, and to guide the perioperative clinical decision-making. OBJECTIVE: To explore the risk factors of severe postoperative complications of  intertrochanteric fracture in the elderly and to establish a risk prediction model.  METHODS: A retrospective study was conducted on clinical data of 519 elderly patients with intertrochanteric fracture in the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to April 2022. The demographic characteristics, preoperative laboratory indicators and surgical variables of the included patients were recorded. Study outcome was the occurrence of serious complications after operation. The forward stepwise method and likelihood ratio test were used to screen the best prediction model. The accuracy and stability of the model were evaluated through the receiver operator characteristic curve, Hosmer-lemeshow goodness of fit test and decision curve analysis, and nomograms were drawn.  RESULTS AND CONCLUSION: (1) American Society of Anesthesiologists classification, 5-factor Modified Frailty Index, ratio of C-reactive protein to albumin, preoperative hemoglobin, and age were important risk factors for serious postoperative complications of intertrochanteric fracture in the elderly. (2) The validation results of the predictive model showed that the area under the receiver operator characteristic curve of severe postoperative complications in the modeling group was 0.786, 95% confidence interval (0.722-0.850). The area under the receiver operator characteristic curve of severe postoperative complications in the validation group was 0.725, 95% confidence interval (0.640-0.808). (3) The P values of Hosmer-lemeshow goodness of fit test in modeling group and validation group were 0.738 and 0.581, respectively, which proved that the models were well calibrated. (4) Decision curve analysis showed that elderly patients with intertrochanteric fractures might benefit from clinical intervention when the threshold probabilities of the modeling group and validation group were 8%-58% and 11%-54%, respectively. (5) This study presents an effective prediction model, which is helpful to predict the occurrence of serious postoperative complications of elderly intertrochanteric fractures and help clinicians take personalized treatment measures. Figures and Tables | References | Related Articles | Metrics

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Application of finite element analysis in spine surgery Gao Xu, Xing Wenhua 2023, 27 (18):  2921-2927.  doi: 10.12307/2023.342 Abstract ( 605 )   PDF (1519KB) ( 276 )   Save BACKGROUND: As the central axis of the human body, the spine is the pillar of the body and has functions such as weight-bearing, shock absorption, protection and movement. When spinal disorders occur, it often leads to serious consequences such as appearance deformity, back pain, lower extremity pain and even paralysis. The application of finite element method in spine surgery can carry out modeling and mechanical analysis of spine diseases, and provide a research method for the pathogenesis, treatment plan and prognosis of spine diseases. OBJECTIVE: To review the application status of finite element analysis method in various types of spinal diseases. METHODS:  The articles about finite element analysis and spinal diseases published in PubMed, CNKI and Wanfang databases were searched by computer. The articles were published from 2012 to 2022. The search terms were: “finite element method, spine, scoliosis, spinal fracture, intervertebral disk degeneration, osteoporosis, biomechanics, review” in Chinese and English. Finally, 53 articles were included for review.  RESULTS AND CONCLUSION: (1) Finite element analysis method is to use mathematical approximation to simulate the real physical system (geometry and load conditions). Using simple interacting elements (i.e., cells), a finite number of unknowns can be used to approximate a real system with infinite unknowns. (2) Finite element analysis has become a powerful tool in the field of spine surgery, enabling surgeons to more intuitively understand the biology of the spine under physiological and pathological conditions. (3) The construction of a patient’s personalized finite element model can be used for patient condition assessment and preoperative and intraoperative planning, so as to avoid nerve, muscle and vascular damage. (4) Since the finite element analysis method is only a digital simulation of real conditions, it cannot accurately simulate the actual situation in the body, and there are many features that cannot be represented by the finite element method. (5) At present, most spine models are studied with adult spine stiffness properties, which lack the material properties of young spines, which can reduce the accuracy of research on developmental spine diseases. Spine models of different age groups should be established to study the material properties of spines of different age groups. Figures and Tables | References | Related Articles | Metrics

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Regeneration mechanism and problems of tissue engineering in rotator cuff tendon-bone healing Wang Xu, Yang Tengyun, Xiong Bohan, Zhang Yaozhang, Lu Xiaojun, Long Dan, Zhao Daohong 2023, 27 (18):  2928-2934.  doi: 10.12307/2023.297 Abstract ( 587 )   PDF (1587KB) ( 373 )   Save BACKGROUND: In recent years, arthroscopic rotator cuff repair has become the “gold standard” of clinical treatment. However, the rate of postoperative retears after rotator cuff repair remains high, mainly because the original rotator cuff structure cannot be restored. Therefore, anatomical healing through surgery alone is not sufficient. With the development of tissue engineering, more and more scholars have found that it has great advantages for rotator cuff healing and can help stimulate the orderly regeneration of the tendon bone interface. As scholars continue to go deeper and deeper, various types of scaffolds, seed cells, and growth factors have emerged, which have great prospects. However, there are few related reviews at the domestic and international levels, which makes it inconvenient for clinicians and scholars in related fields to understand the recent status of research in general.   OBJECTIVE: To provide a summary of recent research on scaffold materials, seed cells, and cytokines related to tissue engineering in the field of rotator cuff tendon bone healing, with the aim of shedding light on basic research and clinical progress in rotator cuff tendon bone healing. METHODS: The search terms “rotator cuff injury, tissue engineering” were searched in English and Chinese by computer in PubMed and CNKI databases. The literature retrieved within 10 years was screened to exclude irrelevant, low quality or duplicate literature, and other relevant literature was included manually. Eventually, 69 papers were included for result analysis.   RESULTS AND CONCLUSION: Tissue engineering has a great potential in the field of regeneration of tendon-bone union sites. (1) Current scaffold materials can be broadly classified into three types (natural material scaffold, synthetic material scaffold, and composite material scaffold), each with its own advantages. However, composite scaffolds seem to be more promising as they can better mimic the original gradient structure of the tendon-bone interface. (2) The pigmentation of various types of stem cells and biologic factors has also been shown to stimulate the repair potential of damaged areas. Moreover, the selection of stem cell types and the study of the intrinsic molecular signaling pathways of various biologic factors still need to be further investigated, so as to clarify the time point and level of intervention of specific biologic factors and achieve the purpose of precisely inducing the regeneration of the original four-layer structure. Figures and Tables | References | Related Articles | Metrics

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Immune complex expression and platelet-rich plasma repairing mechanism for lumbar discogenic neuralgia Li Tusheng, Ding Yu, Jiang Qiang, Zhang Hanshuo 2023, 27 (18):  2935-2942.  doi: 10.12307/2023.299 Abstract ( 655 )   PDF (1672KB) ( 454 )   Save BACKGROUND: Immune mechanism plays an important role in the occurrence and development of lumbar discogenic neuralgia. Platelet-rich plasma is one of the effective means for the treatment of lumbar degenerative diseases such as lumbar discogenic neuralgia. Exploring the expression of immune complex of lumbar discogenic neuralgia and the therapeutic mechanism of platelet-rich plasma can provide new ideas for the prevention and timely treatment of neuralgia secondary to disc degeneration.   OBJECTIVE: To review the immune mechanism of lumbar discogenic neuralgia and the therapeutic mechanism of platelet-rich plasma, and make a prospect. METHODS: PubMed database, CNKI database and VIP database were searched. The English and Chinese search terms were “disc degeneration, lumbar discogenic neuralgia, lumbar discogenic sciatica, sciatica, PRP, platelet rich plasma, immunological response”. After preliminary screening of all articles according to inclusion and exclusion criteria, 86 articles were finally included for review.   RESULTS AND CONCLUSION: The role of immune mechanism in lumbar intervertebral disc degeneration has been extensively studied, and it plays a key role in the generation and development of lumbar discogenic neuralgia. Various immune inflammatory factors are the key mediators leading to nerve root pain. The treatment of lumbar discogenic neuralgia by platelet-rich plasma is mainly based on its rich growth factors, including anti-inflammatory and neuroprotection, immunomodulation, Schwann cell activation and axon regeneration, intervertebral disc degeneration repairing and angiogenesis. Figures and Tables | References | Related Articles | Metrics

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Proprioception characteristics of functional ankle instability: a meta-analysis Wu Yihan, Wei Qiaoye, Pang Yu, Liu Zhongqiang 2023, 27 (18):  2943-2952.  doi: 10.12307/2023.341 Abstract ( 648 )   PDF (845KB) ( 722 )   Save OBJECTIVE: Functional ankle instability is characterized by proprioceptive deficits, decreased neuromuscular control, and recurrent ankle sprains, which severely affect the patient’s daily activities. Proprioception as an important aspect of functional ankle instability, whether there is a deficit in proprioception compared to contralateral limbs and healthy individuals is not known. Therefore, this systematic review aims to analyze the proprioceptive characteristics of functional ankle instability.   METHODS: We searched the CNKI, PubMed, Web of Science, EBSCO-host, Ovid, and EMbase databases from inception to February 2022 to collect observational studies about the proprioception characteristics of functional ankle instability, exposure to at least one proprioceptive deficit in kinesthesia, joint position sense, and force sense. Two researchers independently screened the articles according to the inclusion and exclusion criteria, and evaluated the quality of the included studies according to the Newcastle-Ottawa Scale and the cross-sectional study quality evaluation form developed by the American Institute for Healthcare Research and Quality, and extracted absolute errors relating kinesthesia, joint position sense, and force sense to set target. Meta-analysis was then performed using RevMan 5.3 software.  RESULTS: A total of 26 observational studies were included, including 4 cohort studies, 6 case-control studies and 16 cross-sectional studies, all of which were of medium to high quality. Meta-analysis results showed that patients with unilateral functional ankle instability had inversion kinesthesia defects compared with the contralateral limbs and healthy people (SMD=0.53, 95%CI:0.36-0.71, P < 0.000 01). Compared with the contralateral limb, patients with unilateral functional ankle instability had the defect of inversion joint position sense (active vs. passive replication) (SMD=1.60, 95%CI:0.77-2.43, P=0.000 2). Compared with healthy people, unilateral functional ankle instability patients had the defect of inversion joint position sense (active vs. passive replication) (SMD=0.66, 95%CI:0.25-1.07, P=0.002). Compared with healthy people, unilateral functional ankle instability patients had the defect of active eversion joint position sense (SMD=3.68, 95%CI:1.85-5.52, P < 0.000 1). Compared with healthy people, unilateral functional ankle instability patients had the defect of passive eversion joint position sense (SMD=-0.61, 95%CI:-1.19 to -0.02, P=0.04). There was no significant difference between patients with unilateral functional ankle instability and healthy subjects in plantarflexion joint position sense (active vs. passive replication) (SMD=0.80, 95%CI:-0.19 to 1.79, P=0.11). There was no significant difference between patients with unilateral functional ankle instability and healthy subjects in dorsiflexion joint position sense (active vs. passive replication) (SMD=0.86, 95%CI:-0.01 to 1.74, P=0.05). Patients with unilateral functional ankle instability had coronal plant motion force sense deficits compared with healthy individuals (SMD=1.35, 95%CI:0.85 to 1.85, P < 0.000 01). Subgroup analysis showed that patients with unilateral functional ankle instability had greater eversion force sense error than those with inversion force sense error compared with the healthy population (P=0.44). CONCLUSION: Compared with the contralateral limbs, patients with unilateral functional ankle instability have the defects of inversion kinesthesia. Compared with healthy people, unilateral functional ankle instability patients have the defects of inversion kinesthesia, active and passive inversion joint position sense, active eversion joint position sense and force sense of inversion and eversion. Figures and Tables | References | Related Articles | Metrics