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Table of Content

    08 August 2023, Volume 27 Issue 22 Previous Issue   
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    Finite element analysis of polyetheretherketone and titanium rods in posterior lumbar interbody fusion
    Li Jie, Cao Shuai, Guo Dong, Zhang Qiongchi, He Xijing, Li Haopeng, Lu Teng
    2023, 27 (22):  3445-3450.  doi: 10.12307/2023.398
    Abstract ( 190 )   PDF (2495KB) ( 52 )   Save
    BACKGROUND: Polyetheretherketone rod is a new material for semi-rigid fixation; however, its biomechanical properties in posterior lumbar interbody fusion remain unclear.  
    OBJECTIVE: To compare the biomechanical properties of polyetheretherketone rods and titanium rods in posterior lumbar interbody fusion, and try to answer whether polyetheretherketone rods have the potential to be a substitute for titanium rods, especially when the anterior column of the spine is not adequately supported.
    METHODS: An intact L3-5 lumbar model was constructed using the finite element method. The four posterior lumbar interbody fusion constructs were developed: (1) polyetheretherketone rods with cage; (2) titanium rods with cage; (3) polyetheretherketone rods with bone grafts alone; and (4) titanium rods with bone grafts alone. The range of motion, stress and strain of the related structures were compared among the four posterior lumbar interbody fusion constructs.  
    RESULTS AND CONCLUSION: (1) There was no significant difference in the L4/5 range of motion among all surgical models. (2) Compared to titanium rods, polyetheretherketone rods increased the average strain of interbody bone grafts and the peak stresses of endplates and cages and reduced the peak stresses of the screws and bone-screw interfaces. The ratio of peak stress to yield stress for the polyetheretherketone rods (6%–26%) was higher than that for the titanium rods (3%–12%). (3) Polyetheretherketone rods only slightly reduced the range of motion and disc stress at the L3/4 segment. (4) Compared to titanium rods, polyetheretherketone rods maybe reduce the risks of pseudoarthroses, screw breaking, and loosening but lead to the higher risks of endplate collapse, cage failure, and rod fracture. Polyetheretherketone rods may have a weak advantage over titanium rods in retarding adjacent segment degeneration. Polyetheretherketone rods may be an alternative when interbody fusion is performed with bone grafts alone instead of cages.
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    Three-dimensional finite element analysis of the treatment of lumbar spondylolysis with cannulated lag screw
    Gao Hongliang, Li Xusheng, Wang Zhenhu, Zhang Xiaomin, Li Peng, Zhang Tao, Liu Hua, Li Songkai
    2023, 27 (22):  3451-3456.  doi: 10.12307/2023.375
    Abstract ( 169 )   PDF (2420KB) ( 44 )   Save
    BACKGROUND: The cannulated lag screw technique has many advantages in the treatment of spondylolysis, but there is still the risk of fracture and loosening of the internal fixation. 
    OBJECTIVE: To analyze the biomechanical stability of cannulated lag screw treatment of spondylolysis by establishing L4-S normal model, spondylolysis model and cannulated lag screw treatment model of spondylolysis through three-dimensional finite element software.
    METHODS: One male healthy young soldier volunteer was selected. 3D CT scan was performed on the volunteer’s lumbar spine and sacral spine. The imaging data were obtained and saved in Dicom format. CT data were imported into Mimics research 21.0 software to initially establish a geometric model, and deviation analysis was carried out. The obtained model was output in STEP format. Three groups of models of normal L4-S segment, L5 bilateral isthmus and cannulated lag screw in the treatment of spondylolysis were established after imported into Solidworks 21.0 software. They were represented by A, B and C respectively. The biomechanical characteristics of the three groups of models were compared under five motion states, such as axial compression, flexion, extension, left bending, and left rotation. 
    RESULTS AND CONCLUSION: (1) Compared with models A and C, model B had the largest overall maximum displacement under the five working conditions of axial compression, flexion, extension, left bending, and left rotation. However, the overall maximum displacement of models A and C was not significantly different. (2) After removing the internal fixation in the model C, the maximum stress trend was similar to the model A. The stress of the model B was significantly higher than that of the models A and C during left bending and left rotation. (3) The overall maximum rotation angle of the three groups of models showed that the maximum rotation angle of the model B under the five working conditions was significantly larger than that of the models A and C. The models A and C were similar. The range of motion of the L4 vertebral body in the three groups did not change significantly. The range of motion of the L5 vertebral body in the model B was significantly higher than that in the models A and C, and it was more obvious in the left rotation and left bending. (4) These findings indicate that under the condition of physiological movement of the spine, the change trend of cannulated lag screw in the treatment of lumbar spondylolysis model is the same as that of normal model, which obtains good biomechanical stability and retains the normal mechanical characteristics of the spine, but excessive extension and rotation should be avoided immediately after operation.
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    Biomechanical properties of cortical bone trajectory combined with pedicle screw fixation on vertebral body motion unit: a finite element analysis
    Chen Jianquan, Chen Maoshui, Lyu Zhouming, Chen Rongbin, Yu Zhaoyu, Liu Wanpeng, Lin Xinyuan, Lin Dingkun
    2023, 27 (22):  3457-3462.  doi: 10.12307/2023.385
    Abstract ( 168 )   PDF (2494KB) ( 29 )   Save
    BACKGROUND: The biomechanical research on a single cortical bone track screw has been reported in many articles at home and abroad. There are not many reports on the biomechanical research on the entire motion unit of the vertebral body, cage, and screw rod, especially the stress distribution of the motor unit and the stability of the internal fixation device by the fixation method of cortical bone trajectory combined with pedicle screw.
    OBJECTIVE: To summarize and analyze the biomechanical differences between traditional pedicle screw fixation and cortical bone trajectory combined with pedicle screw fixation in osteoporotic vertebral bodies. 
    METHODS: The CT scan data of one osteoporosis volunteer (bone mineral density T value < -0.25 SD) were obtained, and the L3-S1 vertebral functional unit osteoporosis finite element model was established to simulate the fixation of traditional trajectory screws and cortical bone trajectory combined with pedicle screws after verification of validity. The stress distribution and stability of the two internal fixation methods on the motion unit were compared according to the force and activity of the vertebral body motion unit in the flexion, extension, lateral flexion and rotation states, respectively.
    RESULTS AND CONCLUSION: (1) The results of finite element verification showed that the model could well simulate the physiological activity of lumbar vertebrae in osteoporosis patients. (2) In the flexion and extension states, the maximum stress of the internal fixator was similar to that of the traditional trajectory screw group, but the maximum stress of the nail rod system in the cortical bone trajectory combined with pedicle screw group was greater than that in the traditional trajectory screw group in the lateral flexion and rotation states. In lateral flexion, the cortical bone trajectory combined with pedicle screw group increased by 11.5% compared with traditional trajectory screw group, and in rotation, the cortical bone trajectory combined with pedicle screw group increased by 25.2% compared with traditional trajectory screw group. The maximum equivalent stress of cage in cortical bone trajectory combined with pedicle screw group was greater than that in traditional trajectory screw group, and the maximum equivalent stress of cage in cortical bone trajectory combined with pedicle screw group was 17% higher than that in traditional trajectory screw group during lateral flexion and 15% higher than that in rotation. (3) Two groups of model after in static load, bending forward, stretch, lateral flexion and rotation condition, intervertebral range of motion, two kinds of internal fixation devices can provide similar stability. (4) In general, both fixation methods can enhance the fixation strength of the lumbar fusion segment and provide similar stability, but cortical bone trajectory combined with pedicle screw internal fixation can further enhance the mechanical strength of the fusion segment and provide a better fusion stress environment.
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    Three-dimensional finite element analysis of the stress of the patellofemoral joint after medial patellofemoral ligament reconstruction by different femoral reconstruction insertion points
    Xu Biao, Lu Tan, Yang Junliang, Jiang Yaqiong, Yin Yujiao
    2023, 27 (22):  3463-3468.  doi: 10.12307/2023.351
    Abstract ( 182 )   PDF (1887KB) ( 48 )   Save
    BACKGROUND: There are many ways to reconstruct the patellofemoral ligament. Among them, the lateral insertion of the femur has a greater influence. At present, there are many ways to select femoral insertion points, but there are no conclusions. 
    OBJECTIVE: Through the analysis of three-dimensional finite element software, the change of femoral reconstruction insertion position of medial patellofemoral ligament under different flexion states can analyze the stress of the patellofemoral joint to select a suitable femoral reconstruction insertion.
    METHODS: CT data of normal knee joints of adults were obtained to import Mimics, Geomagic and Soildworks software to extract molds and add ligaments. The femoral insertion points of the ligament were the midpoint between the medial epicondyle and the adductor tubercle, the medial epicondyle, the adductor tubercle, the projection point from the top of the femoral intercondylar fossa to the medial condyle and 10 mm below the adductor tubercle. The mold added with ligament was imported into the mechanical software Ansys to analyze the stress of patellofemoral joint after reconstruction of different femoral insertion points using finite element analysis. 
    RESULTS AND CONCLUSION: (1) When the knee flexion was 0° and 30°, the stress of patellofemoral joint at any femoral insertion point of reconstructed medial patellofemoral ligament was greater than that at other angles (60°, 90°, and 120°). No matter which position was used as the femoral insertion point, when the knee joint was flexed more than 30°, there was basically no difference in the contact stress between the patellofemoral joints. (2) At 0° and 30° of knee flexion, the patellofemoral contact pressure was the largest at the point of the adductor tubercle, and the contact force at the midpoint between the medial epicondyle and the adductor tubercle was the smallest. When the knee was flexed 30°, the midpoint between the medial epicondyle and the adductor tubercle, the projection point from the top of the femoral intercondylar fossa to the medial condyle, and 10 mm below the adductor tubercle as the insertion point showed no significant difference in the contact stress. (3) Results indicate that when reconstructing medial patellofemoral ligament, the best choice of femoral lateral insertion point is the midpoint between the medial epicondyle and the adductor tubercle. This point can effectively restore the stability of knee joint and delay the degeneration of joint and cartilage. 
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    Biomechanical response of ankle traction arthroplasty for ankle osteoarthritis through finite element modeling
    Xia Yubo, Tang Xiaoxia, Luo Wen, Xu Yongsheng, Yuan Changfei, Wang Zhe, Zhou Xiaohan, Tian Miao, Wang Tao, Guo Ying
    2023, 27 (22):  3469-3475.  doi: 10.12307/2023.367
    Abstract ( 208 )   PDF (1954KB) ( 37 )   Save
    BACKGROUND: At present, the surgical methods for ankle osteoarthritis include joint replacement and joint fusion, but both methods have certain problems. Therefore, ankle preservation therapy has become the first choice for the initial treatment of ankle osteoarthritis. Ankle distraction arthroplasty is an important ankle-preserving procedure, which is beneficial to relieve ankle pain and improve function, and contribute to the self-repair of articular cartilage, but there is still a lack of definite biomechanical evidence.  
    OBJECTIVE: To explore the mechanical factors of ankle osteoarthritis without obvious force line change in the early and middle periods using ankle distraction arthroplasty through the finite element modeling to provide mechanical evidence for clinical treatment.
    METHODS: The DICOM file of CT scan data of the foot and ankle of a 27-year-old volunteer was imported into the finite element software for three-dimensional reconstruction and curved surface fitting. The mesh was divided to establish a fine foot and ankle finite element model with bones, ligaments, tendons and cartilage. The biomechanical responses of tibiotalar joint surface stress, talus stress, and talus strain under three different working conditions of 0° neutral, 20° plantar flexion, and 20° dorsiflexion were compared between the ankle osteoarthritis and external fixator groups.  
    RESULTS AND CONCLUSION: (1) Through the finite element simulation calculation, it was found that the overall stress of the ankle joint was smallest in the two groups of models when the neutral position was 0°. When the neutral position was gradually flexion or dorsiflexion, the stress value gradually increased with the change of ankle joint activity. Under the same flexion condition, the overall stress of dorsiflexion was significantly greater than that of the plantar flexion. (2) In terms of the peak stress of the tibiotalar ankle joint, the peak value of the stress of the talar joint surface in the ankle osteoarthritis group increased significantly than that in the normal group, and the peak value of the stress of the tibiotalar joint surface in the external fixator group decreased significantly. (3) For the overall deformation of the ankle joint, the overall deformation of the ankle osteoarthritis group increased the most in the neutral position, while the overall deformation of the external fixator group decreased the most. (4) For the talar stress, the stress of the talus in the ankle osteoarthritis group increased in different degrees under three working conditions. The stress of the talus in the external fixator group decreased, especially in the neutral position. (5) In terms of the forward distance of the talus, the forward distance of the talus in the ankle osteoarthritis group decreased significantly compared with that in the normal group, while the forward distance of the talus in the external fixator group did not increase significantly. (6) It is concluded that through the finite element simulation analysis of two groups of ankle models under different working conditions, it is confirmed that the clinical application of ankle distraction arthroplasty can alter the mechanical stress of tibiotalar joint surface and talus in patients with ankle osteoarthritis, improve the mechanical distribution of the local joints, and delay the development of ankle osteoarthritis.
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    Finite element analysis of different internal fixation methods for Delbet II type femoral neck fracture in children
    Yin Wei, Ouyang Zhen, Zhou Juan, Yang Binhui, Wei Yongkun
    2023, 27 (22):  3476-3480.  doi: 10.12307/2023.381
    Abstract ( 161 )   PDF (1710KB) ( 29 )   Save
    BACKGROUND: The rate of femoral head necrosis is high after Delbet type II femoral neck fractures in children. Finite element method has been widely used to study the stability of femoral neck fractures in adults after internal fixation, but there are few related analyses of femoral neck fractures in children.  
    OBJECTIVE: To study the biomechanical properties of three different internal fixation methods in the treatment of Delbet II type femoral neck fracture in children.
    METHODS: A normal 8-year-old child volunteer was selected as the research subject. CT scanning of the proximal femur of children was performed, and the image data were imported into Mimics 17.0. Three kinds of finite element models, cannulated screw model (CS model), cannulated screw and Kirschner wire model (CS+K model) and locking plate model (LP model) were established in Geomagic 14.0, Cero 3.0 and HyperWorks 13.0 to observe the internal fixation stress, epiphyseal stress and relative displacement of fracture end in the three models.  
    RESULTS AND CONCLUSION: (1) The stress in the fracture end and femoral head of CS+K model was significantly higher than that of CS model and LP model (P < 0.001). The femoral stress of LP model was significantly higher than that of CS+K model and CS model (P < 0.001). (2) The relative displacement of CS model was significantly greater than that of CS+K model and LP model (P < 0.001). (3) The mean stress of epiphyseal plate in LP model was significantly higher than that in CS+K model and CS model (P < 0.001). (4) It is concluded that cannulated screw combined with Kirschner wire fixation in the treatment of Delbet II type femoral neck fracture is more conducive to the stability of fracture, can reduce epiphyseal stress, and effectively reduce the incidence of femoral neck shortening and hip varus.
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    Biomechanical analysis of femoral neck system in unstable femoral neck fractures
    Gu Ye, Wang Qiufei, Fang Tao, Peng Yuqin, Xue Feng, Geng Dechun, Xu Yaozeng, Zhang Wen
    2023, 27 (22):  3481-3485.  doi: 10.12307/2023.347
    Abstract ( 193 )   PDF (2126KB) ( 47 )   Save
    BACKGROUND: The femoral neck system is a novel fixation device for unstable femoral neck fractures.
    OBJECTIVE: To compare and analyze the mechanical stability of three kinds of internal fixation in Pauwels III unstable femoral neck fractures by finite element method. 
    METHODS: On the basis of the validated femoral finite element model (intact group), the model was cut to make a Pauwels III 70° unstable fracture of the femoral neck. Different internal fixation models were implanted to simulate clinical surgery. This study established femoral neck system fixation (model A), inverted triangular cannulated screw fixation (model B) and 4 diamond-shaped cannulated screw fixation (model C). All the nodes under the distal end of the femur were restrained for the three groups of models, and 700 N, 1 400 N and 2 100 N compressive loads were applied to the femoral head. Through calculation and analysis, the Von Mises stress distribution and deformation of each group of models were observed, and the mechanical stability of each group of models was compared. 
    RESULTS AND CONCLUSION: (1) The maximum deformation of the three groups of models under various loads occurred in the femoral head. When compressed for 2 100 N, the deformation of model A was 2.06 mm less than that of intact group 2.17 mm, while the deformations of model B and model C were both higher than that of intact group, with the distributions of 2.39 mm and 2.33 mm. (2) Under various loads, the stress in model A group was also the smallest. Under 2 100 N, the stress peak in model A was 297.31 MPa, distributed at the joint position of anti-rotation screw and locking screw, while the stress peak in model B was 543.18 MPa, distributed at the fracture joint position of the third screw in the inverted triangle. However, the deformation and stress of model C were intermediate between model A and model B, and the maximum stress peak value was distributed at the bottom hollow of the cannulated screw fracture, reaching 315.61 MPa at 2 100 N. (3) The compressive stiffness and stress analysis of models of the three groups showed that model A < model C < model B. (4) It is concluded that the mechanical stability of femoral neck system for femoral neck fracture is better than that of three and four cannulated screws fixation, and it can effectively prevent femoral neck shortening. Femoral neck system is a recommended internal fixation method for unstable femoral neck fractures.
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    Simulated analysis of influence of walking step length on lower limb muscle strength in the elderly
    Song Cuirong, Chen Tongzhen, Liu Meixiao, Zhang Haifeng
    2023, 27 (22):  3486-3491.  doi: 10.12307/2023.391
    Abstract ( 230 )   PDF (2114KB) ( 13 )   Save
    BACKGROUND: Aging is becoming increasingly serious. The elderly with skeletal muscle degeneration do not tolerate high intensity exercise, and are easy to fall, resulting in disability or death. How to improve the lower limb muscle strength of the elderly has become a hot research issue.
    OBJECTIVE: To provide guidance for daily activities through analyzing the influence of walking step length on lower limb muscle strength of the elderly (> 60 years old), and exploring the appropriate walking style. 
    METHODS: Thirty healthy male elderly subjects aged 65-75 years old were randomly selected and their morphological parameters were measured. The skeletal muscle model was established by importing the simulation software Opensim 4.0. Vicon 2.3 three-dimensional motion capture system was used to record the movement track of the subjects’ normal step and large step walking in real time, and the plantar three-dimensional force platform was used to record the ground reaction force on the plantar during walking. The motion data of the subjects were imported into Opensim 4.0 software to establish the movement model, and the dynamic simulation was carried out. The effectiveness of the method was verified by the data of plantar dynamometer. Muscle strength changes of ilium, rectus femoris, psoas major, gluteus maximus, gluteus medius, biceps femoris, adductor magnus and medial femoral muscle were analyzed during walking with different step lengths in the elderly. The muscle strength data of two different pace walks of each subject were imported into SPSS 20.0 for statistical analysis, and paired t-test was performed.  
    RESULTS AND CONCLUSION: (1) By establishing the skeletal muscle model of the subjects and the movement model of walking with different steps, the muscle strength curves of the important muscles of the lower limbs in the process of walking with different steps were derived. (2) Through statistical analysis, there were significant differences in the muscle strength of walking with different paces (P > 0.05). (3) The change rules of step length and lower limb muscle strength were summarized: within a certain range, with the increase of step length, the muscle strength of rectus femoris, medial femoris and semitendinosus increased significantly, while the muscle strength of ilium, psoas maximus, gluteus maximus, gluteus medius and adductor magnus increased slightly. (4) It is shown that walking with increased step length can improve lower limb muscle strength and can provide a theoretical basis for the elderly to choose correct walking style, rehabilitation training and exercise prescription development.  
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    Pedicle screw placement assisted by frame-type parallel orthopedic robot
    Guo Kai, Zhang Jiahao, Huang Xing, Xin Baoquan, Zhang Linxiang, Jiang Lijun, Ni Xiangzhi, You Chaoqun, Cao Dong, Liu Tielong
    2023, 27 (22):  3492-3497.  doi: 10.12307/2023.350
    Abstract ( 168 )   PDF (2375KB) ( 28 )   Save
    BACKGROUND: Our group, together with the Institute of Robotics of Shanghai University and Shanghai Hepu Medical Technology Co., Ltd. developed this Frame-type Parallel Orthopedic Robot in the hope of contributing to the development of domestic orthopedic surgical robots. 
    OBJECTIVE: To test the feasibility of the frame-type parallel orthopedic robot-assisted lumbar spine surgery by animal lumbar spine experiments and to verify its operational performance and the accuracy of the assisted nail placement.
    METHODS: A total of twelve goat lumbar vertebrae were randomized into two groups. In the experimental group (6 vertebrae, 60 nail paths), the screw path was planned according to 3D CT data using the surgical robot and Kirschner wire placement was assisted by frame-type parallel orthopedic robot. The control group (6 vertebrae, 60 nail paths) was manually implanted with Kirschner wire under the 2D X-ray data. The screw path planning time, Kirschner wire placement time and X-ray exposure time were recorded. CT images of both groups were collected after the experiment. The accuracy and the excellent and good rate of Kirschner wire placement were assessed according to the modified Gertzbein-Robbins criteria.
    RESULTS AND CONCLUSION: (1) The screw path planning time of the experimental group was longer than that of the control group (P < 0.001). There were no statistically significant differences in Kirschner wire placement time and X-ray exposure time between the experimental group and the control group (P > 0.05). (2) According to the CT scan of the specimens after the experiment, the success rate and the excellent and good rate of the experimental group were 100% and 96.7%, and those of the control group were 98.3% and 85.0%. The excellent and good rate of the experimental group was significantly higher than that of the control group (P < 0.05). (3) This demonstrates that frame-type parallel orthopedic robot-guided placement of pedicle screws has a higher accuracy rate compared with intraoperative C-arm fluoroscopy-guided freehand screw placement, which can effectively improve surgical safety.
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    Mathematical analysis and application of oblique single-cut rotation osteotomy in repairing complex deformity of long bone
    Gao Weitong, Guo Pengnian
    2023, 27 (22):  3498-3502.  doi: 10.12307/2023.295
    Abstract ( 152 )   PDF (2572KB) ( 10 )   Save
    BACKGROUND: Oblique single-cut rotation osteotomy for long bone deformities maintains maximal contact area and no bone loss after osteotomy, but requires thorough preoperative planning.
    OBJECTIVE: To accurately determine the direction and rotation angle of the osteotomy plane of oblique single-cut rotation osteotomy.
    METHODS: An improved method for the mathematical process of the direction and rotation angle of the osteotomy plane of oblique single-cut rotation osteotomy was presented. The deformation of deformity angle and distortion angle were defined. The rotation angle and the normal direction of the osteotomy plane were calculated to obtain the osteotomy plane.
    RESULTS AND CONCLUSION: The application example showed that the deformity correction based on the calculation results of this method was accurate and the broken ends of bones were in close contact. This method can accurately determine the direction and rotation angle of the bone cutting plane, improve the accuracy of osteotomy, reduce surgical risks and complications, facilitate the convenience of clinical application, computer simulation of bone cutting, and 3D printing of bone cutting guide plate.
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    Effect of posterior cruciate ligament preserving knee prosthesis on gait and lower extremity venous return in varus knee arthroplasty
    Hu Wei, Yan Xianke
    2023, 27 (22):  3503-3507.  doi: 10.12307/2023.379
    Abstract ( 163 )   PDF (1898KB) ( 17 )   Save
    BACKGROUND: Varus knee arthroplasty is an important treatment for osteoarthritis of the knee with varus deformity. Intraoperative joint replacement prostheses include the posterior cruciate ligament preserving type and the posterior cruciate replacement type, and there is some controversy about the therapeutic effects of the two groups of prostheses.  
    OBJECTIVE: To investigate the effect of posterior cruciate ligament preserving knee prosthesis on gait and lower extremity venous return in varus knee arthroplasty.
    METHODS: The medical records of 98 patients with varus knee osteoarthritis in Guizhou Provincial Orthopedics Hospital from October 2019 to October 2020 were retrospectively analyzed, all of whom were treated with total knee arthroplasty. According to the different intraoperative knee prostheses, they were divided into two groups (n=49). The control group used a posterior cruciate replacement knee prosthesis, and the test group used a posterior cruciate ligament preserving knee prosthesis. The two groups were compared in terms of surgical condition, postoperative complication rate, postoperative hospital stay, pre- and postoperative knee range of motion, maximum flexion angle, knee function, degree of joint obliteration, gait parameters, plasma fibrinogen, activated partial thromboplastin time, and D-dimer level.  
    RESULTS AND CONCLUSION: (1) The operation time of the test group was longer than that of the control group. The intraoperative blood loss, postoperative drainage and postoperative hospital stay were less in the test group than those of the control group (P < 0.05). (2) The knee range of motion and maximum flexion angle at 3, 6 and 12 months after surgery were higher than those before surgery in both groups, and above indexes in the test group were higher than those in the control group (P < 0.001). (3) The percentages of gait speed, stride length, and support time were higher in both groups at 3, 6, and 12 months after surgery than before surgery, and the test group was higher than the control group (P < 0.05). (4) The knee joint scores of the Hospital for Special Surgery in the two groups at 3, 6, and 12 months after operation were higher than those before operation (P < 0.05), but there was no significant difference between the two groups (P > 0.05). (5) The scores of degree of joint obliteration in the test group were higher than those in the control group at 3, 6, and 12 months after operation (P < 0.05). (6) Plasma fibrinogen, activated partial thromboplastin time, and D-dimer levels were lower in the test group than those in the control group at 1 and 2 weeks after surgery (P < 0.05). (7) The overall complication rate was lower in the test group (4%) than that in the control group (17%) (P < 0.05). (8) It is suggested that the use of posterior cruciate ligament-preserving knee prosthesis in varus knee arthroplasty can significantly reduce surgical trauma and promote patients' recovery, and can more effectively improve knee range of motion, gait and lower limb venous return and reduce the incidence of postoperative complications, although the operation time is longer.
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    Establishment and validation of prediction models of affected limb swelling after primary unilateral total knee arthroplasty
    Shao Zhuce, Hu Peng, Bi Shuxiong
    2023, 27 (22):  3508-3513.  doi: 10.12307/2023.357
    Abstract ( 158 )   PDF (1724KB) ( 20 )   Save
    BACKGROUND: The affected limb after total knee arthroplasty is often accompanied by swelling, especially around the knee joint, which can seriously affect the early postoperative rehabilitation and functional exercise. Therefore, it is important to analyze the factors influencing the swelling of the affected limb, and the prediction model is based on the regression analysis of the independent influencing factors, and the total score derived from the combination of the influencing factors can visually calculate the probability of swelling in patients with total knee arthroplasty.
    OBJECTIVE: A column line graph prediction model was developed based on LASSO regression analysis of the independent influences on the occurrence of postoperative swelling in patients undergoing total knee arthroplasty.
    METHODS: The clinical data of patients who underwent total knee arthroplasty in the orthopedic joint ward of The Third Hospital of Shanxi Medical University from January 1, 2020 to June 30, 2021 and from January 1, 2018 to May 31, 2019 were retrospectively analyzed and collected. The data were divided into a training population (n=168) and a validation population (n=122) according to the pre and post time period of data collection. LASSO regression analysis was first performed based on the training population to screen for independent influences on the occurrence of postoperative swelling in patients undergoing total knee arthroplasty. Logistics univariate and multivariate regression was performed by screening the initial independent influencing factors. Finally, a column line graph prediction model of postoperative occurrence of swelling in total knee arthroplasty patients was produced by these influencing factors. Receiver operating characteristic curve and its area under the curve, C-index validation, and calibration curve were used to initially evaluate the model discrimination and calibration degree. Model validation was performed by the validation set. The C-index and calibration curve were used to further evaluate the performance of the column line graph model. Finally, decision curve analysis curves were used to see if the model could be used better in clinical practice.
    RESULTS AND CONCLUSION: (1) LASSO regression analysis showed that the modeling population had significant significance in the duration of knee osteoarthritis, body mass index, and intraoperative blood loss. (2) Based on the influencing factors and existing theories, a column line graph prediction model for the occurrence of swelling in the affected limb after surgery in total knee arthroplasty patients was constructed with the receiver operating characteristic curve and its area under the curve (area under the curve=0.68) in the training set, and also the receiver operating characteristic curve in external validation population and its area under the curve (area under the curve=0.67), which finally showed that the model was effective in predicting the column line graph. (3) The C-index was [0.663 (95%CI: 0.487-0.839)] in the modeling cohort and[0.655, 95%CI: 0.537-0.772)] in the validation group, indicating that the prediction accuracy of the model was quite good. The calibration curve fit was good. (4) The decision curve analysis curve showed that the model would have good results in clinical use. (5) The final results indicate that this prediction model for the occurrence of swelling in the affected limb after total knee arthroplasty has good testing efficacy, which can help to clinically screen the possibility of swelling in the affected limb after total knee arthroplasty patients and give personalized interventions to different patients in a timely manner. 
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    Efficacy and safety of combined use of tranexamic acid in total knee arthroplasty
    Cheng Jianjun, Ding Ya, Dong Lei, Pan Tan, Li Xinglong, Yu Haiyang, Wang Hongliang
    2023, 27 (22):  3514-3520.  doi: 10.12307/2023.372
    Abstract ( 198 )   PDF (1539KB) ( 23 )   Save
    BACKGROUND: The use of tranexamic acid in total knee arthroplasty can reduce perioperative blood loss, but the optimal choice of tranexamic acid administration route and dose remains controversial.  
    OBJECTIVE: To investigate the efficacy and safety of tranexamic acid in reducing perioperative blood loss in patients with total knee arthroplasty.
    METHODS: 261 patients undergoing total knee arthroplasty in Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital) from January 2020 to December 2021 were enrolled, including 61 males and 200 females, at the age of (68.0±7.1) years. Among them, 85 cases received intravenous infusion of tranexamic acid 1 g before skin incision and when the incision was sutured (intravenous group); 115 cases received intravenous infusion of tranexamic acid 1 g before skin incision, and 1 g of tranexamic acid was given intravenously when the incision was sutured after surgery (combined group); 61 cases did not use tranexamic acid (blank group). Blood loss of the patients was recorded; blood laboratory data of the patients were collected after surgery; postoperative complications and blood transfusion were counted. All patients were followed up to 1 month after the operation.  
    RESULTS AND CONCLUSION: (1) Compared with the blank group, the total blood loss and invisible blood loss during the perioperative period in the intravenous group and the combined group were significantly lower (P < 0.05). There was no significant difference in the total blood loss and invisible blood loss between the intravenous group and the combined group during the perioperative period (P > 0.05). (2) There was no significant difference in intraoperative blood loss and postoperative venous thrombosis incidence among the three groups (P > 0.05). The blood transfusion rate in the intravenous group and the combined group was lower than that in the blank group (P < 0.05). (3) The hemoglobin levels of patients in the intravenous group and the combined group were higher than those in the blank group on days 1 and 3 after operation (P < 0.05). The platelet counts in the intravenous group and the combined group were higher than those in the blank group on the first day after operation (P < 0.05). The leukocyte count of the intravenous group and the combined group on the first day after operation was lower than that of the blank group (P < 0.05). The leukocyte count in the intravenous group on the first day after operation was lower than that in the combined group (P < 0.05). The erythrocyte sedimentation rate and C-reactive protein level of the intravenous group and the combined group on the first day after operation were lower than those of the blank group (P < 0.05). The erythrocyte sedimentation rate and C-reactive protein level in the intravenous group on the first day after operation were lower than those in the combined group (P < 0.05). (4) These results have suggested that intravenous injection and intra-articular injection are both effective ways of using tranexamic acid, and intravenous injection and intra-articular injection have no synergistic effect.
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    Recent evaluation of individual biological acetabular cup application in hip revision
    Zhou Hongxing, Zhang Baojian, Yuan Xiangsheng
    2023, 27 (22):  3521-3525.  doi: 10.12307/2023.368
    Abstract ( 74 )   PDF (2942KB) ( 8 )   Save
    BACKGROUND: More and more patients received the total hip arthroplasty, and the acetabular loosening occurrence is increasing day and day. Commonly used operative methods include structural bone graft, morselized bone grafting and titanium mesh reconstruction, tantalum metal pads reconstruction, Jumbo cup and Cup-Cage technology.  
    OBJECTIVE: To summarize the clinical effect of the individual biological acetabular cup application in acetabular loosening after total hip arthroplasty and supply a feasible method for the hip revision.
    METHODS: Eleven patients with acetabular loosening after the total hip arthroplasty undergoing acetabular revision used individual biological acetabular cups admitted at Pingdingshan Medical District Second Department of Orthopedics, the 989 Hospital of Chinese People’s Liberation Army Joint Logistics Support Force between March 2017 and March 2019 were included in this study. Of them, there were 7 men and 4 women, with the age of 55-71 years. The individual biological cups were used in the hip revision surgery and followed up for 3 years. Harris score, visual analogue scale score and absolute length difference of both lower limbs were recorded preoperatively and at final follow-up. X-ray films were observed to assess hip functional recovery and bone ingrowth.  
    RESULTS AND CONCLUSION: (1) All patients were underdone by the same doctor, followed up for 3 years and none lost. Among them, one case had symptoms of sciatic nerve, orally took mecobalamin tablets and recovered in 6 months. (2) Harris score, visual analogue scale score and absolute length difference of both lower limbs were significantly improved during the last follow-up (P < 0.05). (3) Last X-ray films showed good bone ingrowth. (4) These results imply that the individual biological acetabular cup application in acetabular loosening after total hip joint arthroplasty can restore the primary stability, restore ideal joint function and better bone ingrowth, and provide a feasible method for hip revision.
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    Model bone experiment of distal locking placement with femoral intramedullary nail
    Cha Xiaofeng, He Zhiyu, Wang Bo, Wu Donghai, Chen Wei, Liu Yilai, Chen Xiaojun
    2023, 27 (22):  3526-3530.  doi: 10.12307/2023.352
    Abstract ( 158 )   PDF (2416KB) ( 9 )   Save
    BACKGROUND: Intramedullary nail is a classical scheme for the treatment of femoral shaft fracture. Its distal aiming frame is widely used in the placement of distal locking nail, which improves the accuracy of distal locking nail placement, but its failure rate cannot be ignored. It is urgent to develop a new technology that can actualize the rapid and accurate locking of distal locking nail and reduce the X-ray radiation damage of bare-handed locking nail.
    OBJECTIVE: To compare the effect of place-occupying compression rod technique and bare-hand locking nail technique in distal locking nail placement of femoral intramedullary nail. 
    METHODS: The eight model bones with the deviation of the compression rod that could not be accurately placed into the distal locking nail were divided into two groups. The place-occupying compression rod group (n=4) adopted the place-occupying compression rod technology. After drilling the hole adjacent to the original pressure rod hole, the accurate pressing rod was carried out, and then the distal locking nail placement carried on. In the bare-hand locking nail group (n=4), the technique of bare-hand nail under the supervision of C-arm was used to complete the placement of locking nail in the distal locking hole. The X-ray exposure times, nail locking time and nail placement accuracy were compared between the two groups. 
    RESULTS AND CONCLUSION: (1) The number of X-ray exposure in the place-occupying compression rod group was significantly less than that in the bare-hand locking nail group (P < 0.05). The time of locking nail in the place-occupying compression rod group was significantly shorter than that in the bare-hand locking nail group (P < 0.05). The accuracy of nail placement in both groups was 100%. (2) The results showed that the technique of place-occupying compression rod and the technique of bare-hand locking nail could complete the placement of distal locking nail accurately, and the technique of place-occupying compression rod has the advantages of shorter operation time and less X-ray radiation compared with the technique of bare-hand locking nail.
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    High tibial osteotomy combined with arthroscopy to treat degenerative tear in the posterior horn of medial meniscus combined with varus deformity of the knee
    Zhong Hehe, Jin Ying, Liu Xiuqi, Xiang Kuan, Wu Shuhong, Peng Jiachen, Liu Yi
    2023, 27 (22):  3531-3536.  doi: 10.12307/2023.349
    Abstract ( 192 )   PDF (2750KB) ( 14 )   Save
    BACKGROUND: Previous studies have found that both high tibial osteotomy and high tibial osteotomy combined with arthroscopy can effectively treat medial compartment osteoarthritis with varus deformity of the knee, but there are few studies comparing the therapeutic effects of the two. 
    OBJECTIVE: To compare the clinical outcome of high tibial osteotomy and high tibial osteotomy combined with arthroscopy to treat degenerative tear in the posterior horn of medial meniscus combined with varus deformity of knee joint.
    METHODS: From July 2015 to January 2019, data of 48 knee osteoarthritis patients with degenerative tear in the posterior horn of medial meniscus combined with varus deformity of knee joint in Affiliated Hospital of Zunyi Medical University were retrospectively analyzed. The 24 patients in the trial group were treated with high tibial osteotomy combined with arthroscopy. The 24 patients in the control group were treated with high tibial osteotomy. The knee joint function scores and imaging detection indexes at different time points after operation were compared between the two groups. 
    RESULTS AND CONCLUSION: (1) The hospital for special surgery knee score and knee Lysholm score of patients in the trial group at 6 and 12 months after operation were higher than those in the control group (P < 0.05). There was no significant difference in the hospital for special surgery knee score and knee Lysholm score between the two groups at 24 and 36 months after operation (P > 0.05). The visual analogue scale score of patients in the trial group was lower than that in the control group at 6 months after surgery (P < 0.05). There was no significant difference in the visual analogue scale scores between the two groups at 12, 24, and 36 months after surgery (P > 0.05). (2) The imaging examination at 12 months after operation showed that the lower limb alignment and femoral tibial angle were effectively improved in both groups, and the relative positions of the femoral tibial angle and lower limb alignment passing through the tibial plateau and the posterior tibial slope of the tibial plateau were not significantly different between the two groups (P > 0.05). (3) It is concluded that high tibial osteotomy and high tibial osteotomy combined with arthroscopic surgery can effectively treat degenerative tear in the posterior horn of medial meniscus combined with varus deformity of knee joint, effectively improve joint function and relieve pain symptoms. High tibial osteotomy combined with arthroscopy exhibited good early clinical efficacy. 
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    Comparison of the third generation multiloc intramedullary nail, common curved intramedullary nail and proximal humeral locking plate in the treatment of complex proximal humeral fractures
    Liu Tao, Zha Mingjian, Ke Rongjun
    2023, 27 (22):  3537-3543.  doi: 10.12307/2023.356
    Abstract ( 182 )   PDF (6025KB) ( 5 )   Save
    BACKGROUND: For complex proximal humeral fractures, internal fixation is usually used in clinical treatment. Which fixed approach has the advantage is still undecided.  
    OBJECTIVE: To compare the efficacy of the 3rd generation multiloc intramedullary nail, common curved intramedullary humeral nail and proximal humeral locking plate in the treatment of complex proximal humeral fractures (Neer 3 and 4 parts).
    METHODS: A total of 38 inpatients with complex proximal humeral fractures (Neer 3 and 4 parts) treated by surgery from August 2018 to March 2022 in Zhenjiang Ruikang Hospital and undergone postoperative follow-up were selected. There were 20 males and 18 females. Their ages ranged from 57 to 74 years. Of them, 13 patients received the third generation multiloc intramedullary nail fixation; 12 patients received common curved intramedullary nail fixation; 13 patients received proximal humeral locking plate fixation. Fracture healing time, visual analogue scale score, Constant-Murley shoulder score, DASH score of upper limb dysfunction, and imaging examination results were observed among the three groups in follow-up.  
    RESULTS AND CONCLUSION: (1) All 38 patients were followed up for 12 to 18 months. There was no significant difference in visual analogue scale score among the three groups at 7 days after surgery (P > 0.05). There was no significant difference in fracture healing time among the three groups (P > 0.05). (2) There was no significant difference among the three groups in the angle of shoulder forward flexion lifting, external rotation, internal rotation and abduction at 1, 3, 6, and 12 months after operation (P > 0.05). The imaging examination results showed that the humeral neck shaft angle of the multiloc intramedullary nail group was greater than that of the common curved intramedullary nail group and the locking plate group at 3, 6, and 12 months after operation (P < 0.05). The humeral head varus angle and humeral head height loss were lower than those in the common curved intramedullary nail group and the locking plate group at 3, 6 and 12 months after operation (P < 0.05). (3) The Constant-Murley shoulder joint scores of the multiloc intramedullary nail group at 1, 3, 6, and 12 months after operation were higher than those of the common curved intramedullary nail group and the locking plate group (P < 0.05). The DASH scores of upper limb dysfunction at 1, 3, 6, and 12 months after operation were lower than those in the common curved intramedullary nail group and the locking plate group (P < 0.05). (4) The findings indicate that for complex proximal humeral fractures (Neer parts 3 and 4), the third generation multiloc intramedullary nail has significant advantages in anti-compression, anti-varus and maintenance of neck shaft angle fixation and has the characteristics of quick recovery of shoulder function.
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    Surgical versus conservative treatment of volar Die-punch fractures of the medial column of the distal radius: who can get a more stable wrist joint?
    Zhao Yuhang, Yang Zhaohui
    2023, 27 (22):  3544-3549.  doi: 10.12307/2023.354
    Abstract ( 192 )   PDF (2274KB) ( 11 )   Save
    BACKGROUND: For most Die-punch fractures of the distal radius, functional reset can be achieved by manual closed reduction. However, most of these injuries are young and middle-aged patients. They have higher requirements for wrist joint function after fracture healing. It remains poorly understood whether surgical treatment can achieve better results. 
    OBJECTIVE: To analyze the clinical effect of surgical treatment and conservative treatment of distal middle column Die-Punch fracture. 
    METHODS: Totally 41 cases of Die-punch fractures of the volar side of the medial column of the distal radius were selected from the Second Hospital of Shanxi Medical University from January 1, 2010 to December 31, 2020. In the conservative treatment group (n=19), patients underwent manual reduction and plaster external fixation. In the surgical treatment group (n=22), patients underwent open reduction and internal fixation with metal locking plate. At 1 year after surgery, the patients underwent X-ray to measure the palmar angle, ulnar deviation angle and radius height. The stability of the wrist joint was assessed by Scapolunate angle, radial angle, and capitolunate angle. Pathological wrist subluxation was assessed by effective radioscapholunateflexion angle to measure wrist range of motion. Wrist joint function was assessed by the disabilities of arm, shoulder and hand score and Mayo score. 
    RESULTS AND CONCLUSION: (1) The mean follow-up time was 14.5 months in 41 patients, and the mean bone healing was 8.5 weeks. There were no complications such as loosening and fracture of internal fixation. (2) At 1 year after surgery, the palm inclination angle and wrist flexion angle of the patients in the surgical treatment group were greater than those in the conservative treatment group (P < 0.001). Radial height settlement value was less in the surgical treatment group than that in the conservative treatment group (P < 0.001). Wrist instability rate was lower in the surgical treatment group than that in the conservative treatment group (18%, 79%; P <0.001). There was no pathological subluxation of the wrist joint in the surgical treatment group and four cases of pathological subluxation of the wrist joint in the conservative treatment group, and there was a significant difference between the two groups (P < 0.001). (3) One year after surgery, disabilities of arm, shoulder and hand score in the surgical treatment group were lower than those in the conservative treatment group (P < 0.001), and the Mayo score was higher than that in the conservative treatment group (P < 0.001). (4) The results suggest that compared with conservative treatment, open reduction and internal fixation for distal middle column palmaral Die-punch fracture can achieve more stable wrist joint and better wrist joint function. 
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    Application of tranexamic acid in elderly patients with femoral intertrochanteric fracture
    Qiu Hao, Zhu Yun, Weng Zheng, Liu Dun, Chen Shimou, Jin Guorong, Chen Yu
    2023, 27 (22):  3550-3554.  doi: 10.12307/2023.366
    Abstract ( 180 )   PDF (1442KB) ( 15 )   Save
    BACKGROUND: Studies have shown that tranexamic acid can reduce blood loss in patients with total hip and total knee replacement, reduce blood transfusion rate, and does not affect coagulation function, and does not increase the risk of lower extremity deep vein thrombosis. However, there are few studies on the application of tranexamic acid in elderly intertrochanteric fracture surgery, and there is still a lack of reliable clinical data to support it.  
    OBJECTIVE: To investigate the efficacy and safety of tranexamic acid in trochanteric fixation nail-advanced for femoral intertrochanteric fracture in the elderly.
    METHODS: A total of 50 patients who met the inclusion criteria and were included in Chongqing Ninth People’s Hospital from January 2021 to April 2022 were enrolled in this study. The subjects were divided into two groups according to the random number table method. In the experimental group, 1 g of tranexamic acid was added into 100 mL normal saline and drip intravenously 15 minutes before operation. In the control group, 100 mL normal saline was drip intravenously 15 minutes before operation. The operation time, intraoperative blood loss, postoperative drainage, blood transfusion, hemoglobin, hematocrit, fibrin (before and on the third day after operation), and thrombosis (at 3 days, 1, 3 and 6 weeks after operation) were recorded in both groups.  
    RESULTS AND CONCLUSION: (1) There was no significant difference in operation time, preoperative hemoglobin, hematocrit, preoperative and postoperative fibrin between the two groups (P > 0.05). The postoperative hemoglobin and hematocrit in the control group were significantly lower than those in the experimental group (P < 0.05). (2) The intraoperative blood loss, postoperative drainage volume, hidden blood loss and total blood loss in the experimental group were less than those in the control group (P < 0.05). (3) There was no significant difference in thrombotic events between the two groups (P > 0.05). The blood transfusion events in the experimental group were significantly lower than those in the control group (P < 0.05). (4) In the elderly patients with femoral intertrochanteric fracture undergoing trochanteric fixation nail-advanced surgery, the application of tranexamic acid can reduce the intraoperative blood loss, postoperative drainage volume and hidden blood loss, reduce the total perioperative blood loss, reduce the blood transfusion rate, and increase the postoperative hemoglobin and hematocrit, without increasing the risk of thromboembolic events and the impact on fibrin.
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    Cervical microendoscopic laminoplasty remarkably improves cervical curvature in the treatment of the spinal cord line type III cervical spondylotic myelopathy
    Ling Xiaoming, Zhang Chunlin, Yan Xu, Shao Chenglong
    2023, 27 (22):  3555-3560.  doi: 10.12307/2023.316
    Abstract ( 155 )   PDF (2219KB) ( 59 )   Save
    BACKGROUND: Most cervical spondylotic myelopathy with cervical curvature straight or cervical kyphosis are spinal cord line type III cervical spondylotic myelopathy. Previous studies have reported that cervical expansive open-door laminoplasty could get satisfied decompression effect of cervical spondylotic myelopathy with curvature straight or cervical kyphosis, while there is no report about the spinal cord line type III cervical spondylotic myelopathy decompression effect of cervical microendoscopic laminoplasty.  
    OBJECTIVE: To analyze the decompression effect and charactericstics of cervical microendoscopic laminoplasty on spinal cord line type III cervical spondylotic myelopathy.
    METHODS: Totally 40 spinal cord line type III cervical spondylotic myelopathy patients (13 males, 27 females, average age of 51.6 years, average disease duration of 16.2 months, average follow-up time of 18.3 months, 55 spinal cord line type III cervical herniated discs) who underwent cervical microendoscopic laminoplasty in the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2021 were retrospectively analyzed. PACS software was utilized to measure the pre-operative and last follow-up cervical magnetic resonance imaging index of the patients. The pre-operative and last follow-up herniated discs volume, cervical Cobb angle and the improved anterior spinal cord compression degree score were compared.  
    RESULTS AND CONCLUSION: (1) All the spinal cord line type III cervical spondylotic myelopathy obtained satisfied decompression effect. The pre-operative improved anterior spinal cord compression degree score was lower than that at last follow-up (P < 0.05). The pre-operative herniated discs volume was smaller than that at the last follow-up (P < 0.05). The cervical Cobb angle increased and cervical curvature was significantly improved (P < 0.05). (2) The results suggested that cervical microendoscopic laminoplasty which had both direct and indirect decompression effect could induce cervical herniated discs to get extensive resorption of herniated nucleus pulposus phenomenon and increase cervical lordosis. The cervical microendoscopic laminoplasty can avoid or reduce anterior discectomy in spinal cord line type III cervical spondylotic myelopathy patients and provide new strategy and basis for clinical treatment of spinal cord line type III cervical spondylotic myelopathy.
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    Effect of tetramethylpyrazine on iron metabolism after spinal cord injury in rats
    Fan Xiao, Tao Jingwei, Jiang Shengyuan, Deng Bowen, Mu Xiaohong
    2023, 27 (22):  3561-3566.  doi: 10.12307/2023.360
    Abstract ( 192 )   PDF (2329KB) ( 46 )   Save
    BACKGROUND: Iron metabolism disorder is an important pathological factor leading to ferroptosis of nerve cells after spinal cord injury, which is not conducive to the repair of spinal cord injury. Tetramethylpyrazine, as the active ingredient monomer of Ligusticum Chuanxiong, a traditional Chinese medicine for activating qi and activating blood, has been proven to have good anti-inflammatory, anti-lipid peroxidation and neuroprotective effects on spinal cord injury. It is necessary to further clarify its mechanism of promoting spinal cord injury repair.
    OBJECTIVE: To study the regulation mechanism of tetramethylpyrazine on iron metabolism after spinal cord injury in rats, and to explore its related mechanism of improving spinal cord injury.
    METHODS: Totally 36 Sprague-Dawley rats were randomly divided into sham operation group, model group and tetramethylpyrazine group, with 12 rats in each group. In the sham operation group, only laminectomy was performed and normal saline was injected intraperitoneally after operation. Spinal cord injury models were prepared in model group and tetramethylpyrazine group. Normal saline and tetramethylpyrazine were injected intraperitoneally after operation, and the tissues were taken 4 weeks after operation. BBB limb motor function score was used to evaluate the limb motor function of rats. Nissl staining was used to observe the morphology of neurons. Prussian staining was used to observe the iron deposition in spinal cord tissue. Iron detection kit was used to detect the iron content in spinal cord tissue. Immunohistochemistry was used to detect the expression of ferritin heavy chain 1 and ferritin light chain protein. Western blot assay was used to detect the expression of ferritin heavy chain 1 and ferritin light chain protein.  
    RESULTS AND CONCLUSION: (1) The BBB score of model group and tetramethylpyrazine group was significantly lower than that of sham operation group at each time point (P < 0.01). Since the 14th day after operation, the BBB score of tetramethylpyrazine group was significantly higher than that of model group (P < 0.01). (2) Nissl staining results showed that the morphology and structure of neurons in the sham operation group were normal; a large amount of blood stasis and disordered morphology and structure of neurons were observed in the model group; blood stasis was less and morphology and structure of neurons were improved in the tetramethylpyrazine group. (3) Prussian staining results showed that there was less iron deposition in the sham operation group, and more iron deposition in the model group and tetramethylpyrazine group. The average optical density of positive Prussian staining in the model group and tetramethylpyrazine group was significantly higher than that in the sham operation group (P < 0.01). The average optical density of positive Prussian staining in tetramethylpyrazine group was significantly lower than that in the model group (P < 0.01). (4) The detection of iron content showed that the iron content in model group and tetramethylpyrazine group was significantly higher than that in sham operation group (P < 0.01). The iron content in tetramethylpyrazine group was significantly lower than that in model group (P < 0.01). (5) Immunohistochemical results showed that the average optical density of positive ferritin heavy chain 1 and ferritin light chain protein expression in model group and tetramethylpyrazine group was significantly lower than that in sham operation group (P < 0.01). The average optical density of positive ferritin heavy chain 1 and ferritin light chain protein expression in tetramethylpyrazine group was significantly higher than that in model group (P < 0.01). (6) Western blot assay showed that the relative expression of ferritin heavy chain 1 protein and ferritin light chain protein in model group and tetramethylpyrazine group was significantly lower than that in sham operation group (P < 0.01). The relative expression of ferritin heavy chain 1 protein and ferritin light chain protein in tetramethylpyrazine group was significantly higher than that in model group (P < 0.01). (7) It is concluded that tetramethylpyrazine can regulate the disorder of iron metabolism after spinal cord injury by regulating the expression of ferritin heavy chain 1 and ferritin light chain protein, so as to play a neuroprotective role and promote the recovery of limb motor function in spinal cord injury rats.
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    Correlation of MRI quantitative measurement of medial meniscus extrusion and medial meniscus injury pattern with cartilage damage
    Chen Hao, Wang Rui, Jiang Shaowei, Wu Lei
    2023, 27 (22):  3567-3572.  doi: 10.12307/2023.393
    Abstract ( 189 )   PDF (1907KB) ( 27 )   Save
    BACKGROUND: The medial meniscus extrusion beyond the edge of the tibial plateau can be observed on MR images of the medial meniscus of the knee joint during injury. It is worth exploring whether the external protuberance is related to the mode of medial meniscus injury and the degree of medial interventricular cartilage injury of the knee joint.
    OBJECTIVE: To quantitatively measure the extrusion of medial meniscus under magnetic resonance imaging, and to study the factors affecting the value of medial meniscus extrusion, and whether it is related to the injury mode of medial meniscus and the degree of cartilage injury in medial compartment. 
    METHODS: In this study, 117 patients diagnosed as knee meniscus posterior horn injury by sports injury in First Affiliated Hospital of Anhui Medical University were selected. They underwent knee joint MRI scan and knee arthroscopic meniscus surgery. The meniscus extrusion value (medial meniscus extrusion) was measured under MRI in each patient. The body mass index of each patient, whether due to acute injury, the mode of meniscus injury confirmed by arthroscopy and the grade of cartilage injury in the medial compartment were recorded from the medical record, and the correlation between the meniscus extrusion value and the above-mentioned factors was analyzed.
    RESULTS AND CONCLUSION: (1) There were 31 (26.5%) acute injury patients with definite recall, 86 (73.5%) acute injury patients with no clear recall; there was a significant difference in the meniscus extrusion value between the two groups (P=0.001). (2) There were 56 (47.9%) patients with low body mass index (body mass index ≤ 25 kg/m2) and 61 patients (52.1%) with high body mass index (body mass index > 25 kg/m2); there was a significant difference in the meniscus extrusion value between the two groups (P=0.008). (3) According to the site of meniscus injury, there were meniscus posterior body injury group (60 cases, 51.2%), posterior horn injury group (37 cases, 31.6%), and posterior root fracture group (20 cases, 17.1%); there was a significant difference in the meniscus extrusion value between the two groups (P=0.000). (4) According to the injury confirmed by arthroscopy, patients with non-medial meniscus posterior root rupture were divided into compound meniscus fracture group (n=49) and non-compound meniscus fracture group (n=48); there was a significant difference in the meniscus extrusion value between the two groups (P=0.000). (5) The areas under receiver operating characteristic curve of moderate and severe cartilage injury in medial compartment and medial meniscus posterior root tearing predicted by medial meniscus extrusion were 0.794 and 0.942, respectively. (6) It is indicated that the size of medial meniscus extrusion reflects the presence or absence of acute trauma in the patient's disease course, their body mass index, and pattern of medial meniscus injury. Medial meniscus extrusion has a good predictive value for medial meniscus posterior root rupture. 
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    CT study on the normal development and variation of the atlas
    Lan Zuozhen, Qian Yanan, Chi Jincheng, Huang Bingxu, Duan Shaoyin
    2023, 27 (22):  3573-3579.  doi: 10.12307/2023.353
    Abstract ( 58 )   PDF (2240KB) ( 32 )   Save
    BACKGROUND: The development and evolution of atlas are complex, and there are a few research reports. CT imaging can clearly show the atlas. It is of great clinical significance to clarify the normal development process, anatomical structure, variation and malformation of atlas.
    OBJECTIVE: To show the normal development and variation of atlas using CT imaging.
    METHODS:  The atlas CT data of patients aged 0-14 years in the picture archiving and communication system of Xiamen Children’s Hospital and Zhongshan Hospital of Xiamen University were collected, and the CT data of 732 patients were finally included. The observation items included: The ossification centers of anterior arch and vertebral arch, the epiphyseal plates of vertebral arch, anterior and posterior median, the tubercle of transverse ligament and the variation and deformity of atlas. 
    RESULTS AND CONCLUSION: (1) Among 732 cases of atlas, CT images exhibited that 679 (92.76%) had normal development, 53 (7.24%) variation or deformity. Among them, there were 27 cases of incomplete bone ring, 23 cases of accessory ossification center and accessory epiphyseal plate, and 3 cases of atlanto-occipital joint deformity. (2) There were three ossification centers, including two lateral vertebral arches and one anterior arch. The bilateral ossification centers of two vertebral arches appeared in the fetal period; the anterior arch ossification center of one vertebral arch appeared from 2 days to 2 years after birth, the median age with 6 months and the interquartile-range with 4-11 months. (3) There were four epiphyseal plates, including two vertebral arch epiphyseal plates, one anterior median epiphyseal plate, and one posterior median epiphyseal plate. The two epiphyseal closures of vertebral arch were at the median age of 6.2 years, interquartile-range of 4.5-7.0. The occurrence rate of anterior median epiphyseal plate was 37.43%. That of anterior median was at the median age of 4.8 years, interquartile-range of 2.8-6.0 years and the posterior median at 2.8 years, interquartile-range of 2-3.8 years. (4) The appearance of transverse ligament nodules was at the median age of 9 years, interquartile-range of 5.5-10. (5) These findings have concluded that there is a specific age range between the appearance of ossification center and the closing of epiphyseal plate. The variations or deformities of atlas are mainly the incomplete bone ring, accessory ossification center or epiphyseal line. CT image showing the development or deformity of atlas is clear and accurate, which has many advantages. 
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    Aging morphological characteristics of uncinate process of cervical vertebra and its clinical significance
    Wang Xing, Ageru, Jiregelegen, Zhang Chi, Zhao Lei, Zhang Yuanyuan, Bu Jiaqi, Keerqin, Zhao Xueting, Yang yuanhuizi, Wang Chaoqun, Li Kun, Zhang Shaojie, Shi Jun, Li Zhijun
    2023, 27 (22):  3580-3586.  doi: 10.12307/2023.359
    Abstract ( 161 )   PDF (2528KB) ( 9 )   Save
    BACKGROUND: As a unique structure of cervical vertebra, the occurrence and development of uncinate joint are closely related to the stability and range of motion of cervical vertebra, but it is also closely related to the incidence of cervical spondylosis. Understanding the developmental characteristics of uncinate joint is of great significance to the type, diagnosis and treatment of cervical spondylosis.  
    OBJECTIVE: To find the changing rules of uncinate process with age and increasing vertebral order by measuring the related diameters of uncinate process in cervical uncinate joints of different ages.
    METHODS: In a retrospective study, the imaging data of 1 447 cases of cervical vertebrae of different ages were collected. According to the age, they were divided into < 10 years, 10-19 years, 20-29 years, 30-39 years, 40-49 years, 50-59 years, ≥ 60 years groups. The uncinate process length, width, height, uncinate-transverse distance, uncinate process distance, anterior foot distance and posterior foot distance of uncinate process were measured.  
    RESULTS AND CONCLUSION: (1) The results showed that there were differences between males and females in the related structure of uncinate process, and the length, height and width of uncinate process increased slowly with the increase of vertebral sequence and age. The distance between uncinate process, the distance between the front foot of uncinate process and the distance between the posterior foot of uncinate process increased slowly with the increase of vertebral sequence, but the distance between them did not change significantly with the increase of age. The distance between hook and transverse increased slowly with the increase of vertebral order, but the change with age was not significant. (2) These results have concluded that there are gender and lateral differences in the uncinate process related structure of the uncinate joint of the cervical vertebra, and the overall trend increases slowly with the increase of age and vertebral order. Mastering the aging characteristics and development law of the uncinate joint can provide a theoretical basis for the prevention, diagnosis and treatment of related cervical spondylosis.
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    Influencing factors and current situation of parametric design of knee prosthesis
    Liu Chang, Liu Lei, Ma Chaoqun, Cao Chuanxu, Xu Changzhi
    2023, 27 (22):  3587-3593.  doi: 10.12307/2023.389
    Abstract ( 112 )   PDF (1576KB) ( 67 )   Save
    BACKGROUND: Parametric design of knee prosthesis is an effective method to reduce the loss of prosthesis and improve the survival rate of prosthesis. However, there is still a lack of comprehensive analysis on the parameterization of knee prosthesis.  
    OBJECTIVE: To summarize the failure forms of total knee arthroplasty, the research progress of parametric design of knee prosthesis, and put forward some suggestions.
    METHODS: Using the terms “TKA, Knee prosthesis, Tibial liner, Parametric design, Prosthesis replacement, Prosthesis loosening, Failure mode, Durability, Kinematics” as Chinese and English key words, relevant articles were searched in PubMed, Embase, CNKI, Wanfang and VIP databases. Finally, 64 articles were included. The development of knee prosthesis from three aspects was summarized and analyzed: Failure form of artificial knee joint prosthesis; development of parametric design of knee prosthesis; perfecting the parametric design of knee prosthesis.  
    RESULTS AND CONCLUSION: (1) Aseptic loosening, prosthesis infection, instability and tibial pad wear are the main failure forms of knee prosthesis. The knee prosthesis should be retained for several years after implantation. The damage of knee prosthesis, bone loss and the destruction of the original knee balance will have adverse effects on the recovery of the disease and human health. Therefore, we should pay attention to the removal of diseased knee joint and the implantation of prosthesis. Once an accident occurs before and after treatment, it should be diagnosed and treated according to the condition as soon as possible to prevent accidents. (2) The parametric design of prosthesis should make it have better biocompatibility, good contact performance, stable kinematic characteristics and low friction, so that patients can get better rehabilitation effect. (3) The contact mechanical and kinematic properties of knee prosthesis are affected by the consistency of coronal and sagittal curvature radii, respectively. The change of parameters will inevitably lead to the change of performance, so the competition between the kinematic performance and contact mechanical performance of knee prosthesis is inevitable. In the parametric design of knee prosthesis, both should be controlled within a reasonable range. (4) Fitness is an important index in the parametric design of prosthesis, and the division of its high and low levels has not yet been realized, which will be an important problem that scholars should overcome in the parametric design. (5) The research on the parameterization of knee prosthesis can improve its contact performance, make it have more stable kinematic characteristics, and provide important theoretical basis for the production, development and clinical application of prosthesis. It is of great significance to improve the success rate of knee prosthesis replacement, reduce the revision rate of knee prosthesis, and improve the quality of life of patients.
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    Influence of hip-preservation surgeries on subsequent total hip arthroplasty for osteonecrosis of the femoral head
    Wang Zhangzheng, Mo Liang, Zhou Chi, Liu Yuhao, Yan Hongsong, He Wei
    2023, 27 (22):  3594-3601.  doi: 10.12307/2023.374
    Abstract ( 182 )   PDF (1596KB) ( 10 )   Save
    BACKGROUND: Hip-preservation surgery is an important method for the treatment of young patients with early femoral head necrosis. However, there are many types of hip-preservation surgery, and all kinds of hip-preservation surgery have their own limitations and inevitable failure rate. Some patients received poor results after hip-preservation surgery, and had to undergo total hip arthroplasty.  
    OBJECTIVE: To review the research progress on the influence of various hip-preservation surgeries on subsequent total hip arthroplasty for osteonecrosis of the femoral head.
    BACKGROUND: Hip-preservation surgery is an important method for the treatment of young patients with early femoral head necrosis. However, there are many types of hip-preservation surgery, and all kinds of hip-preservation surgery have their own limitations and inevitable failure rate. Some patients received poor results after hip-preservation surgery, and had to undergo total hip arthroplasty.  
    OBJECTIVE: To review the research progress on the influence of various hip-preservation surgeries on subsequent total hip arthroplasty for osteonecrosis of the femoral head.
    METHODS:  Databases of Embase, CNKI and PubMed were searched with the key words of “osteonecrosis of the femoral head, hip-preservation surgery, core decompression, bone grafting, osteotomy, porous tantalum implantation, hip resurfacing arthroplasty” in Chinese and English, respectively. By reading the titles and abstracts, repetitive studies and low-quality or irrelevant articles were excluded. Finally, 58 articles were included for reviewing.  
    RESULTS AND CONCLUSION: (1) At present, the clinical application of hip-preservation surgery mainly includes core decompression, non-vascularized bone grafting, vascularized bone grafting, osteotomy, tantalum rod implantation and other categories, and different hip-preservation surgeries have their own characteristics and different influences on subsequent total hip arthroplasty. (2) As a “minimally invasive” operation, simple core decompression has little impact on subsequent total hip arthroplasty, but it may change the bone structure in the intertrochanteric region and increase the risk of intraoperative fracture in total hip arthroplasty. (3) Residual bone graft materials (especially fibula graft) in bone grafting affected the opening and expansion of medullary cavity and placement of femoral stem prosthesis during total hip arthroplasty. Vascularized bone grafting (especially musculoskeletal flap graft) increased the trauma of soft tissue, which was not conducive to the functional recovery of hip joint after total hip arthroplasty. (4) Osteotomy has the greatest influence on subsequent total hip arthroplasty, because it causes greater local soft tissue trauma and femoral deformity. Total hip arthroplasty after osteotomy is relatively difficult, and compared with other hip-preservation surgeries, osteotomy has disadvantages based on its influence on subsequent total hip arthroplasty. (5) There is a problem that the removal of tantalum rod implants increases the difficulty of total hip arthroplasty in the follow-up, and although the study found that the residual tantalum fragments did not increase the linear wear rate of the prosthesis in the short term, we still need to pay attention to the long-term effects of residual tantalum fragments. (6) Although all types of hip-preservation surgeries increase the difficulty of subsequent total hip arthroplasty to a certain extent, literature reports are generally positive. There is no literature report that previous hip-preservation surgery is not conducive to the prosthesis survival rate and hip function score after subsequent total hip arthroplasty, and total hip arthroplasty can still be used as a reliable treatment after hip preservation failure.
    Databases of Embase, CNKI and PubMed were searched with the key words of “osteonecrosis of the femoral head, hip-preservation surgery, core decompression, bone grafting, osteotomy, porous tantalum implantation, hip resurfacing arthroplasty” in Chinese and English, respectively. By reading the titles and abstracts, repetitive studies and low-quality or irrelevant articles were excluded. Finally, 58 articles were included for reviewing.  
    RESULTS AND CONCLUSION: (1) At present, the clinical application of hip-preservation surgery mainly includes core decompression, non-vascularized bone grafting, vascularized bone grafting, osteotomy, tantalum rod implantation and other categories, and different hip-preservation surgeries have their own characteristics and different influences on subsequent total hip arthroplasty. (2) As a “minimally invasive” operation, simple core decompression has little impact on subsequent total hip arthroplasty, but it may change the bone structure in the intertrochanteric region and increase the risk of intraoperative fracture in total hip arthroplasty. (3) Residual bone graft materials (especially fibula graft) in bone grafting affected the opening and expansion of medullary cavity and placement of femoral stem prosthesis during total hip arthroplasty. Vascularized bone grafting (especially musculoskeletal flap graft) increased the trauma of soft tissue, which was not conducive to the functional recovery of hip joint after total hip arthroplasty. (4) Osteotomy has the greatest influence on subsequent total hip arthroplasty, because it causes greater local soft tissue trauma and femoral deformity. Total hip arthroplasty after osteotomy is relatively difficult, and compared with other hip-preservation surgeries, osteotomy has disadvantages based on its influence on subsequent total hip arthroplasty. (5) There is a problem that the removal of tantalum rod implants increases the difficulty of total hip arthroplasty in the follow-up, and although the study found that the residual tantalum fragments did not increase the linear wear rate of the prosthesis in the short term, we still need to pay attention to the long-term effects of residual tantalum fragments. (6) Although all types of hip-preservation surgeries increase the difficulty of subsequent total hip arthroplasty to a certain extent, literature reports are generally positive. There is no literature report that previous hip-preservation surgery is not conducive to the prosthesis survival rate and hip function score after subsequent total hip arthroplasty, and total hip arthroplasty can still be used as a reliable treatment after hip preservation failure.
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    Complications after spinal fusion in patients with metabolic syndrome: a systematic review and meta-analysis
    Ma Maoxiao, Cui Guofeng, Zhang Xue, Zhang Hong, Liu Youwen, Yue Chen
    2023, 27 (22):  3602-3608.  doi: 10.12307/2023.373
    Abstract ( 173 )   PDF (1873KB) ( 40 )   Save
    OBJECTIVE: Metabolic syndrome has been shown to negatively affect postoperative outcomes across a range of surgical procedures. However, it is unclear whether metabolic syndrome is also associated with complications following spinal fusion surgery.  
    METHODS: CNKI, Wanfang, VIP, PubMed, OVID and Web of Science databases were comprehensively searched. Studies on postoperative complications of spinal fusion in patients with metabolic syndrome were selected. Relevant outcome measures included all-cause complications, cardiovascular complications, pulmonary complications, surgical site infection, sepsis, venous thromboembolic events (including deep vein thrombosis and pulmonary embolism), urinary tract infection, 30-day postoperative readmission rate, 30-day postoperative reoperation rate, 30-day postoperative mortality and hospitalization costs. Data were extracted and meta-analyzed or qualitatively synthesized for 11 kinds of outcomes.  
    RESULTS: (1) Eight studies, containing 1 prospective cohort study and 7 retrospective cohort studies, involving a total of 283 593 patients, were included. The overall quality of the included studies was good. (2) Meta-analysis results showed that metabolic syndrome increased the risk of all-cause complications [RR= 1.53, 95%CI(1.22, 1.93), P=0.000 3], pulmonary complications [RR=1.68, 95%CI(1.29, 2.17), P < 0.000 1], cardiac complications [RR=2.05, 95%CI(1.47, 2.87), P < 0.000 1], surgical site infection [RR=1.73, 95%CI(1.37, 2.20), P < 0.000 01], and 30-day readmission [RR=1.44, 95%CI(1.16, 1.79), P=0.001] compared with the non-metabolic syndrome. (3) Qualitative analysis suggested that metabolic syndrome was associated with increased medical costs.
    CONCLUSION: Metabolic syndrome patients are at increased risk of all-cause complications, pulmonary complications, cardiovascular complications, surgical site infection, and 30-day readmission after spinal fusion surgery.
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