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Table of Content

    28 September 2023, Volume 27 Issue 27 Previous Issue   
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    Finite element analysis of hip stress distribution at different hip abduction angles in patients with developmental dysplasia of the hip
    Guo Sutong, Guo Yu, Wang Ling, Ding Yujian, Ren Tianhao, Xu Haitao, Wang Yulin, Feng Dehong
    2023, 27 (27):  4265-4270.  doi: 10.12307/2023.647
    Abstract ( 268 )   PDF (2441KB) ( 23 )   Save
    BACKGROUND: There are relatively few finite element studies on hip dysplasia, and the influence of the size of hip abduction angle on the biomechanical distribution of the hip joint is not clear.  
    OBJECTIVE: To apply the finite element method to analyze the hip joint stress distribution on the healthy side and the affected side of patients with hip dysplasia under different abduction angles, and to provide solutions for the prevention, treatment and rehabilitation of hip dysplasia.
    METHODS: A patient with left-sided hip dysplasia was selected from the CT scan data of bilateral hip joints, and the hip joint model was established by Mimics software, solidified by Geomagic Wrap software and assembled with cortical bone and cancellous bone by Solidworks software. The Ansys Workbench software was used to load the joint load, and the stress distribution of the hip joint under the condition of single foot landing under different abduction angles was analyzed.  
    RESULTS AND CONCLUSION: (1) The model constructed in this study was consistent with the actual situation. As the hip abduction angle increased, the maximum stress value of the femoral neck in the normal hip part gradually increased and was always located on the medial side of the femoral neck, and the maximum stress value of the femoral head was the smallest when the hip abduction on the healthy side was 15°, and the maximum stress value above the acetabulum was the smallest when the hip abduction was 20°. (2) The maximum stress value in the affected hip of developmental dysplasia of the hip patients was always located above the acetabulum, and the maximum stress value in the acetabulum was minimal when the abduction of the hip was 25°; the maximum stress value in the femoral head was minimal when the hip was abducted at 20°, and the maximum stress value in the femoral neck was minimal when the hip was abducted at 0° and was located posterior to the femoral neck. As the hip abduction angle increased, the maximum stress point in the femoral neck gradually moved towards the medial inferior aspect of the femoral neck.
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    Finite element analysis of oblique-pulling manipulation in the treatment of lumbar synovial incarceration
    Lu Yu, Xiang Junyi, Yin Benjing, Bao Chaoyu, Bi Heng, Li Jizheng, Chen Shuai, He Guangxiong, Li Jubao
    2023, 27 (27):  4271-4276.  doi: 10.12307/2023.619
    Abstract ( 187 )   PDF (1995KB) ( 13 )   Save
    BACKGROUND: Oblique-pulling manipulation has a reliable curative effect on lumbar synovial incarceration, and it has been widely used in the clinic. However, the related research on the treatment of lumbar synovial incarceration by oblique-pulling manipulation is still relatively lacking.  
    OBJECTIVE: To analyze the biomechanical mechanism and effect of oblique-pulling manipulation in the treatment of lumbar synovial incarceration by three-dimensional finite element method, and provide theoretical basis for the treatment of lumbar synovial incarceration by oblique-pulling manipulation.
    METHODS: The CT data of patients with lumbar synovial incarceration were collected, and the three-dimensional finite element model of L4-5 motor unit of spine was established by using Mimics and Ansys software. The operation process of the oblique-pulling manipulation in the left lateral position was simulated, and the influence of the oblique-pulling manipulation on the biomechanics, morphological changes and facet joint contact area of each tissue structure of L4-5 segment of lumbar spine was analyzed.  
    RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of lumbar L4-5 segment was established, and the validity of the model was verified. (2) Before and after the oblique-pulling manipulation was applied, the stress of left facet joint cartilage increased from 2.959 MPa to 14.35 MPa; the strain increased from 0.078 34 to 0.345 1, and the contact area of articular cartilage increased from 20.806 2 mm2 to 94.872 7 mm2. On the other hand, the stress of the right facet joint cartilage decreased from 3.127 MPa to 0 MPa; the strain decreased from 0.081 96 to 0, and the articular cartilage contact surface decreased from 16.705 3 mm2 to 0 mm2 on the right. (3) It is concluded that oblique-pulling manipulation has a good effect on patients with lumbar synovial incarceration. It can change the stress and strain of the articular process and the contact area of the upper and lower articular processes, fully release and open the articular process, and achieve the therapeutic purpose of reducing the articular process and relieving the synovial incarceration.
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    Mechanical effect of oblique-pulling manipulation on triarticular complex after human lumbar intervertebral disc degeneration
    Xu Guangming, Liang Ziyang, Wang Hongbo, Zhang Zhen, Xiao Qinghua, Yang Jiyong, Lin Xiaosheng
    2023, 27 (27):  4277-4282.  doi: 10.12307/2023.499
    Abstract ( 179 )   PDF (1760KB) ( 7 )   Save
    BACKGROUND: Biomechanical studies on the treatment of lumbar intervertebral disc degeneration by oblique-pulling manipulation mainly focus on the stress and displacement analysis of the annulus fibrosus, nucleus pulposus and bony structure, while mechanical studies on the three-articular complex after lumbar intervertebral disc degeneration have not been found.  
    OBJECTIVE: To analyze the biomechanical dynamic changes of the three-joint complex after lumbar intervertebral disc degeneration by oblique-pulling manipulation with finite element method.
    METHODS: CT images were imported to Mimics, Geomagic Studio, SolidWorks, Hypermesh and other finite element software to construct L4 and L5 vertebral body, intervertebral disc, ligament, joint capsule and other finite element models. According to the different material properties of lumbar disc degeneration, the values were assigned to establish normal, mild and moderate degeneration models. The mechanical distribution differences of the three-joint complex with different degrees of lumbar disc degeneration were analyzed by oblique-pulling manipulation.  
    RESULTS AND CONCLUSION: (1) After oblique-pulling manipulation, the maximum stresses of normal, mild and moderate degenerative intervertebral discs were 0.78, 3.21, and 3.94 MPa, respectively, while the corresponding maximum displacement of the intervertebral disc gradually decreased. (2) After oblique-pulling manipulation, the annulus fibrosus stress of normal, mild and moderate degenerative intervertebral discs increased gradually, and the annulus fibrosus stress of moderate degenerative intervertebral discs increased significantly. The maximum stresses in the nucleus pulposus of normal, mild and moderate degenerative intervertebral discs were 0.87, 0.56, and 0.44 MPa, and the maximum stretched heights of the joint capsule were 1.74, 2.48, and 3.10 mm, respectively. (3) The results suggest that the normal intervertebral disc without degeneration can reduce the stress loading of the lumbar triarticular complex and play a protective role. Oblique-pulling manipulation of moderate degenerative intervertebral disc is safe, and its maximum stress will not cause damage to lumbar tissue.
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    Construction of finite element model of hallux valgus foot and biomechanical analysis of the first metatarsophalangeal joint
    Tang Zhi, Lang Lei, Wang Renyuan, Gu Song
    2023, 27 (27):  4283-4290.  doi: 10.12307/2023.611
    Abstract ( 183 )   PDF (11518KB) ( 10 )   Save
    BACKGROUND: Finite element model construction and biomechanical analysis make it possible to explore the formation of hallux valgus and the recovery of related structures and functions.  
    OBJECTIVE: To establish a finite element model of moderate hallux valgus foot in the neutral position with load to analyze the changes of the angle of the first metatarsophalangeal joint and the stress distribution of the corresponding bones under the action of external forces of different parts and sizes.
    METHODS: One female volunteer with moderate hallux valgus was selected, and CT image data were collected. The computer 3D imaging technology was used to conduct 3D finite element modeling to verify the validity of the model, and standardize the measurement method of the angle of the first metatarsophalangeal joint and the angle between the first and second metatarsal. Variables were controlled and the force was changed in turn to observe the changes of the above two angles, and analyze the stress distribution of the first metatarsal and proximal phalanx.  
    RESULTS AND CONCLUSION: (1) An effective finite element model of moderate hallux valgus foot was established, which showed that a large stress concentration appeared in the first metatarsal. The distribution trend was from the medial middle and lateral middle of the bone body, gradually decreasing towards the dorsal and basal sides of the bone. (2) The feasibility of the method for determining the axis reference point of the first metatarsal, the second metatarsal and the proximal phalanx of the great toe was verified in finite element analysis. (3) The horizontal force acting on the lateral middle area of the distal phalanx of the first great toe has a direct effect on the change of the first metatarsophalangeal angle, but it has no linear effect. The regional force acting on the medial capsule of the metatarsophalangeal joint mainly affects the size of the first-second metatarsophalangeal angle. The horizontal force acting on the medial surface of the proximal metatarsal has little effect on the two angles.
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    Digital measurement of femoral valgus angle and femoral posterior condyle angle in elderly people over 60 years old in northern China and comparison with young and middle-aged population
    Li Jiawei, Li Canran, He Yujie, Wu Chao, Jin Feng, Zhang Kai, Li Xiaohe
    2023, 27 (27):  4291-4296.  doi: 10.12307/2023.396
    Abstract ( 163 )   PDF (2088KB) ( 7 )   Save
    BACKGROUND: Total knee arthroplasty is an effective treatment for end-stage osteoarthritis of the knee. The femoral valgus angle and femoral posterior condyle angle are important parameters for preoperative evaluation, and selecting the proper angle for osteotomy will be beneficial to the reconstruction of the force line of the lower limb and the stability of the prosthesis after surgery. Therefore, the study of femoral valgus angle and femoral posterior condyle angle is of great significance for the precise osteotomy of total knee arthroplasty.  
    OBJECTIVE: To measure the femoral valgus angle and femoral posterior condyle angle in different age groups of elderly people in Inner Mongolia Autonomous Region and to understand the distribution of these two parameters in different age groups.
    METHODS: A total of 175 patients receiving lower extremity vascular examination from January 2018 to December 2021 in The Affiliated Hospital of Inner Mongolia Medical University and The Second People’s Hospital of Ulanqab were selected in this study. They were divided into four groups: < 60 years old (group A, n=41), 60-69 years old (group B, n=52), 70-79 years old (group C, n=41), and > 80 years old (group D, n=41). The CT data of the lower extremity blood vessels of the patients were collected. Mimics 21.0 software was used to reconstruct 3D model and rotate to standard orthostatic position. Simulated lower limb X-ray films were used to measure the femoral valgus angle. CT cross-section was used to measure the femoral posterior condyle angle. The SPSS 25.0 software was used to analyze the difference of two parameters among different age groups, and difference of two parameters between sexes in the same age group and the correlation between the two parameters and age.
    RESULTS AND CONCLUSION: (1) For the same gender, the femoral valgus angle of groups A and B was smaller than that of groups C and D (P < 0.05). For male patients, the femoral posterior condyle angles in groups A and B were smaller than those in groups C and D (P < 0.05). For female patients, the femoral posterior condyle angle in group A was smaller than that in groups C and D (P < 0.05), and that in group B was smaller than that in group D (P < 0.05). (2) In the same group, there was no significant difference in femoral valgus angle and femoral posterior condyle angle between men and women (P > 0.05). (3) Pearson correlation analysis showed that femoral valgus angle and femoral posterior condyle angle were positively correlated with age, and the correlation coefficients were 0.31 and 0.46, respectively (P < 0.01). (4) The results confirm that when performing total knee arthroplasty for elderly people, the effect of age on femoral valgus angle and femoral posterior condyle angle should be considered. Preoperative CT examination of the lower extremity and 3D reconstruction measurement are recommended to clarify the femoral valgus angle and femoral posterior condyle angle for individualized osteotomy.
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    Changes in sagittal parameters of cervical spine after single-level Mobi-C artificial disc replacement and ROI-C anterior cervical fusion
    Ran Yu, Bai Chunxiao, Liu Chuyin, Zhao Xueqian, Long Shuiwen, Qin Changlong, Li Zhongze, Zhang Chao, Jia Yusong, Chen Jiang
    2023, 27 (27):  4297-4303.  doi: 10.12307/2023.384
    Abstract ( 153 )   PDF (1947KB) ( 10 )   Save
    BACKGROUND: Preliminary studies have shown that double-level cervical disc replacement can significantly improve the sagittal parameters of the cervical spine, and is superior to the double-level ROI-C fusion cage, but there are differences in the sagittal parameters of the cervical spine in different surgical segments.  
    OBJECTIVE: To study the differences between single-level Mobi-C artificial cervical disc replacement and sagittal parameters of the cervical spine after ROI-C anterior cervical fusion.
    METHODS: Sixty patients with radicular, spinal cord or mixed cervical spondylosis who were treated in Dongzhimen Hospital, Beijing University of Chinese Medicine from January 2018 to February 2020 were retrospectively analyzed and divided into Mobi-C cervical artificial disc replacement group (disc group) and ROI-C anterior cervical fusion group (fusion group) according to the surgical method. All patients completed effective follow-up for more than half a year, mean (12.1±5.0) months. Visual analogue scale scores, cervical spine JOA scores, and X-ray films were detected before and 1 week after surgery and during final follow-up. The following cervical sagittal parameters were measured: C2-7 Cobb angle, C0-2 Cobb angle, C2-7 sagittal vertical axis, neck tilt, T1 slope, C7 slope, thoracic inlet angle, and spinal function unit angle. Intra- and intergroup differences were analyzed between both groups. A Pearson correlation analysis was conducted.  
    RESULTS AND CONCLUSION: (1) At the 1 week after surgery and the last follow-up, visual analogue scale scores were significantly lower than before surgery (P < 0.05). Cervical spine JOA score was significantly higher (P < 0.05). (2) Compared with the preoperative data, there were no significant differences in C2-7 Cobb angle, C2-7 sagittal vertical axis or T1 slope in intervertebral disc group (P > 0.05); C0-2 Cobb angle and high T1 slope decreased (P < 0.05), while spinal function unit angle increased (P < 0.05). There were no significant differences in C2-7 Cobb angle, C2-7 sagittal vertical axis or T1 slope in the fusion group (P > 0.05), but spinal function unit angle and C7 slope increased (P < 0.05). Spinal function unit angle of the disc group was higher than that of the fusion group (P < 0.05). (3) The postoperative sagittal parameters of the patients in the fusion group showed a significant positive correlation between C2-7 Cobb angle and C7 slope; neck tilt was significantly positively correlated with thoracic inlet angle; T1 slope was significantly positively correlated with C7 slope; C7 slope was significantly positively correlated with C0-2 Cobb angle. In replacement group, C2-7 Cobb angle was significantly positively correlated with C7 slope, spinal function unit angle and T1 slope, and significantly negatively correlated with C0-2 Cobb angle; neck tilt was significantly positively correlated with thoracic inlet angle, and negatively correlated with C2-7 sagittal vertical axis, T1 slope and spinal function unit angle; C2-7 sagittal vertical axis was significantly positively correlated with C7 slope, spinal function unit angle and T1 slope; T1 slope was significantly positively correlated with C7 slope and spinal function unit angle; C7 slope was significantly positively correlated with spinal function unit angle. (4) In the disc group, postoperative thoracic inlet angle, T1 slope and C0-2 Cobb angle of patients with high T1 slope were significantly lower than those before operation (P < 0.05), while the spinal function unit angle was significantly higher than that before operation (P < 0.05). However, no significant changes were found in the fusion group. (5) It is concluded that Mobi-C intervertebral disc and ROI-C fusion device have significant efficacy in the treatment of single-level cervical spondylosis. Compared with the ROI-C cage, the Mobi-C disc restores the physiological curvature mainly by reconstructing the local cervical lordosis and upper cervical lordosis, and still maintains this ability in the high T1 slope angle patient population.
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    Dynamic monitoring of plasma human alpha-defensin 1-3 and peripheral blood inflammatory markers after primary total knee arthroplasty
    Chen Jinlun, Deng Peng, Ye Pengcheng, Cao Houran, Zeng Huiliang, Feng Wenjun, Zeng Jianchun, Zeng Yirong
    2023, 27 (27):  4304-4311.  doi: 10.12307/2023.642
    Abstract ( 157 )   PDF (1637KB) ( 17 )   Save
    BACKGROUND: Previous studies demonstrated that synovial fluid human α-defensin 1-3 can provide a high accuracy for diagnosing periprosthetic joint infection. However, arthrocentesis is an invasive manipulation that repeated examination may increase the risk of developing periprosthetic joint infection and confuse the orthopedists on the cause and onset time of the disease so that it is unsuitable for conventional dynamic detection after total knee arthroplasty. Oppositely, peripheral blood tests have the advantages of micro-trauma, convenient access to samples and possibility of continuous and dynamic monitoring. However, no study about the changes of human α-defensin 1-3 content in plasma following primary total knee arthroplasty has been published by now.  
    OBJECTIVE: To observe the dynamic changes of human α-defensin 1-3 content in plasma and inflammatory marker levels in peripheral blood following primary total knee arthroplasty, so as to provide a new method for early screening for periprosthetic joint infection after total knee arthroplasty.
    METHODS: From April to December 2015, patients who had undergone unilateral primary total knee arthroplasty because of advanced knee osteoarthritis were prospectively included in the study. The inflammatory marker levels in peripheral blood were tested on the preoperative day and postoperative 1, 3, 5 days, 2 weeks, 1, and 3 months. Sandwich enzyme-linked immunosorbent assay was used to detect the content of plasma human α-defensin 1-3.  
    RESULTS AND CONCLUSION: Finally, 27 patients were included in the study. The postoperative level of C-reactive protein and erythrocyte sedimentation rate in peripheral blood showed a rise first followed by a decline defined single-peaked change pattern. The content of white blood cell, neutrophil and neutrophil percentage in peripheral blood and human α-defensin 1-3 in plasma showed a double-peaked change pattern. That was, after the arthroplasty, it first rose and then fell, and then rose again and then fell again. The changing rate and extent of plasma human α-defensin 1-3 were more obvious than peripheral blood white blood cell, neutrophil and neutrophil percentage. The prominent “bimodal situation” suggests that plasma human α-defensin 1-3 may be a good biomarker for dynamic monitoring of inflammatory activity after total knee arthroplasty, which provides new ideas and evidence for monitoring and diagnosing periprosthetic infection after total knee arthroplasty.
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    Assistance of traction table for total hip arthroplasty through the direct anterior approach for treating femoral neck fracture in the elderly
    Li Junran, Zhai Jingxiu, Zhao Hongbo, Wang Lei, Wang Hongrun, Liang Junsheng, Li Ligeng
    2023, 27 (27):  4312-4317.  doi: 10.12307/2023.638
    Abstract ( 197 )   PDF (2038KB) ( 13 )   Save
    BACKGROUND: Total hip arthroplasty through the direct anterior approach has a significant minimally invasive effect and has the advantages of less soft tissue damage, less bleeding, less pain, and fast recovery. However, it is difficult to operate. Whether the traction table should be required or not during surgery is still controversial.  
    OBJECTIVE: To analyze the clinical efficacy of assisting by the traction table in direct anterior approach-total hip arthroplasty for femoral neck fracture in the elderly.
    METHODS: A retrospective study was conducted to assess the clinical data of 126 elderly patients with femoral neck fractures from January 2019 to March 2020 in Second Hospital of Tangshan. 67 patients were operated by the assistance of traction table and included as the traction table group. 59 patients were operated in non-traction table and set as the conventional operation group. The preoperative preparation time, the operation time, the anesthesia time, intraoperative blood loss, and postoperative radiological evaluation of prosthesis were recorded between the two groups. Hip joint function after operation was assessed by Harris score. Complications in the two groups were documented.  
    RESULTS AND CONCLUSION: (1) All patients were followed up over 12 months after operation. (2) The traction table group showed significant longer preoperative preparation time, shorter operation time, less intraoperative blood loss and better central fixation ratio of femoral prosthesis than those in the conventional operation group (P < 0.05). (3) No significant difference was found between the traction table group and the conventional operation group for the anesthesia time, the ratio of the acetabular cup located in the safe zone, the ratio of limb length discrepancy shortened than 10 mm, Harris scores and complications in 1 week, 1, 6 and 12 months after the operation (P > 0.05). (4) The results conclude that compared with performing traditional total hip arthroplasty through the direct anterior approach without the use of a traction table on the treatment of geriatric patients suffering from femoral neck fracture, assistance of traction table in direct anterior approach-total hip arthroplasty can significantly shorten operation time, reduce the intraoperative blood loss and improve accuracy of femoral prosthesis. However, using a traction table can also prolong the preoperative preparation time.
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    OrthoPilot navigation system assisted total hip arthroplasty improves the accuracy and safety of acetabular cup placement
    Ren Yi, Lu Ming, Qin Kunpeng, Zhang Hui, Gao Weilu, Li Yetian, Wang Jun, Yin Li, Yin Zongsheng
    2023, 27 (27):  4318-4323.  doi: 10.12307/2023.648
    Abstract ( 168 )   PDF (1796KB) ( 13 )   Save
    BACKGROUND: As a classic surgical method for the treatment of femoral head necrosis and femoral neck fracture, total hip arthroplasty has some problems, such as poor placement of prosthesis, postoperative dislocation and so on. OrthoPilot navigation assisted total hip arthroplasty can theoretically improve the accuracy and safety of prosthesis placement. At present, there are few studies on its application in total hip arthroplasty in China.  
    OBJECTIVE: To explore the feasibility and short-term clinical effect of OrthoPilot navigation assisted total hip arthroplasty.
    METHODS: A retrospective analysis was performed in 23 patients who received OrthoPilot navigation assisted total hip arthroplasty in the Department of Joint surgery of the First Affiliated Hospital of Anhui Medical University from June 2019 to April 2022. A total of 23 patients with freehand total hip arthroplasty were matched at 1:1 according to sex, age, body mass index and preoperative Harris score. The anteversion and inclination angles during and after operation were measured and counted. The operation time, total blood loss, postoperative drainage, average hemoglobin loss and postoperative Harris scores were calculated.  
    RESULTS AND CONCLUSION: (1) The operation time in the navigation group was (152.4±39.9) minutes and in the non-navigation group was (115.3±35.4) minutes, with statistically significant (P=0.02). (2) In terms of angle measurement, the anteversion angle of acetabular cup was (42.3±3.5)° during operation and (42.6±5.5)° after operation, with no significant difference (P=0.574) in the navigation group. The inclination angle of acetabular cup was (18.5±3.4)° during operation and (19.3±3.9)° after operation, with no significant difference (P=0.567) in the navigation group. (3) According to “Lewinnek safe zone”, 22 hips were in the safety zone and 1 hip outside the safety zone after operation in the navigation group, while 17 hips were in the safety zone and 6 hips outside the safety zone after operation in the non-navigation group, showing a significant difference (χ2=4.212, P=0.04). (4) In terms of surgical treatment, there was no significant difference in total blood loss, postoperative drainage, average hemoglobin loss, Harris score, and the incidence of postoperative lower extremity deep venous thrombosis between the two groups. (5) The average follow-up was 3 months after operation, and there were no patients with early infection or dislocation in the two groups. (6) These results verify that OrthoPilot navigation assisted total hip arthroplasty can improve the accuracy and safety of acetabular cup placement, and its short-term clinical effect is not significantly different from that of freehand total hip arthroplasty.
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    Preoperative planning-based navigation system-assisted total hip arthroplasty: a randomized controlled clinical study
    Guo Feng, Zhang Zhifeng, Sun Zhiwen, Lyu Xin, Piao Junjie, Wang Di, Niu Shuang, Chen Xiaowei, Zhang Yibo
    2023, 27 (27):  4324-4331.  doi: 10.12307/2023.605
    Abstract ( 176 )   PDF (2029KB) ( 14 )   Save
    BACKGROUND: Total hip arthroplasty is an effective treatment for advanced osteoarthritis of the hip, rheumatoid arthritis, ischemic necrosis of the femoral head, ankylosing spondylitis of the hip, pain, ankylosis and functional deficits due to fractures of the femoral neck in advanced age. The longevity of the acetabular prosthesis after total hip arthroplasty depends primarily on the accurate placement of the acetabular cup. A preoperatively planned navigation system was applied to assist total hip arthroplasty.  
    OBJECTIVE: To evaluate the effectiveness of a preoperative planning-based navigation system for achieving optimal mounting accuracy of implanted acetabulars in total hip arthroplasty and to elucidate the clinical utility of this navigation system.
    METHODS: A centralized randomization system was used to assign subjects to the group to reduce selection bias. Subjects were randomized in a 1:1 ratio to the navigation group (20 cases) and the conventional technique group (23 cases), with one patient lost to follow-up in the navigation group. Total hip arthroplasty was performed in the lateral decubitus position with a posterolateral approach. The navigational group used a preoperative planning-based navigation system to assist in the implantation of the acetabular cup, and the conventional technique group used conventional surgical instruments to guide the implantation of the acetabular cup. The acetabular position was determined by CT at 1 month (±7 days) postoperatively and the abduction and anteversion angles were measured and recorded; the Harris score, WOMAC score and SF-36 score were performed.  
    RESULTS AND CONCLUSION: (1) The mean abduction angle of the acetabular prosthesis placed using preoperative planning-based navigation system was (41.82±5.26)˚ and the mean abduction angle of the acetabular prosthesis placed using conventional surgical techniques was (43.69±5.83)˚, with no significant difference (P=0.29). The mean anteversion angle of the acetabular prosthesis placed using preoperative planning-based navigation system was (18.95±5.24)˚ and the angle was (21.73±6.50)˚ for acetabular prostheses placed with conventional surgical techniques, with no significant difference (P=0.14). (2) 94.7% of acetabular prostheses placed with the aid of preoperative planning-based navigation system were placed within the Lewinnek safety zone, and 60.9% of acetabular prostheses placed in the conventional technique group were placed within the Lewinnek safety zone (χ²=4.844, P=0.028); 73.7% of acetabular prostheses placed with the aid of preoperative planning-based navigation system were placed within the Callanan safety zone, while 34.8% of acetabular prostheses placed in the conventional technique group were placed within the Callanan safety zone (χ²=6.313, P=0.012), and the accuracy of the navigation group was significantly better than that of the conventional technique group. (3) The intraoperative bleeding of total hip arthroplasty was not significant in the two groups, and the operating time was significantly longer in the navigation group. The Harris score, WOMAC score and SF-36 score improved significantly in both groups after arthroplasty compared with those before arthroplasty (P < 0.05). (4) These results concluded that both preoperative planning-based navigation system-assisted total hip arthroplasty and conventional total hip arthroplasty significantly improved patients' functional scores, and the preoperative planning-based navigation system improved the positioning accuracy of the acetabular arthroplasty in a safe area, but the navigation group took longer to operate.
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    Comparison of robot-assisted and free-hand cortical bone trajectory screw in lumbar spinal surgery for senile osteoporosis
    Ma Sai, Liu Bo, Li Nan, He Da
    2023, 27 (27):  4332-4336.  doi: 10.12307/2023.399
    Abstract ( 192 )   PDF (1694KB) ( 7 )   Save
    BACKGROUND: Compared with pedicle screws, cortical bone trajectory screws can improve the holding force, but they have longer learning curve and high misplacement rate. Orthopedic robots can overcome the above limitations and improve the accuracy and safety of screw placement.  
    OBJECTIVE: To compare the accuracy and safety of robot-assisted with those of free-hand cortical bone trajectory screw placement in senile osteoporotic patients with lumbar spinal surgery.
    METHODS: From June 2015 to March 2021, data of patients aged ≥65 years old with osteoporosis, who underwent lumbar cortical bone trajectory screw instrumentation in Beijing Jishuitan Hospital, were retrospectively analyzed. A total of 64 patients were included in the study. In the robot group (n=23), 92 TiRobot-assisted cortical bone trajectory screws were implanted. In the free-hand group (n=41), 164 cortical bone trajectory screws were implanted. The modified Gertzbein-Robbins scale was used to assess the accuracy of screw placement and the incidence of proximal facet joint violation. Operative time, intraoperative blood loss, postoperative hospital stay, and complications were observed.  
    RESULTS AND CONCLUSION: (1) In the robot group, the proportion of clinically acceptable screws (97.8%) was significantly higher than the 87.2% in the free-hand group (P < 0.001). (2) There was no statistically significant difference in the rate of cephalic facet joint violation between the robot and free-hand groups (P = 0.157). (3) There was no statistically significant difference in the blood loss, postoperative hospital stay, or wound infection between the two groups. (4) These findings indicate that in osteoporotic patients with lumbar spine surgery, robot-assisted placement of cortical bone trajectory screw is more accurate and safe compared with free-hand placement.
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    Comparison of the opening angle and cervical vertebra function of two different hinge rongeurs in French-door laminoplasty
    Sun Jun, Zhan Mingbin, Liu Xizhe, Liu Shaoyu
    2023, 27 (27):  4337-4344.  doi: 10.12307/2023.628
    Abstract ( 161 )   PDF (2708KB) ( 9 )   Save
    BACKGROUND: French-door laminoplasty is a commonly used procedure for the treatment of cervical multi-segment degenerative myelopathy. At present, the prediction and control of the intraoperative opening angle need further improvement.   
    OBJECTIVE: To compare the opening angle and clinical outcomes of two different hinge rongeurs in the cervical French-door laminoplasty.
    METHODS: Data of 57 cervical multi-segment degenerative myelopathy patients in Seventh Affiliated Hospital of Sun Yat-sen University and First Affiliated Hospital of Sun Yat-sen University from June 2018 to June 2020 were retrospectively analyzed. The patients were divided into 20° rongeur group (n=31) and 15° rongeur group (n=26). Comparative study was made to find out the differences in functional outcomes (modified Japanese Orthopaedic Association score and visual analogue scale score), radiological outcomes (lamina angle, sagittal diameter of spinal canal, and hinge healing), and postoperative complications (axial symptoms and C5 nerve root paralysis).   
    RESULTS AND CONCLUSION: (1) There was no significant difference in postoperative modified Japanese Orthopaedic Association score and postoperative visual analogue scale score between the two groups. (2) The postoperative lamina angles of the two groups were significantly higher than the preoperative lamina angles (P < 0.01). Among them, the postoperative lamina angle of the 15° hinge group (62.74±7.62)° was significantly smaller than that of the 20° hinge group (68.55±8.71)° (P < 0.01). The sagittal diameter of spinal canal of 15° rongeur group (13.52±2.16) mm was significantly lower than that of the 20° rongeur group (15.39±2.85) mm (P < 0.01). (3) At 4 weeks after operation, the fusion rate of the hinge in the 15° rongeur group was significantly higher than that of the 20° rongeur group (49%, 35%, P < 0.01). (4) There was no significant difference in the incidence of postoperative complications between the two groups. (5) It is indicated that when the hinge rongeur is used, the opening angle can be predicted before the operation and accurately controlled during the operation. Compared with the 20° hinge rongeur, using the 15° hinge rongeur to make the hinge can expand the lamina angle about 25° and reach about 63° after operation, avoiding the opening angle and the sagittal diameter of the spinal canal being too large. Both the 15° hinge rongeur and the 20° hinge rongeur can achieve satisfactory decompression effect, but the hinge healing time in the 15° hinge rongeur group is shorter, which is beneficial to the recovery of postoperative neurological function.
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    Application of multi-slice spiral CT combined with 3D printing in the treatment of rotationally unstable pelvic fractures
    Alimu·Keremu, Liang Zhilin, Pazila·Aila, Maimaitiaili·Abulikemu, Aikebaier·Tuxun
    2023, 27 (27):  4345-4350.  doi: 10.12307/2023.602
    Abstract ( 159 )   PDF (5885KB) ( 18 )   Save
    BACKGROUND: Pelvic fractures are a serious type of fracture, and there are limitations in the two-dimensional plane display effect of pure multi-slice spiral CT three-dimensional images, and there is a lack of preoperative planning guidance for pelvic fractures.  
    OBJECTIVE: To analyze clinical effect of multi-slice spiral CT combined with 3D printing in patients with rotationally unstable pelvic fractures.
    METHODS: From January 2017 to December 2020, clinical data of 90 patients with rotationally unstable pelvic fractures admitted to the First People’s Hospital of Kashgar were included. They were grouped according to the random number table method. In the study group, 47 patients underwent multi-slice spiral CT combined with 3D printing technology to guide the operation. In the control group, 43 patients used multi-slice spiral CT for preoperative guidance before open reduction and internal fixation. After 1 year of follow-up, the fracture healing time of the two groups was recorded to evaluate the quality of pelvic reduction. The pelvic function recovery results were evaluated with reference to the Majeed pelvic quantitative scoring standard. The postoperative adverse event rate in the two groups was calculated.  
    RESULTS AND CONCLUSION: (1) The screw dislocation rate in the study group was lower than that in the control group (P < 0.05), and the fracture healing time was shorter than that in the control group (P < 0.05). The excellent and good rate of pelvic fracture reduction 3 months after operation was higher in the study group than that of the control group (P < 0.05). (2) Compared with 3 months after operation, the pelvic function scores of the two groups at 6 and 12 months after operation were higher (P < 0.05). There was no significant difference in pelvic function scores between the two groups at 3, 6, and 12 months after operation (P > 0.05). (3) Among the 47 cases in the study group, 1 case of fracture displacement and 2 cases of traumatic arthritis occurred, and the incidence of adverse events was 6%. Among the 43 cases in the control group, malunion occurred in 1 case, heterotopic ossification in 1 case, fracture displacement in 2 cases, traumatic arthritis in 2 cases, and pelvic instability in 2 cases, with an adverse event rate of 19%. There was no significant difference in the adverse event rate between the two groups (P > 0.05). (4) It is suggested that for rotationally unstable pelvic fractures, compared with multi-slice spiral CT alone, the use of multi-slice spiral CT combined with 3D printing technology in the guidance of the surgical plan can improve the quality of fracture reduction, shorten the fracture healing time and reduce the screw dislocation rate.
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    Factors associated with subscapularis injury and predictive efficacy based on three-dimensional CT reconstruction
    Li Daen, Wu Yafei, Qiu Shang, Wang Gang, Gao Xuren, Chen Xiangyang
    2023, 27 (27):  4351-4356.  doi: 10.12307/2023.637
    Abstract ( 192 )   PDF (1657KB) ( 8 )   Save
    BACKGROUND: As the largest and only anterior rotator cuff muscle in the rotator cuff muscle group, the subscapularis muscle is often neglected for its injury, and the local injury of the subscapular muscle is still difficult to diagnose. In recent years, studies have found that the coracohumeral distance and coracoid overlap distance were used as predictors of subscapularis muscle injury.
    OBJECTIVE: To investigate the relationship between the coracohumeral distance, coracoid overlap distance and the difference between the coracohumeral distance of the patient’s bilateral shoulder joint and subscapularis injury, and to evaluate the diagnostic efficacy of each parameter on subscapularis injury.
    METHODS: Preoperative clinical and imaging data of patients with degenerative rotator cuff injury from February 2021 to June 2022 were retrospectively collected, and patients were divided into the group with rotator cuff injury combined with subscapularis tear (subscapularis tear group, 28 patients) and the group with rotator cuff injury without subscapularis tear (control group, 56 patients) based on intraoperative arthroscopic findings. The CT data of the enrolled patients were imported into Mimics software in DICOM format. The scapula and proximal humerus of the patients were reconstructed; the measurement points were determined to establish the measurement plane; the coracohumeral distance and coracoid overlap distance of the patients were measured in 3-matic software. The differences in parameters between the two groups of patients and bilateral differences within the groups were compared, and receiver operating characteristic curve analysis was performed for each parameter to determine the area under the curve and the optimal cut-off value for each parameter.
    RESULTS AND CONCLUSION: (1) Coracohumeral distance among groups: (7.00±0.87) mm in the subscapularis tear group and (9.08±1.02) mm in the control group. Coracohumeral distance in the subscapularis tear group was significantly smaller than that in the control group (P < 0.01). Coracoid overlap distance among groups: (21.05±1.98) mm in the subscapularis tear group and (19.46±1.55) mm in the control group. Coracoid overlap distance in the subscapularis tear group was significantly larger than that in the control group (P < 0.01). (2) Difference in coracohumeral distance between the two groups: The coracohumeral distance of the affected side of the subscapularis tear group (7.00±0.87) mm was significantly smaller than that of the healthy side (9.26±0.87) mm, and the difference was statistically significant (P < 0.01). (3) The receiver operating characteristic analysis: the areas under the curve for the difference in coracohumeral distance, coracoid overlap distance, and bilateral coracohumeral distance were 0.884, 0.729, and 0.905, respectively; the best cut-off values were 7.65 mm, 20.2 mm, and 1.15 mm, respectively. (4) It is concluded that the coracohumeral distance, coracoid overlap distance, and bilateral coracohumeral distance difference are all related to subscapularis injury, and all can be used as predictors of subscapularis injury, with coracohumeral distance difference having the highest predictive efficacy, and the three measured parameters can provide some reference values in preoperative clinical diagnosis.
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    Effect of sigmoid notch of distal radius on the stability of distal radioulnar joint based on CT images
    Shang Zijian, Guo Lin, Wang Zhi, Meng Xianghong, Chen Fei, Zhang Xuejun
    2023, 27 (27):  4357-4361.  doi: 10.12307/2023.625
    Abstract ( 192 )   PDF (1816KB) ( 7 )   Save
    BACKGROUND: Studies have shown that the bony anatomy of the radius and ulna plays a role in the stability of the distal radioulnar joint, especially the shape of the distal radius sigmoid notch. Previous studies have mostly focused on cadaver studies or biomechanical studies, while few studies have used imaging methods to assess the effect of morphology on the stability of the distal radioulnar joint.  
    OBJECTIVE: To assess the effect of different shapes of sigmoid notch of distal radius on the stability of distal radioulnar joint by CT.

    METHODS: The CT images of wrist and forearm of 151 cases were analyzed retrospectively. According to the morphological characteristics of the sigmoid notch of the distal radius on the axial CT image, it was divided into four shapes “Flat”, “Ski”, “C” and “S”. The chi-square test was used to compare the differences between the 4-type notch. According to the clinical diagnosis of distal radioulnar joint instability, they were divided into instability group and stability group to compare the effects of different forms of radial sigmoid notch on the stability of distal radioulnar joint.  

    RESULTS AND CONCLUSION: (1) There were 151 patients with wrist injury, including 77 males and 74 females, with an average age of 39.0 (55.0-32.0) years. There were 42 cases of Flat type radial sigmoid notch (27.8%), 47 cases of Ski type radial sigmoid notch (31.1%), 39 cases of C type radial sigmoid notch (25.8%), and 23 cases of S type radial sigmoid notch (15.2%). (2) According to the clinical diagnosis, the patients were divided into distal radioulnar joint instability group and stability group. There were 85 cases (56.3%) in the instability group, including 27 cases of Flat type, 30 cases of Ski type, 11 cases of C type and 17 cases of S type. There were 66 cases (43.7%) in the stable group, including 15 cases of Flat type, 17 cases of Ski type, 28 cases of C type and 6 cases of S type. (3) The statistical results showed that there were significant differences in the stability of distal radioulnar joint with different shapes of sigmoid notch of distal radius (Pearson X2=17.583, P=0.001). The distal radioulnar joint instability rate of type C sigmoid notch was the lowest, and there was a statistical difference with the other three types. The instability rate of distal radioulnar joint in Flat, S and Ski type sigmoid notch was higher, and there was no significant difference among the three groups. (4) It is concluded that Ski type and Flat type sigmoid notches of the distal radius are the most common, while type C sigmoid notch of the distal radius is helpful to maintain the stability of distal radioulnar joint.

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    Static balance and limits of stability in patients with chronic nonspecific low back pain
    Luo Wei, Zhong Tao, Huang Zhirui, Gao Yan, Huang Zhen
    2023, 27 (27):  4362-4366.  doi: 10.12307/2023.632
    Abstract ( 182 )   PDF (1477KB) ( 17 )   Save
    BACKGROUND: Balance ability is an important factor affecting the posture control of patients with chronic nonspecific low back pain and the main reason for falling, fractures and disabilities. Most of the existing studies only analyze the position of bipedal, and rarely report the static equilibrium characteristics and limits of stability of monopodial and bipedal on the premise of distinguishing the mixed factors brought by dominant and non-dominant legs.  
    OBJECTIVE: To analyze the characteristics of static balance and limits of stability in patients with chronic nonspecific low back pain.
    METHODS: From April 2020 to December 2021, 20 chronic nonspecific low back pain patients (low back pain group) and 20 healthy subjects (healthy group) were recruited among the interns of Guangzhou Panyu Central Hospital. The Pro-kin balancer was chosen to perform the static balance of single/biped standing and limit of stability test and to record the index values of the corresponding test, such as: plantar pressure center and limit of stability when bipedal standing, as well as such as the vertical and horizontal amplitude, the mean of vertical and horizontal sway velocities, the area of the movement, and the length of the movement when single and bipedal standing.  
    RESULTS AND CONCLUSION: (1) Under the eyes open/closed state, the plantar center of pressure of the healthy group was concentrated in the axial center, while the low back pain group showed a larger discrete distribution, and the distribution was mainly on the non-dominant leg. (2) Comparing the static balance of bipedal standing: There was no significant difference between the two groups in the open eye state (P > 0.05), and the low back pain group had higher values of static balance indexes than the healthy group in the closed eye state (P < 0.05). (3) Comparing the static balance of standing on one foot: The values of the static balance indexes of the dominant leg in the low back pain group were greater than those of the non-dominant leg (P < 0.05), and there was no significant difference between the superior and non-dominant legs in the healthy group (P > 0.05). The static balance index value of the dominant leg in the low back pain group was significantly greater than that of the healthy group (P < 0.05), and there was no significant difference between the two groups on the non-dominant leg (P > 0.05). (4) The limit of stability values on the left side (positive left, front left, rear left) and right side (positive right, front right, rear right) of the healthy group were significantly greater than those of the low back pain group (P < 0.05). (5) The results indicated that the static balance of standing on two feet with eyes closed, the static balance of standing on one foot of the dominant leg and the limit of stability balance ability on the left and right sides was significantly decreased, and the maintenance of balance ability was visually dependent, and there was a great risk of falling.
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    Effect of distal tibial tuberosity-high tibial osteotomy on patellofemoral joint degeneration and patellar height
    Li Xiaomin, Tian Xiangdong, Tan Yetong, Xue Zhipeng, Ma Sheng, Hu Yuanyi, Huang Ye, Ding Tiansong
    2023, 27 (27):  4367-4372.  doi: 10.12307/2023.601
    Abstract ( 176 )   PDF (3560KB) ( 10 )   Save
    BACKGROUND: As a kind of medial open wedge osteotomy, distal tibial tuberosity-high tibial osteotomy has been widely used in clinical practice, but there are still few reports about the effect of this method on patellofemoral joint degeneration and patellar height.  
    OBJECTIVE: To investigate the effect of distal tibial tuberosity-high tibial osteotomy on the degeneration of patellofemoral joint and patellar height.
    METHODS: Totally 63 medial compartment knee osteoarthritis patients combined with mild-to-moderate patellofemoral joint degeneration, who were treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2019 to January 2020, were retrospectively analyzed. There were 20 males and 43 females. They received arthroscopy cleaning technique and distal tibial tuberosity-high tibial osteotomy. All patients finished surgery and were followed up. Removal of the implant and re-arthroscopy were recommended after good healing at the fracture site. Knee 45° axial radiographs were used with Kellgren-Lawrence grading, Iwano grading and International Cartilage Repair Society grading to evaluate the degeneration of patellofemoral joint during the two operations. Caton-Deschamps index, Blackburne-Peel index and Inall-Salvati index were used to evaluate the changes of patellar height during the two surgeries. The Visual Analogue Scale and the Western Ontario and McMaster Universities Osteoarthritis Index were utilized to assess knee pain and function at the time of both surgeries. The weight bearing line ratio was used to evaluate the lower limb force line of patients during the two surgeries.  
    RESULTS AND CONCLUSION: (1) All the 63 patients were followed up for 20-36 months. (2) On the knee 45° axial radiographs, Kellgren-Lawrence grading, Iwano grading and International Cartilage Repair Society grading at the second operation showed progressive changes, but there was no significant difference compared with that at the first operation (P > 0.05). (3) There was no significant difference in the patellar height measured by the three methods during the second operation compared with the first operation (P > 0.05). (4) The knee Visual Analogue Scale of pain score, Western Ontario and McMaster Universities Osteoarthritis Index score and weight bearing line ratio of the second operation were significantly better than those of the first operation (P < 0.05). (5) It is indicated that in patients with the medial compartment knee osteoarthritis combined with mild-to-moderate patellofemoral joint degeneration, but without symptoms of patellofemoral joint, treatment effect of distal tibial tuberosity-high tibial osteotomy is remarkable. The surgery could obviously relieve knee pain, improve the function of knee joint, and had no obvious effect on patellar height and patellofemoral joint degeneration in the short term.
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    Relationship of the morphology of three types of callus in the extension area after tibial bone transfer with bone healing
    Cheng Kang, Wang Bin, Tu Zhenxing, Wang Zixin, Zheng Yongxin, Tian Yuqing, Yang Xiao
    2023, 27 (27):  4373-4378.  doi: 10.12307/2023.327
    Abstract ( 89 )   PDF (2236KB) ( 7 )   Save
    BACKGROUND: Bone transfer operation has gradually become the “gold standard” for the treatment of tibial bone defects. During bone regeneration and mineralization, the morphology of the callus in the extension area of the tibia was significantly different. The study of the relationship of the morphology of the callus in the extension area with bone healing and limb function can provide clinical guidance.  
    OBJECTIVE: To explore the relationship of the morphology of three types of callus in the extension area after tibial bone transfer with bone healing and limb function.
    METHODS: A retrospective analysis was performed in 86 patients with large segmental tibial bone defect who were admitted from May 2014 to June 2022. According to the three types of callus in the extension area, it could be divided into concave type, uniform type and bulging type. There were 14 cases of concave type, 60 cases of uniform type, and 12 cases of bulging type. All patients were treated with single-plane bone transport for the treatment of large segmental tibial bone defects. During the period, the central transverse diameter of the bone regeneration area, the transverse diameter of both ends of the osteotomy, the length of extension, the bone transport time, the mineralization time of the bone regeneration area, the healing index and related complications were recorded. Bone healing and limb function were assessed according to the Association for the Study and Application of Ilizarov's Methods score.  
    RESULTS AND CONCLUSION: (1) All 86 patients were followed up after operation for 21 to 37 months, with a mean of (29.0±6.7) months. No internal fixation infection occurred during the treatment of the three types of callus in the extension area, and all of them achieved bony union. (2) There was no statistical significance in the preoperative general data of patients of the three groups (P > 0.05), and they were comparable. (3) The healing indices of concave type, uniform type and bulging type were (73.5±25.4), (51.1±18.8), and (39.6±7.9) d/cm, respectively, and the comparison between groups was statistically significant (P < 0.05). (4) According to Association for the Study and Application of Ilizarov's Methods bone healing score, there were excellent in 11 cases and poor in 3 cases in the concave group, excellent in 53 cases and poor in 7 cases in the uniform group, and excellent in 12 cases and poor in 0 cases in the bulging group; there was no significant difference between the groups (P > 0.05). (5) According to the Association for the Study and Application of Ilizarov's Methods limb function results, there were excellent in 3 cases and good in 11 cases in the concave group, excellent in 17 cases and good in 43 cases in the uniform group, and excellent in 4 cases and good in 8 cases in the bulging group; there was no significant difference between the groups (P > 0.05). (6) The results showed that there was no significant difference among the concave type, the uniform type and the bulging type in the Association for the Study and Application of Ilizarov's Methods bone healing and affected limb function scoring standards. However, there was a significant difference in the comparison of the healing index, the concave type > the uniform type > the bulging type, namely, the bulging type had the shortest healing time, followed by the uniform type, and the concave type was slowest.
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    Correlation of medial and lateral posterior tibial slope and their differences with anterior cruciate ligament injury
    Li Panpan, Qing Haomiao, Ren Sixie, Zhang Yuanyuan
    2023, 27 (27):  4379-4384.  doi: 10.12307/2023.610
    Abstract ( 181 )   PDF (1783KB) ( 5 )   Save
    BACKGROUND: Related studies suggest that the anatomical morphology of the proximal tibia may be correlated with the injury of the anterior cruciate ligament. As one of the anatomical factors of the knee joint, the research on the relationship between the posterior tibial slope and anterior cruciate ligament injury has become a hotspot.  
    OBJECTIVE: To analyze the correlation of medial and lateral posterior tibial slope with anterior cruciate ligament injury.
    METHODS: The magnetic resonance imaging images of knee joint of 314 patients in Chengdu Second People’s Hospital were retrospectively analyzed. According to the anterior cruciate ligament imaging findings, there were 123 patients in the normal control group, 107 patients in the partial injury group and 84 patients in the complete injury group. The medial and lateral posterior tibial slope and the differences between medial and lateral compartment of the three groups were measured in the three groups to analyze the influencing factors of anterior cruciate ligament injury.  
    RESULTS AND CONCLUSION: (1) There was no statistical difference in the medial and lateral posterior tibial slope and the differences between medial and lateral compartment between male and female in 314 patients (P > 0.05). (2) The medial and lateral posterior tibial slope in the group with partial anterior cruciate ligament injury and complete anterior cruciate ligament injury was higher than that in the normal group (P < 0.05). The difference of medial and lateral posterior tibial slope was not significantly different among the three groups (P > 0.05). (3) Binary Logistic regression analysis showed that the medial posterior tibial slope was an independent risk factor for anterior cruciate ligament injury (P < 0.05). ROC curve showed that the diagnostic critical value of medial posterior tibial slope was 10.50°, area under curve AUC=0.676 [95%CI: 0.618,0.735, P < 0.001]; sensitivity was 55.5%; specificity was 71.5%. (4) The results indicate that the medial and lateral posterior tibial slope increased in patients with anterior cruciate ligament injury, but the difference between the two was not significantly different from that of the normal control group. The medial posterior tibial slope may be a predictor of the risk of anterior cruciate ligament injury. The greater the medial posterior tibial slope, the greater the possibility of anterior cruciate ligament injury.
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    Three-dimensional finite element method to analyze biomechanical characteristics of spinal manipulation
    Liu Baijie, Zhou Honghai, He Xinyu, Qin Hongtu, Chen Longhao, Tian Junming, Lu Qingwang
    2023, 27 (27):  4385-4392.  doi: 10.12307/2023.613
    Abstract ( 211 )   PDF (1828KB) ( 14 )   Save
    BACKGROUND: As a physical therapy method with remarkable curative effect for spinal diseases, spinal manipulation has been widely used by scholars at home and abroad and gradually developed into standardization and systematization. Its mechanism of action and safety have always been the focus of medical attention. Three-dimensional finite element method is an effective tool for numerical simulation of human mechanical behavior. It has certain research value and clinical significance to clarify the biomechanical effect of manipulation on spinal structure through technical analysis.  
    OBJECTIVE: To review the development of three-dimensional finite element method and its application in biomechanics of cervical, thoracolumbar and lumbar manipulations.
    METHODS: The first author used “finite element, biomechanics, spine, cervical vertebrae, thoracolumbar, lumbar vertebra, manipulation” as English search terms, and used computer to search PubMed and Web of Science databases from establishment to April 2022. There were a total of 495 related articles. The “finite element analysis, spine, cervical spine, thoracic and lumbar spine, lumbar spine, massage, manipulation, biomechanics” were used as the Chinese search terms. A total of 593 related articles from the establishment of the database to April 2022 were checked in CNKI, Wanfang, and VIP databases using computers, and 80 of them were selected for review according to the inclusion criteria.  
    RESULTS AND CONCLUSION: (1) Through the three-dimensional finite element method to analyze the stress and strain of the spine structure under the action of massage manipulation, the stress value and displacement value of each part of the model can be obtained, which can objectively, intuitively and accurately reflect the vertebral body, intervertebral disc, ligament, muscle, blood vessel, nerve, etc. The mechanical effect status of the components provides strong evidence for explaining the mechanism of spinal manipulation, improving the safety and effectiveness of manipulation, greatly promoting the development of clinical manipulation techniques, and has a good development potential. (2) The three-dimensional finite element method has made an important progress in the study of the biomechanics of spinal manipulation. The simulation of paravertebral soft tissue components of the spinal model has been continuously improved. The basic research of cervical and lumbar massage manipulations has continued to deepen, and the biomechanical analysis of massage manipulations has developed from solid mechanics to fluid mechanics. (3) However, there are still problems such as insufficient representation of the imaging sources of the spine model and the material setting data of each component in the current application. The simulation and loading of spinal manipulation manipulations are too simple, and many basic researches on thoracic manipulation manipulations have not been carried out. The researchers need to further improve, so that the three-dimensional finite element method can better meet the needs of clinical and scientific research of spinal manipulation.
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    Research status and progress of establishment and validation of finite element model of adolescent idiopathic scoliosis
    Peng Lu, Duan Zhili, Li Zhenyu, Li Junhui, Li Yunhong, Wang Song, Liu Weiqiang
    2023, 27 (27):  4393-4400.  doi: 10.12307/2023.388
    Abstract ( 189 )   PDF (2089KB) ( 20 )   Save
    BACKGROUND: Adolescent idiopathic scoliosis has a high prevalence and complex condition in China and has a significant risk to the physical and mental health of adolescents. The establishment of finite element models based on patient medical images can effectively analyze spinal stresses, simulate the recovery effects of different treatments, and provide a scientific basis for the selection of patient treatment modalities. However, there are many different ways to build finite element models and no unified standard has been formed yet; the quality of models varies and the validation methods need to be improved.  
    OBJECTIVE: The current status of modeling studies in adolescent idiopathic scoliosis in recent years is reviewed in terms of software selection, modeling of key structures (vertebral body, disc, ligament, and trunk models), and material allocation. The research progress of model validation is outlined from the perspectives of geometry, comparison of existing literature, and experimental validation. The deficiencies and development directions of finite element models are summarized to provide references for related studies.
    METHODS: The first author searched the Web of Science and China National Knowledge Infrastructure databases in December 2021 for relevant literature published from January 2010 to the present, using “adolescent idiopathic scoliosis, finite element, biomechanics” as Chinese and English search terms. The highly cited authoritative articles were traced, and finally 83 articles were included for analysis.  
    RESULTS AND CONCLUSION: (1) Finite element analysis method can reconstruct the three-dimensional model of spine, simulate the physiological state of spine through biomechanical analysis, and provide theoretical basis and scheme reference for conservative treatment and surgical treatment of adolescent idiopathic scoliosis. (2) The establishment method of finite element model in China is different from that outside China. Domestic researchers use full spinal CT to reconstruct the vertebrae through reverse engineering and establish intervertebral discs, ligaments, articular cartilage endplate, up and down structure according to the model of vertebrae. However, the foreign researchers use multiple plane X-ray devices such as the EOS imaging system, which is lack of description of the model establishment process. (3) Although the specific software selection in the process of model building is different, the software classification includes medical image processing software, three-dimensional modeling software and finite element analysis software. (4) The finite element material assignment of vertebrae and intervertebral discs has formed a unified standard, but the material assignment of ligament model is also different due to different unit settings, and the assignment of ligament will significantly affect the results of the model. (5) The verification methods of finite element models mainly include geometric verification compared with original medical images, mechanical verification compared with existing literature results and clinical trial verification of finite element analysis results.
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    Endoscopic transforaminal lumbar interbody fusion for degenerative diseases of the lumbar spine: decompression fusion and preservation of posterior spine anatomy
    Jin Xinjie, Lu Xiangdong, Zhao Yibo, Zhao Xiaofeng, Qi Detai, Zhao Bin
    2023, 27 (27):  4401-4407.  doi: 10.12307/2023.629
    Abstract ( 167 )   PDF (1703KB) ( 11 )   Save
    BACKGROUND: Lumbar degenerative disease is a common disease in middle-aged and elderly patients. Traditional lumbar spine surgery is more traumatic and takes a long time to recover after surgery. In recent years, spinal endoscopic technology has achieved great development, and endoscopic transforaminal lumbar interbody fusion, as a new treatment for lumbar degenerative diseases, is worth promoting in patients with indications for lumbar degenerative diseases because of the advantages of less trauma, shorter recovery time, less postoperative pain, and less bleeding.  
    OBJECTIVE: To review the research progress of endoscopic transforaminal lumbar interbody fusion in lumbar degenerative diseases, review the occurrence, development, advantages, limitations, and development trend of endoscopic transforaminal lumbar interbody fusion.
    METHODS: The first author used a computer to search PubMed, Web of Science and Wanfang databases for the literature published from 2010 to 2022. Key words were “endoscopic lumbar fusion, lumbar degenerative disease, minimally invasive spine” in Chinese and English. Duplicate, poor quality and irrelevant articles were excluded for review analysis.  
    RESULTS AND CONCLUSION: (1) Degenerative diseases of the lumbar spine are the pathological basis of disc herniation, spinal stenosis, and vertebral slippage, and are the main cause of discogenic lower back pain. Endoscopic transforaminal lumbar interbody fusion is a novel technique for the treatment of degenerative diseases of the lumbar spine. (2) In recent years, endoscopic lumbar spine surgery has evolved from simple decompression to simultaneous decompression and fusion, with satisfactory short-term results. Microscopic fusion and flexible anesthesia are the greatest highlights of this technique, which has the advantages of less surgical trauma, less bleeding, shorter hospital stay, less postoperative pain, faster recovery, and preservation of the posterior spinal structures, but because of the need for repeated intraoperative fluoroscopy, the relatively high radiation exposure to the surgeon and the patient, as well as the higher requirements for the surgeon’s operating skills. (3) The use of endoscopic transvertebral foramina for the treatment of degenerative lumbar spine disease is now considered to be a potentially effective novel treatment compared to conventional surgery. In previous studies of endoscopic transforaminal lumbar interbody fusion, there were some shortcomings in the use of large amounts of saline to flush the surgical site intraoperatively causing occult blood loss, and these occult blood losses could not be calculated, which was not included in the relevant literature. Second, because fewer hospitals can perform endoscopic transforaminal lumbar interbody fusion and lack the support of large samples and long-term follow-up evidence, its long-term efficacy still needs further study.
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    Risk and prevention of intervertebral implant subsidence after anterior cervical decompression and fusion
    Peng Jiancheng, Yao Xiaoling, Ling Haiqian, Lai Ying, Li Jie
    2023, 27 (27):  4408-4413.  doi: 10.12307/2023.604
    Abstract ( 199 )   PDF (1712KB) ( 5 )   Save
    BACKGROUND: Intervertebral implant subsidence is one of the common complications after anterior cervical decompression and fusion, and it is important to understand this complication.  
    OBJECTIVE: To summarize the domestic and foreign articles on the subsidence of intervertebral implants after anterior cervical decompression and fusion in order to provide clinical guidance for spine surgeons.
    METHODS: A computed-based online retrieval of CNKI, Wanfang and PubMed databases was conducted with Chinese and English keywords of “intervertebral implant, subsidence, anterior cervical decompression and fusion, cage, review, biomechanical analysis, three-dimensional finite element, three-dimensional printing technology, complications, biomaterials”.
    RESULTS AND CONCLUSION: (1) Among the preoperative factors, osteoporosis, lower body mass index, higher T1 slope and inverted cervical spine angle were the risk factors for cage subsidence after anterior cervical approach. (2) C6/7 is the most common segment for the subsidence of the interbody cage after anterior cervical approach. The incidence of long segments is higher than that of short segments. Most articles believe that titanium plate-cage internal fixation system can effectively reduce the subsidence risk. (3) The width, diameter and height of the implant are related to the postoperative subsidence rate and the risk of subsidence increases when the implant is placed in the center of the endplate. (4) Rectangular, anatomical, 12-lobed, porous structure cage and bionic pit surface can effectively reduce the risk of subsidence when placed on the side of the cage. (5) Compared with titanium alloy cages, polyether ether ketone cages have lower subsidence risk. Degradable materials and composite materials have been studied more in recent years, but their safety and effectiveness still need to be further proved. (6) Excessive curettage of the endplate, excessive distraction of the intervertebral body, prolonged distraction of the cervical retractor, poor screw placement, and poor implant placement angle are the risk factors of postoperative intervertebral implant subsidence; premature cervical collar removal after surgery increases the risk of subsidence. (7) Biomechanical research, materials research, 3D printing technology, and long-term follow-up are effective ways to study the subsidence of intervertebral implants after anterior cervical decompression and fusion in the future.
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    Significance of Piezo1 protein in the pathogenesis of osteonecrosis of femoral head
    Chen Bohao, He Qi, Yang Junzheng, Pan Zhaofeng, Xiao Jiacong, Li Miao, Li Shaocong, Zeng Jiaxu, Wang Haibin, Zheng Jia, Zhang Meng
    2023, 27 (27):  4414-4420.  doi: 10.12307/2023.603
    Abstract ( 187 )   PDF (5644KB) ( 12 )   Save
    BACKGROUND: Piezo1, a mechanically-sensitive ion channel protein, participates in the occurrence and development of many orthopedic diseases, but its role in the pathogenesis of osteonecrosis of femoral head has not been systematically reported.  
    OBJECTIVE: To analyze the significance of Piezo1 in the pathogenesis and progression of osteonecrosis of femoral head, providing theoretical basis for the early clinical prevention and treatment of osteonecrosis of femoral head.
    METHODS: The Chinese and English search words “osteonecrosis of femoral head” “Piezo1” “bone formation” “bone loss” “angiogenesis” “inflammation” were searched on CNKI and PubMed. A total of 1 032 papers were retrieved, and 92 papers were finally included according to the inclusion criteria for the review.  
    RESULTS AND CONCLUSION: (1) Piezo1 can participate in the development of trauma-induced osteonecrosis of femoral head by influencing the differentiation and proliferation of osteoblasts, osteoclasts and endothelial cells through mechanical stimulation of the extracellular environment. (2) Piezo1 mediates inflammatory pathways to regulate the development of steroid-induced and alcohol-induced osteonecrosis of femoral head. (3) It is suggested that Piezo1 may participate in the pathological process of osteonecrosis of femoral head caused by different pathogenic factors in different ways, to provide a new target and direction for the treatment of osteonecrosis of femoral head.
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    Clinical and imaging features of slipped capital femoral epiphysis
    Gao Yue, Fu Ziwei, Wu Yanbo, Pan Shinong, Lu Zhao
    2023, 27 (27):  4421-4428.  doi: 10.12307/2023.631
    Abstract ( 169 )   PDF (2708KB) ( 5 )   Save
    BACKGROUND: Slipped capital femoral epiphysis is a common hip disease affecting children and adolescents, causing hip pain and lameness. The incidence of slipped capital femoral epiphysis varies widely, and the etiology is related to gender, mechanical, endocrine, obesity, and genetic factors.   
    OBJECTIVE: To review the core mechanism of slipped capital femoral epiphysis, to discuss the imaging manifestations and quantitative index evaluation based on the pathophysiological mechanism, the progress of treatment methods and unresolved problems. 
    METHODS: The first author used “slipped epiphysis of femoral head, complications, AVN, FAI, hip chondrolysis, SCFE imaging diagnose, X-ray, CT, MRI” as English search terms, and “slipped epiphysis of femoral head, complications, AVN, FAI, chondrolysis, X-ray, CT, MRI” as Chinese search terms. Relevant articles published in PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched by computer, and screened and evaluated, summed up, and finally 63 related articles were included for review.  
    RESULTS AND CONCLUSION: (1) The current international mainstream views on the pathogenesis of slipped capital femoral epiphysis tend to be the combined effects of mechanical injury factors, endocrine factors and obesity genetic factors. (2) Imaging methods play an increasingly important role in the diagnosis of slipped capital femoral epiphysis. X-ray and three-dimensional CT are more commonly used in the diagnosis of slipped capital femoral epiphysis. MRI can be used to observe changes in epiphyseal plate edema other than bone changes. (3) Different diagnostic methods and measurement parameters can comprehensively and quantitatively evaluate the condition of slipped capital femoral epiphysis patients from the aspects of bone changes, softening injuries and muscle atrophy. (4) Complications of slipped capital femoral epiphysis include avascular necrosis of the femoral head, femoroacetabular impingement sign, chondrolysis, and degenerative arthritis, resulting in long-term and devastating clinical outcomes. (5) Based on the main pathological mechanism, the treatment methods mainly include surgery, endocrine and rehabilitation, and certain results have been achieved. (6) Clinically, patients with slipped capital femoral epiphysis mostly go to the doctor because of pain and claudication in the affected hip and knee. The imaging manifestations are mainly epiphyseal plate widening and relative displacement of femoral head epiphysis and metaphysis. (7) Therefore, in view of the clinicopathological features and complications of patients with slipped capital femoral epiphysis, doctors need to correctly understand the role of imaging in the auxiliary diagnosis of slipped capital femoral epiphysis, and they need to do a good job in the diagnosis and disease assessment on admission, evaluation of surgical effects, and postoperative follow-up, as well as the prediction of contralateral slipped epiphysis in patients with unilateral slipped capital femoral epiphysis, in order to provide an accurate and objective basis for clinical diagnosis and treatment. 
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