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18 October 2023, Volume 27 Issue 29 Previous Issue   

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Design and finite element analysis of a novel anterolateral plate for posterior lateral column fractures of the tibial plateau Zhang Lu, Wang Renchong, Xie You, Hu Juzheng, Wen Dingfu, Yang Tongchi, Huang Shuzhong, Shi Zhanying 2023, 27 (29):  4593-4598.  doi: 10.12307/2023.654 Abstract ( 581 )   PDF (2147KB) ( 44 )   Save BACKGROUND: Due to the special anatomical location of posterolateral column fracture of tibial plateau, there is no consensus on the choice of surgical approach and internal fixation.  OBJECTIVE: To compare the biomechanical stability of novel plate and three common internal fixators in the fixation of posterolateral column fracture of tibial plateau by finite element analysis, and verify the feasibility of novel plate. METHODS: The CT data of a volunteer were collected and the new type of plate was designed and imported into SolidWorks software to establish a fracture model of the posterolateral column fracture of the tibial plateau. Four internal fixation models (novel plate, L-shaped locking plate, oblique T-shaped plate, and lag screw) were established, with axial loads of 500, 1 000 and 1 500 N. The maximum displacement of fracture block and stress distribution and peak value of internal fixator were compared among different internal fixation models. RESULTS AND CONCLUSION: With the increase of axial force, the displacement of fracture block and the peak stress of internal fixation in different internal fixation models increased approximately in equal ratio. The displacement nephogram and the stress nephogram showed similar distribution characteristics. (1) Under three loads, fracture block displacement from high to low was as follows: lag screw group > L-shaped locking plate group > novel plate group > oblique T-shaped plate group. The maximum displacement of the fracture block in the novel plate group, the L-shaped locking plate group and the lag screw group was located at the proximal end of the lateral border, and the displacement gradually decreased from the proximal end to the distal end. The maximum displacement of the fracture block in the oblique T-shaped plate group was located in the middle of the lateral border, and the displacement gradually decreased from the outside to the inside. (2) Under three loads, stress peak value of internal fixation from high to low was as follows: oblique T-shaped plate group > novel plate group > lag screw group > L-shaped locking plate group. (3) Stress distribution of internal fixation of novel plate group and oblique T-shaped plate group was relatively uniform. In lag screw group, obvious stress concentration could be seen in the middle of medial screws. The stress distribution of L-shaped locking plate group was the most uniform. (4) The results showed that the stress distribution of the internal fixtures in the L-shaped locking plate group was the most uniform and minimal, but the fracture block displacement was large and similar to that of the lag screw group. Therefore, the biomechanical stability of the novel plate was better than that of L-shaped locking plate and lag screw, with a good application foundation. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of middle clavicle fracture with ortho-bridge system intramedullary fixation Ma Tianyong, Wang Dewei 2023, 27 (29):  4599-4606.  doi: 10.12307/2023.645 Abstract ( 378 )   PDF (3106KB) ( 100 )   Save BACKGROUND: The intramedullary fixation treatment for the middle clavicle fracture is effective and safe. However, issues such as nail loosening and displacement, as well as soft tissue irritability of the nail tail, are prevalent. Some interlocking intramedullary nails are demanding to operate; thus, their widespread utilization is confined. Treatment of intramedullary clavicle fracture can be further refined. Accordingly, to alleviate these issues, a novel intramedullary fixation instrument needs to be developed.   OBJECTIVE: To explore the biomechanical stability of ortho-bridge system intramedullary fixation in the treatment of middle clavicle fracture by means of finite element analysis so as to offer a scientific foundation for clinical application. METHODS: The finite element model of transverse middle clavicle fracture was established by relevant software utilizing the CT data of the clavicle from a young volunteer. The locking plate, ortho-bridge system, and titanium elastic nail finite element models were assembled in accordance with the principle of internal fracture fixation. Finally, meshing, applying loads, and data processing were accomplished with the ANSYS 15.0 program. In each model, the stress distribution, maximum Von Mises stress and maximum displacement of clavicle and internal fixation were compared.   RESULTS AND CONCLUSION: (1) Under different loads, the stress distribution of the ortho-bridge system intramedullary fixation of the middle clavicle fracture was comparable to that of the titanium elastic nail fixation. Near the fractured end of the intramedullary connecting rod, the phenomenon of stress concentration was observed. The secondary stress concentration occurred in the extramedullary locking area of the ortho-bridge system, causing the overall stress of the ortho-bridge system group to be more dispersed than that of the titanium elastic nail group. (2) Under the axial compression force, the maximum Von Mises stress of the clavicle in the ortho-bridge system group 251.96 MPa was greater than that of the other groups, whereas the maximum Von Mises stress of the fractured surface 33.79 MPa was lower than the two control groups. Under cantilever bending and clockwise/counterclockwise torsion loads, the maximum Von Mises stresses of the clavicle and the fractured surface of the ortho-bridge system group were less than those of the titanium elastic nail group, but greater than those of the locking plate group. (3) Under varying loads, the maximum Von Mises stress of the implant in the three groups of internal fixation appeared near the fractured end. Among them, the titanium elastic nail exhibited the highest peak implant stress, followed by the ortho-bridge system, and the locking plate exhibited the least. (4) Under different loads, the maximum displacement of the clavicle in each group occurred primarily at its distal clavicle. Among them, the titanium elastic nail group displayed the greatest maximum displacement of the distal clavicle and fractured end, followed by the ortho-bridge system group, the locking plate group, and the normal clavicle. (5) The findings indicate that the biomechanical stability of ortho-bridge system intramedullary fixation is superior to that of titanium elastic nail in the treatment of middle clavicle fracture. The risk of loosening and displacement of the internal fixation is lower than the titanium elastic nail; however, the fixation strength is not as strong as the locking plate. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of position effects on reduction of facet joint displacement by cervical rotatory manipulation for cervical spondylotic radiculopathy Ye Linqiang, Chen Chao, Liu Yuanhui, Li Zhen, Lu Guoliang 2023, 27 (29):  4607-4611.  doi: 10.12307/2023.653 Abstract ( 357 )   PDF (1818KB) ( 48 )   Save BACKGROUND: Positions of cervical rotatory manipulation mainly include flexion, neutral, extension and rotation direction. It is still not clear which positions are more beneficial for cervical rotatory manipulation to reduce facet joint displacement in treatment of cervical spondylotic radiculopathy. OBJECTIVE: To compare biomechanical effects of positions on reduction of facet joint displacement by cervical rotatory manipulation in treatment of cervical spondylotic radiculopathy. METHODS: A three-dimensional finite element model of the normal C5-C6 was constructed and validated. Cervical rotatory manipulation was simulated with rotation to the right side in flexion, neutral and extension, respectively. Displacement distributions in forward-backward and upward-downward directions of C5 bilateral inferior articular processes were compared among cervical rotatory manipulation performed in different positions. The same node in C5 inferior articular process of the reduced side was selected as reference point for displacement value. Displacement values in forward-backward and upward-downward directions of C5 inferior articular process of the reduced side were compared among cervical rotatory manipulation performed in different positions. RESULTS AND CONCLUSION: (1) With cervical rotatory manipulation performed in flexion, neutral and extension, ipsilateral C5 inferior articular process of rotation moved backward and downward while contralateral C5 inferior articular process of rotation moved forward and upward. Thus, the sliding trend of C5 inferior articular process was significantly correlated with the direction of rotation, but not with positions of flexion, neutral and extension. (2) When cervical rotatory manipulation was performed in flexion, neutral and extension, forward displacement of contralateral C5 inferior articular process of rotation was 1.32, 1.22 and 0.77 mm, respectively, and upward displacement was 1.49, 1.29 and 0.29 mm, respectively. (3) The findings showed that forward-upward displacement of contralateral inferior articular process of rotation was maximum in flexion, indicating that rotation to the healthy side in flexion might be more beneficial for cervical rotatory manipulation to reduce facet joint displacement in treatment of cervical spondylotic radiculopathy. Figures and Tables | References | Related Articles | Metrics

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Stress analysis between implant prostheses with different moduli and surrounding bones Shao Yixin, Guan Tianmin, Zhu Ye, Lin Bing, Guo Chongyang, Pan Ting 2023, 27 (29):  4612-4619.  doi: 10.12307/2023.671 Abstract ( 399 )   PDF (2397KB) ( 46 )   Save BACKGROUND: Stress shielding can lead to the failure of implant prostheses to repair bone defects, mainly due to the fact that the elastic modulus of the implant is greater than that of the surrounding bone tissues.   OBJECTIVE: To explore methods for eliminating the stress shielding by analyzing the influence of the elastic modulus of the implanted prosthesis on the stress distribution. METHODS: The bone tissue models of experimental canine and human bone tissues were obtained by CT scanning, and then were optimized. The gradient assignment was performed to establish a reliable bone mechanics model, and the finite element simulation was performed after the combination with the implanted prosthesis. First, the finite element simulation of experimental canine and human bone tissues and the corresponding implanted prosthesis was performed to simulate the distribution of stress and displacement of prosthesis with different elastic moduli after prosthesis implantation. Second, the reasons for the stress shielding even with small elastic modulus differences were analyzed. The bone and implant prosthesis models were established, and a method for assigning material properties was established. Finally, the feasibility of the model and material property assignment method was verified, and the influence of the relationship between the elastic modulus of the implanted prosthesis and the elastic modulus of the bone on the formation of stress shielding was quantitatively analyzed by randomly selecting the stress points.   RESULTS AND CONCLUSION: The mechanical properties of bone models of experimental canine and human bone tissues established by gradient assignment method are close to the actual bones. The finite element simulation mechanics test proved that the implantation of different elastic modulus had less effect on the relative displacement between the prosthesis itself and the surrounding bones. Moreover, quantifying the effects of elastic moduli on the stress distribution after implantation of the prosthesis into the bone will contribute to the research in the future. Figures and Tables | References | Related Articles | Metrics

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Comparative analysis of artificial intelligence and two-dimensional digital template preoperative planning-assisted total hip arthroplasty to predict prosthesis size Zhang Hang, He Qiang, Liu Qing, He Yunli, Wang Tao, Feng Zhe, Zhang Qian, He Sen 2023, 27 (29):  4620-4627.  doi: 10.12307/2023.656 Abstract ( 1635 )   PDF (2364KB) ( 58 )   Save BACKGROUND: There is currently a lack of extensive multi-center clinical research on the accuracy of the artificial intelligence (AI) HIP planning system for predicting the prosthesis size. Compared with the two-dimensional template planning, it remains poorly understood whether it is more accurate and whether it has advantages in restoring the acetabular and femoral eccentricity and rotation center.  OBJECTIVE: To investigate the accuracy of AI HIP preoperative planning system in predicting the size of total hip arthroplasty prosthesis and its influencing factors, and to analyze its value in restoring eccentricity and rotation center.  METHODS: According to the random number table method, 70 cases were divided into two groups (n=35). AIHIP (study group) and Smart Joint two-dimensional digital template (control group) were used for preoperative planning. The accuracy of predicting the prosthesis size between the two groups was compared, and the potential factors affecting the accuracy of AI HIP prediction were analyzed, including age, gender, body mass index, International Society of Osseous Circulation (ARCO) staging and femoral medullary cavity classification (Dorr classification). The acetabular eccentricity, femoral eccentricity, horizontal and vertical displacement difference of the center of rotation, and the length difference of both lower extremities were measured before and after operation.    RESULTS AND CONCLUSION: (1) The prediction of the prosthesis size on the acetabular side and femoral side was 57.1% (20/35) and 42.9% (15/35) in the study group, and 31.4% (11/35) and 34.3% (12/35) in the control group. The prosthesis compliance rates of the study group on acetabular side and femoral side were 94.3% (33/35) and 82.9% (29/35), while those of the control group were 74.3% (26/35) and 62.9% (22/35); the difference between the two groups was statistically significant (P < 0.05). (2) Logistic regression analysis showed that gender, body mass index and femoral canal classification had no effect on the accuracy of the femoral stem. Compared with the control group, AI HIP had more advantages in planning the Dorr A femoral medullary cavity, and the comparison between the two groups was statistically significant (P=0.012). The postoperative femoral eccentricity and total eccentricity in the control group were greater than those in the study group, and the differences were statistically significant (all P < 0.05). (3) In the horizontal direction, the average displacement of the center of rotation was 1.8 (-0.7, 4.1) mm in the study group, and 2.3 (-0.5, 5.0) mm in the control group; in the vertical direction, the average displacement in the study group was 0.8 (-1.5, 2.7) mm and -1.5 (-3.6, 2.5) mm in the control group, with no statistical significance (P > 0.05). There was no significant difference in the length of both lower limbs between the two groups after operation, which was 3.05 (2.01, 3.89) mm in the study group and 3.63 (2.60, 5.30) mm in the control group (Z=-1.736, P=0.083). (4) These results confirm that the AI HIP preoperative planning system has higher accuracy than the digital two-dimensional template in predicting the size of the acetabular and femoral stem prostheses, and has more advantages in planning the shape of the Dorr A femoral medullary canal. Using artificial intelligence deep learning technology helps to more reliably predict the length and eccentricity of the lower limbs and restore the center of rotation of the hip joint. Figures and Tables | References | Related Articles | Metrics

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3D-printed prostheses for large bone defect reconstruction following bone tumor surgery Daniyar·Saderden, Huang Xiaoxia, Chen Jiangtao, Tian Zheng, Akbar·Yunus 2023, 27 (29):  4628-4634.  doi: 10.12307/2023.669 Abstract ( 355 )   PDF (2115KB) ( 56 )   Save BACKGROUND: Tumor segment resection is one of the standard methods for the treatment of bone tumors. However, the reconstruction of bone defects after tumor resection faces many challenges. A growing number of researchers are focusing on 3D-printed prostheses for bone defect repair and reconstruction following bone tumor surgery.   OBJECTIVE: To explore the feasibility of 3D-printed prostheses in the reconstruction of large bone defect following bone tumor surgery and to evaluate the postoperative outcomes. METHODS: Retrospective analysis of clinical data of 24 patients [19 males and 5 females, age 23.8 (6-61) years] who underwent bone tumor resection and 3D-printed prosthesis implantation in the Department of Bone Oncology, the First Affiliated Hospital of Xinjiang Medical University from December 2020 to September 2021 was conducted. There were 7 cases with distal femur tumor, 5 with pelvis tumor, 4 with proximal tibia tumor, 3 with middle femur tumor, 1 with distal tibia tumor, 1 with proximal humerus tumor, 1 with middle humerus tumor, 1 with scapula tumor, 1 with ulna tumor, and 22 cases with primary tumors (13 osteosarcoma, 4 Ewing sarcoma, 2 giant cell tumor of bone, 1 chondroblastoma, 1 chondrosarcoma, and 1 osteoblastoma), 2 metastatic carcinoma. Preoperative and postoperative imaging data were recorded and neoadjuvant chemotherapy was administered in 17 cases before surgery. The Musculoskeletal Tumour Society score was used to assess limb function before surgery and 6 months after surgery, and pain was assessed by the Visual Analog Scale, as well as the complications were recorded.   RESULTS AND CONCLUSION: (1) All patients undergoing resection of the tumor segment and 3D-printed prosthesis implantation for the reconstruction of the bone defect were followed for 6-49 months, and the results showed that the length of osteotomy was (18.2 ± 7.3) cm and an average intraoperative bleeding volume was 740 (100-3 000) mL. (2) Two patients died of systemic metastasis, the remaining 22 had no pulmonary metastasis or recurrence during the follow-up period, and 1 patient developed aseptic loosening of the prosthesis at 25 months postoperatively. (3) The Musculoskeletal Tumour Society scores were significantly increased, while Visual Analog Scale scores were significantly decreased (P < 0.05) at 6 months postoperatively. (4) The Musculoskeletal Tumor Society score was rated excellent in all 22 patients at the final follow-up. (5) These results suggest that 3D-printed prosthesis is suitable for the reconstruction of large bone defects caused by bone tumor resection. Patients have good postoperative function and few complications. However, further investigations are needed to explore long-term follow-up results. Figures and Tables | References | Related Articles | Metrics

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Relationship between spine-pelvic sagittal plane balance and effects of percutaneous balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures Dong Zhou, Tao Hui, Liu Yiming, Wang Shansong, Li Chun, Hu Yong 2023, 27 (29):  4635-4640.  doi: 10.12307/2023.665 Abstract ( 285 )   PDF (1702KB) ( 39 )   Save BACKGROUND: The high prevalence of osteoporotic vertebral compression fractures leads to a significant socioeconomic and medical burden, and there are controversies about the optimal timing and treatment methods. Percutaneous balloon kyphoplasty can reduce complications, relieve pain, and enhance structural integrity of the vertebral body.  OBJECTIVE: To investigate the influence of spinal-pelvic sagittal balance on the therapeutic effects of percutaneous balloon kyphoplasty on osteoporotic vertebral compression fractures. METHODS: The medical records of 74 patients admitted to Hefei First People's Hospital from August 2018 to January 2020 for percutaneous balloon kyphoplasty were retrospectively analyzed, and the included patients were equally divided into the good outcome and poor outcome groups (n=37 per group) according to the postoperative recovery. The visual analog scale scores, Japanese Orthopaedic Association scores, and imaging data of the two groups were compared at baseline and during the postoperative period.  RESULTS AND CONCLUSION: (1) Cement leakage occurred in three patients in the poor outcome group and four patients in the good outcome group postoperatively, respectively. (2) Visual analog scores in both groups at 1 month postoperatively were similar to baseline (P > 0.05), while the scores were improved significantly at 12 months postoperatively, with the good outcome group significantly better than the poor outcome group (P < 0.05). (3) There was no significant difference in the loss rate of injured vertebral height, Cobb angle, angle of pelvic incidence, pelvic tilt, sacral slope, angle of lumbar anterior convexity, sagittal deviation and thoracic lordosis angle between the both groups (P > 0.05) at baseline, while the loss rate of injured vertebral height, Cobb angle, and sagittal deviation in both groups were significantly improved at 1 month postoperatively (P < 0.05). The rate of height loss of the injured spine, Cobb angle, sagittal deviation, thoracic lordosis angle, pelvic tilt, sacral slope were significantly increased in the poor outcome group compared with the good outcome group (P < 0.05), while the angle of pelvic incidence and angle of lumbar anterior convexity were significantly decreased in the poor outcome group compared with the good outcome group at 12 months postoperatively (P < 0.05). (4) Pearson correlation analysis revealed that Japanese Orthopaedic Association scores were negatively correlated with sagittal deviation, thoracic lordosis angle, pelvic tilt, sacral slope, angle of pelvic incidence (P < 0.05), while were positively correlated with the angle of lumbar anterior convexity (P < 0.05). In addition, the visual analog scale scores were positively correlated with sagittal deviation, thoracic lordosis angle, sacral slope, and angle of pelvic incidence (P < 0.05), while were negatively correlated with the angle of lumbar anterior convexity and pelvic tilt (P < 0.05). (5) These results suggest that percutaneous balloon kyphoplasty can correct deformity, stabilize fracture, and relieve pain, thereby benefiting most of the patients with osteoporotic vertebral compression fractures. Moreover, spine-pelvic sagittal plane balance can affect the clinical efficacy. Figures and Tables | References | Related Articles | Metrics

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Comparison of reduction strength between long-arm single-axis pedicle screw fixation and single-plane pedicle screw fixation in the treatment of traumatic thoracolumbar fractures Chen Xiao, He Binbin, Zhou Youliang, Zhao Liang, Zhang Xinguo, Jiang Ziyun, Shen Zhe 2023, 27 (29):  4641-4646.  doi: 10.12307/2023.652 Abstract ( 318 )   PDF (1674KB) ( 32 )   Save BACKGROUND: Percutaneous long-arm single-axis pedicle screw fixation and minimally invasive percutaneous single-plane pedicle screw internal fixation are both classical minimally invasive surgical options commonly used in clinical practice, but the two surgical methods in the treatment of thoracolumbar fractures are still controversial.  OBJECTIVE: To compare the advantages and limitations of two procedures, long-arm single-axis pedicle screw percutaneous approach and minimally invasive percutaneous single-plane pedicle screw internal fixation, in the treatment of thoracolumbar fractures.  METHODS: Ninety patients with thoracolumbar fractures admitted to Shenzhen Hospital of Guangzhou University of Chinese Medicine from March 2017 to June 2021 were included and assigned to the control group (n=45) and the trial group (n=45). The control group received minimally invasive percutaneous single-plane pedicle screw internal fixation. The trial group received long-arm single-axis pedicle screw percutaneous approach. The indexes related to perioperative general condition, pain level, and recovery were compared between the two groups.  RESULTS AND CONCLUSION: (1) Compared with the control group, the trial group had less intraoperative blood loss, shorter operative time and hospital stay (P < 0.05). (2) At 2 weeks and 1 month after operation, Oswestry dysfunction index score and Cobb angle in the trial group were lower than those in the control group (P < 0.05). The anterior and posterior heights of the injured vertebra were higher in the trial group than those of the control group (P < 0.05). At 2 months after operation, the Oswestry dysfunction index score and Cobb angle in the trial group were lower than those in the control group (P < 0.05). There was no significant difference in the anterior and posterior heights of the injured vertebra between the two groups (P > 0.05). At 2 weeks after operation, the visual analog scale score was lower in the trial group than that in the control group (P < 0.05). (3) Among the 45 cases in the control group, there were 2 cases of incision infection, 2 cases of dyskinesia, and 1 case of implant-related adverse reactions, with a total incidence rate of 11%. Among the 45 cases in the trial group, there were 2 cases of dyskinesia, and the total incidence was 4%. There was no significant difference in the total incidence of complications between the two groups (P > 0.05). (4) Both long-arm single-axis pedicle screw percutaneous approach and minimally invasive percutaneous single-plane pedicle screw internal fixation can achieve better results in the treatment of thoracolumbar fractures. However, the former has shorter operative time and less intraoperative blood loss, so the former is the ideal surgical option for obtaining the same benefit. Figures and Tables | References | Related Articles | Metrics

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Sex and age differences in the anatomical parameters of normal knee joints evaluated by X-ray Chen Changmei, Zeng Xianchun, Wang Rongpin, Wu Jiahong 2023, 27 (29):  4647-4651.  doi: 10.12307/2023.664 Abstract ( 372 )   PDF (1610KB) ( 35 )   Save BACKGROUND: Total knee arthroplasty is one of the effective treatments for end-stage knee osteoarthritis. The design of prosthetic joints to match the national population is particularly urgent because of the serious complications that often arise when replacement prostheses designed according to foreign population standards are applied to the domestic population. Nevertheless, knowledge of the normal values of the anatomical parameters of the knee joint and sex, age, and side differences in them can provide a reference for the design of replacement prostheses.   OBJECTIVE: To explore the normal anatomical parameters of bilateral normal knee joints and the age and sex differences in Guiyang. METHODS: We conducted a retrospective observational cohort study of 2 978 patients with normal knee joints in Guiyang from 13 666 patients who underwent knee X-ray examination in Guizhou Provincial People’s Hospital from January 2015 to January 2021. Anatomical parameters, including the line parameters (knee space width, femoral condyle diameter, tibial plateau diameter, and Insall-Salvati index), and the angle parameters (femoral angle, femoral tibial angle, tibial angle, and posterior tibial slope) were measured on anteroposterior and lateral radiographs of the knee joint. Age, sex and side differences were compared.   RESULTS AND CONCLUSION: (1) Sex differences in the femoral angle, femoral tibial angle, tibial angle, knee joint space, transverse diameter of femoral condyle, transverse diameter of tibial plateau, and Insall-Salvati index were found (P < 0.05). The femoral angle and Insall-Salvati index were higher in women than in men, while other parameters were lower in women than in men. There was no significant difference in posterior tibial slope (t=-0.64, P=0.523). (2) There were significant age differences in femoral tibial angle, lateral knee joint space in men and femoral tibial angle, tibial angle tibial plateau diameter in women (P < 0.05). (3) The femoral tibial angle in men and women aged 36-45 years and the tibial angle in women was the largest. The lateral knee joint gap of man aged 27-35 years (7.78±0.72) mm was larger than that in other groups. The transverse diameter of tibial plateau in women aged 18-26 years (72.08±5.81) mm was greater than that in other groups. There was no significant difference in other parameters (P > 0.05). (4) There were significant differences in the femoral angle, femoral tibial angle, tibial angle, posterior tibial slope, knee space, femoral condyle diameter, and Insall-Salvati index between bilateral knees (P < 0.05). Parameters were increased at the right side compared with the left side with the exception of femoral angle. There was no significant difference in the transverse diameter of tibial angle and tibial plateau (P > 0.05). (5) The results confirm that sex and side differences in the anatomical parameters of normal knee joints exist in subjects from Guiyang; however, the age differences are hardly detected. This study can provide normal knee values for prosthesis design in Guiyang. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of femoral intertrochanteric fracture treated with intramedullary nail with different lateral wall classifications Zhou Long, Wang Liang, Xu Rui, Bao Yidong, He Shuangjian, Xu Xibin 2023, 27 (29):  4652-4657.  doi: 10.12307/2023.649 Abstract ( 364 )   PDF (2705KB) ( 48 )   Save BACKGROUND: At present, there is a controversy on the internal fixation for the femoral intertrochanteric fracture with fracture of lateral wall. The main method is the proximal femoral nail antirotation. The biomechanical study of intramedullary fixation for femoral intertrochanteric fracture with different lateral wall classifications is less.   OBJECTIVE: To compare the biomechanical characteristics of proximal femoral nail antirotation in the treatment of femoral intertrochanteric fracture with different lateral wall classifications by finite element analysis, and to explore the influence of lateral wall on the internal fixation of femoral intertrochanteric fracture. METHODS: A healthy elderly female patient was selected. A 3D finite element model of proximal femur and proximal femoral nail antirotation was established by using Mimics 21.0, Geomagic Wrap, Creo 6.0 and Abaqus 2020 software according to the CT scanning data of proximal femur. The proximal femoral nail antirotation assembly model was established by simulating lateral wall stable, dangerous and ruptured intertrochanteric fractures. The Von Mises stress and displacement distributions of three models of internal fixation were observed under the same load in static and walking conditions.   RESULTS AND CONCLUSION: (1) The maximum Von Mises stress and displacement of A3.3 type intertrochanteric fracture were the largest under dynamic state; the maximum Von Mises stress was about twice of type A2.3, and 2.7 times of type A1.3; the maximum Von Mises displacement was about 1.5 times of type A2.3 and 3 times of type A1.3, and there was no significant difference among the various types under static state. (2) The Von Mises stress A3.3 at femoral neck, fracture end and main nail was larger than that of A1.3 and A2.3 under dynamic and static states, especially at main nail. (3) The Von Mises displacements of femoral head, femoral neck, fracture end, lateral wall, medial wall, main nail and spiral blade in A3.3 type were larger than that in A1.3 and A2.3 types; the change was not obvious under static state. (4) These results suggest that the integrity of the lateral wall can reduce the internal fixation stress, make the stress and displacement distribution more reasonable, and help to maintain the stability of intertrochanteric fracture. Figures and Tables | References | Related Articles | Metrics

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Effect of iron overload on cartilaginous tissue in a mouse model of knee osteoarthritis evaluated by micro-CT Li Shaocong, He Qi, Pan Zhaofeng, Yang Junzheng, Chen Bohao, Wang Haibin, Zhou Chi 2023, 27 (29):  4658-4663.  doi: 10.12307/2023.651 Abstract ( 372 )   PDF (2188KB) ( 33 )   Save BACKGROUND: Knee osteoarthritis may be related to abnormal iron metabolism, and it is very meaningful to understand the effect of iron overload on knee osteoarthritis.   OBJECTIVE: To explore the effect of iron overload on the incidence of knee osteoarthritis.  METHODS: Thirty 7-week-old C57B/6J wild-type mice were selected and randomly divided into a normal control group, an operation control group, and an operation+iron dextran group, with 10 mice in each group. At the age of 8 weeks, the operation+iron dextran group received intraperitoneal injection of iron dextran 500 mg/kg, once a week, and the injection was terminated at the age of 18 weeks. At the age of 10 weeks, the operation control group and the operation+iron dextran group received left posterior knee medial meniscus instability surgery. All mice were sacrificed at 18 weeks of age. Tibial microstructure parameters were detected by micro-CT. Safranin O-fast green staining was used to observe the degree of pathological damage of articular cartilage. Prussian blue staining confirmed the deposition of iron in mouse joints.  RESULTS AND CONCLUSION: (1) Micro-CT test showed that compared with the normal control group, the relative trabecular volume, trabecular thickness and trabecular number of subchondral bone were significantly decreased (P < 0.05), and the trabecular separation and structural model index were increased (P < 0.05) in the operation control group and operation+iron dextran group. Compared with the operation+iron dextran group, relative trabecular volume, trabecular thickness and trabecular number were increased (P < 0.05); trabecular separation and structural model index were decreased (P < 0.05) in the operation control group. (2) Safranine O staining showed that compared with the normal control group and the operation control group, the subchondral bone of the operation+iron dextran group had serious defects and ruptures on the surface of cartilage, and the number of surface chondrocytes decreased significantly. The higher Osteoarthritis Research Society International score indicated the higher severity of arthritis. (3) Prussian blue staining results showed that a large number of iron deposition particles dyed dark blue could be seen in the synovium of the operation+iron dextran group, while there were no obvious iron deposition particles in the normal control group and the operation control group. (4) These results demonstrate that iron overload can aggravate the damage of knee osteoarthritis, and increase the loss of cartilage proteoglycan components and the bone loss of subchondral bone, clarifying the relationship between iron overload and knee osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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Serum proteomics based on isobaric tags for relative and absolute quantitation technology in patients with nontraumatic osteonecrosis of the femoral head Zhang Enjing, Cai Jinkui, Xu Haijia, Li Tianhang, Li Zhanghua 2023, 27 (29):  4664-4669.  doi: 10.12307/2023.662 Abstract ( 297 )   PDF (1966KB) ( 72 )   Save BACKGROUND: Nontraumatic osteonecrosis of the femoral head is a group of diseases characterized by progressive worsening of hip pain and dysfunction, which seriously endangers human health. Its pathogenesis, early diagnosis and treatment remain a major challenge for clinical orthopedic surgeons.   OBJECTIVE: Using isobaric tags for relative and absolute quantitation technology, proteomics was used to screen key proteins that may be associated with nontraumatic osteonecrosis of the femoral head. Analysis of the expression characteristics and potential biological functions of these proteins laid the foundation for further research on the etiology and molecular mechanisms of nontraumatic osteonecrosis of the femoral head. METHODS: Serum proteins were extracted from nontraumatic osteonecrosis of the femoral head patients and healthy humans, and then labeled using isobaric tags for relative and absolute quantitation technology. Liquid chromatography combined with tandem mass spectrometry was performed to separate and analyze the peptides. Differentially expressed proteins were obtained through identifying and quantifying the proteins using Proteome Discoverer 2.1 software and analyzed via GO annotation, KEGG pathway annotation, and functional enrichment clustering analysis.   RESULTS AND CONCLUSION: (1) A total of 137 differentially expressed proteins were obtained from 1 006 proteins identified by mass spectrometry, of which the expression of 54 and 83 proteins was up-regulated and down-regulated, respectively. (2) The differentially expressed proteins associated with the development of nontraumatic osteonecrosis of the femoral head included apolipoprotein B, apolipoprotein A2, apolipoprotein E, complement C4 and C7, etc. (3) The analysis results of KEGG signaling pathway enrichment showed that the major signaling pathways of key targets comprised p53 signaling pathway, transcriptional growth factor β signaling pathway, and dilated cardiomyopathy signaling pathway. It is concluded that apolipoproteins were closely related to nontraumatic osteonecrosis of the femoral head. This study provides insight into the molecular mechanisms underlying nontraumatic osteonecrosis of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Effect of different Scarf osteotomy angles on orthopedic surgery for flat foot Zhang Xingfei, Zhou Jiandong, Wang Wencheng, Zhang Yuxuan, Tian Jian, Xu Yajun 2023, 27 (29):  4670-4676.  doi: 10.12307/2023.646 Abstract ( 342 )   PDF (2132KB) ( 51 )   Save BACKGROUND: Scarf osteotomy is an effective procedure for correcting the valgus of the flat foot, which is a three-dimensional orthopedic procedure. Whether the angle of the osteotomy will affect the orthopedic strength needs to be studied.   OBJECTIVE: To simulate Scarf osteotomy at different angles in 3-matic software, and to analyze the effect of Scarf osteotomy angle on flat foot orthopedics. METHODS: Three-dimensional models of the flat foot on weight-bearing state were imported into 3-matic software to obtain the sketches of the frontal lateral and coronal rear foot. The relevant indexes of flat feet were measured as the flat feet indexes before operation. In the same model, the traditional Evans combined with medial displacement calcaneal osteotomy, as well as different angles of Scarf osteotomy, such as 45°, 60°, 75°, 90°, 105°, 120° were performed. After the osteotomy was completed, the flat foot-related indicators were measured again, and compared with those before the operation.   RESULTS AND CONCLUSION: Simple bone surgery had little effect on the talus pitch angle and the talo-first metatarsal angle on lateral side. Evans operation had greater correction of fore foot abduction, while Scarf osteotomy had no significant effect on it. For the effect on the hind foot valgus, Scarf osteotomy showed greater effects than the traditional Evans combined with medial displacement calcaneal osteotomy. The contact area of the osteotomy was larger than that of the traditional one, and decreased gradually with the increase of the angle of Scarf osteotomy. In addition, this study found that perpendicular to the lateral wall of the opposite bone after osteotomy, along the perpendicular to the lateral wall of the external bone can play a part in the role of deepening the arch. Figures and Tables | References | Related Articles | Metrics

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Zoledronic acid inhibits lipopolysaccharide-induced osteoclast differentiation by regulating NLRP3 signaling pathway Liu Guanjuan, Song Na, Huo Hua, Luo Shanshan, Cheng Yuting, Xiong Yue, Hong Wei, Liao Jian 2023, 27 (29):  4677-4683.  doi: 10.12307/2023.425 Abstract ( 371 )   PDF (4515KB) ( 52 )   Save BACKGROUND: Zoledronic acid can inhibit bone resorption, but whether it can inhibit inflammatory bone disease and its related mechanisms are completely unclear. OBJECTIVE: To investigate the effect of zoledronic acid on the proliferation and differentiation of osteoclasts induced by lipopolysaccharide.  METHODS: RAW264.7 cells were treated with lipopolysaccharide for osteoclastic induction and dyed with tartrate-resistant acid phosphatase and F-actin. RAW264.7 cells were cultured in vitro and divided into blank control group (no intervention), control group (treated with lipopolysaccharide), and 0.1, 1, 5 μmol/L zoledronic acid groups (lipopolysaccharide+0.1, 1, 5 μmol/L zoledronic acid). After 6 hours of culture, the level of tumor necrosis factor α in the supernatant was detected by ELISA, and the protein expression levels of NLRP3, caspase-1, interleukin-1β, cleaved-caspase-1 and tumor necrosis factor α were detected by western blot assay. On the 5th day of culture, the formation of osteoclasts was observed by tartrate-resistant acid phosphatase staining, and the expression of actin rings in osteoclasts was observed by F-actin staining.  RESULTS AND CONCLUSION: (1) Lipopolysaccharide could induce RAW264.7 cells to differentiate into osteoclasts. (2) The level of tumor necrosis factor α was higher in the control group than the blank control group (P < 0.05) and lower in the 0.1 and 5 μmol/L zoledronic acid groups than the control group (P < 0.05). Results from tartrate-resistant acid phosphatase and F-actin staining indicated that 1 and 5 μmol/L zoledronic acid could inhibit lipopolysaccharide-induced differentiation of RAW264.7 cells into osteoclasts. (3) Compared with the control group, 0.1, 1, and 5 μmol/L zoledronic acid could inhibit the protein expression of NLRP3, caspase-1, interleukin-1β, and tumor necrosis factor α (P < 0.05), while 1 and 5 μmol/L zoledronic acid could inhibit the protein expression of cleaved-caspase-1 (P < 0.05). (4) To conclude, zoledronic acid can inhibit osteoclast formation induced by lipopolysaccharide, which acts possibly through regulating the NLRP3 signaling pathway.  Figures and Tables | References | Related Articles | Metrics

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Short-term follow-up of modified elastic fixation Latarjet procedure for recurrent anterior dislocation of shoulder with obvious glenoid bone defect Liu Xiuqi, Chen Fang, Zhong Hehe, Xiong Huazhang, Lyu Guoqing, Wu Shuhong, Liu Yi 2023, 27 (29):  4684-4689.  doi: 10.12307/2023.644 Abstract ( 329 )   PDF (12197KB) ( 23 )   Save BACKGROUND: Although arthroscopically assisted Latarjet procedure is the “gold standard” for the treatment of recurrent anterior dislocation of shoulder with obvious glenoid bone defect, it has high complications such as shoulder joint degeneration and progression. The clinical effect of the arthroscopically modified elastic fixation Latarjet procedure  has been good in recent years, but most of them are case reports. Modified elastic fixation Latarjet procedure  in the treatment of recurrent anterior dislocation of shoulder with obvious glenoid bone defect is necessary to be further evaluated.   OBJECTIVE: To investigate the short-term clinical effect of modified elastic fixation Latarjet procedure  in the treatment of recurrent anterior dislocation of shoulder with glenoid bone defect. METHODS: Totally 42 patients with recurrent anterior dislocation of shoulder with obvious glenoid bone defect diagnosed and treated in Affiliated Hospital of Zunyi Medical University from January 2017 to October 2019 were collected into our study. They were treated with modified elastic fixation Latarjet procedure. Visual analogue scale score, university of California at Los Angeles shoulder rating scale, American shoulder and elbow surgeons, Rowe score and Walsh-Duplay score were compared before and after surgery. Postoperative CT and 3D reconstruction of shoulder joint and plain radiograph of shoulder joint were performed to evaluate the position of bone fragments, the degree of correction of glenoid defect, the degeneration of shoulder joint, and the healing and absorption of transposition coracoid process.   RESULTS AND CONCLUSION: (1) The operation process of 42 patients was successful, and there were no serious complications such as nerve or vascular injury after operation. All patients completed the follow-up of 20-34 months. (2) The visual analogue scale score, university of California at Los Angeles shoulder rating scale score, American shoulder and elbow surgeons score, Rowe score, Walsh-Duplay score were significantly improved at 10 days after surgery compared with before operation, and no dislocation or subluxation occurred again in all patients. (3) At the last follow-up, all patients underwent shoulder CT, which showed that the shoulder glenoid reached the normal level, without transposition, coracoid process absorption or bone nonunion. (4) The modified elastic fixation Latarjet procedure  can obtain satisfactory clinical effect in the treatment of recurrent anterior dislocation of shoulder with obvious glenoid bone defect. The operation time is short, with minimally invasive and fine arthroscopic operation. The position of coracoid process is satisfactory. There is no recurrent dislocation or subluxation after operation. It can significantly improve the function of shoulder joint. Figures and Tables | References | Related Articles | Metrics

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Analysis of influencing factors of fear of falling in patients with knee osteoarthritis and construction of nomogram model Ma Wei, Pang Jian, Zhang Jiefan, Xu Kun, Wang Yongyu, Zhang Min, Chen Bo, Shi Ying, Zhan Hongsheng 2023, 27 (29):  4690-4695.  doi: 10.12307/2023.650 Abstract ( 473 )   PDF (1682KB) ( 124 )   Save BACKGROUND: Fear of falling will aggravate the instability of the knee joint in patients with knee osteoarthritis, leading to the reduction of activities and the decline of the overall body function. Therefore, screening the factors affecting the fear of falling in patients with knee osteoarthritis and constructing a nomogram model can reduce the injury caused by the fear of falling and provide a reference for the formulation of individualized diagnosis and treatment plans.  OBJECTIVE: To explore the influencing factors and conditions of fear of falling in patients with knee osteoarthritis, and to establish a predictive model for the risk of fear of falling in patients with knee osteoarthritis.  METHODS: A cross-sectional study method was used to enroll 560 patients with knee osteoarthritis who visited Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 2019 to February 2021. Among them, 469 were in the falling fear group and 91 were in the non-falling fear group. The general information of patients, the Western Ontario and McMaster Universities Arthritis Index, and the Hospital Anxiety and Depression Scale scores were analyzed and compared between the two groups to determine the influencing factors of the fear of falling in knee osteoarthritis patients. Receiver operating characteristic curves of the influencing factors were drawn to obtain the Youden’s index with diagnostic value for the fear of falling. The maximum value of the Youden index of each factor was the best diagnostic value (cutoff value) of the knee osteoarthritis fear of falling. A nomogram was drawn to establish the knee predictive model for the fear of falling in patients with knee osteoarthritis.  RESULTS AND CONCLUSION: (1) Logistic regression analysis showed that height and male were the protective factors for the fear of falling in patients with knee osteoarthritis, and age, unemployment, Western Ontario and McMaster Universities Arthritis Index stiffness scale score, and anxiety scale score were the risk factors for the fear of falling in patients with knee osteoarthritis. (2) Receiver operating characteristic curve results showed that Western Ontario and McMaster Universities Arthritis Index had a significant diagnostic value for knee osteoarthritis patients (Youden’s index=0.733), followed by age, anxiety, and gender. (3) The results of the nomogram showed that the maximum score of the Western Ontario and McMaster Universities Arthritis Index stiffness scale (8 points) could account for 41.6% of the predictors of knee osteoarthritis fear of falling. (4) It is concluded that there is a high incidence of fear of falling among patients with knee osteoarthritis, and joint stiffness and female gender may be risk factors for fear of falling, while low height may be a protective factor for fear of falling, and there is a need to focus on fear of falling and the management of related factors in clinical treatment interventions.  Figures and Tables | References | Related Articles | Metrics

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Mechanism underlying the mutual regulation between circadian rhythm and autophagy Chen Chao, Wang Xuenan, Zhan Enyu, Lyu Zhengpin, Zhang Fan 2023, 27 (29):  4696-4703.  doi: 10.12307/2023.480 Abstract ( 436 )   PDF (1686KB) ( 188 )   Save BACKGROUND: At present, circadian rhythm of autophagy has gradually become a research hotspot in life sciences and human health. It plays an important role in maintaining human health, and many studies have confirmed that abnormal autophagy caused by circadian rhythm disorders can induce various diseases, such as neurodegeneration, cancer, aging, and autoimmunity. With the in-depth research, there is increasing evidence for the regulatory association between autophagy and circadian rhythm. However, their mutual regulation mechanism has not yet been elucidated. OBJECTIVE: To explore the relationship between circadian rhythm and autophagy, review the latest research progress in molecular circadian clock, circadian rhythm of autophagy, and the mutual regulation mechanism of circadian rhythm and autophagy, thereby giving a detailed overview of the specific molecular mechanism. METHODS: “Circadian rhythm, autophagy, molecular circadian clock, regulation, gene” were used as English and Chinese search terms. Relevant literature was searched in the PubMed, Web of Science, CNKI, and WanFang Databases. Finally, 107 articles were included for review according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) Circadian rhythm is a 24-hour physiological and behavioral rhythm generated by the molecular circadian clock. The molecular circadian clock is closely related to its production, mainly through the binding of BMAL1:CLOCK heterodimer to the E-box in the target molecule promoter to further activate the transcription of Cry, Per, Rev-erb, and Ror genes, thereby modulating the production of circadian rhythms. (2) Some genes, transcription factors, and pathways involved in autophagy are rhythmic in circadian changes, regulated by multiple circadian clock core components (such as Per2, BMAL1, and REV-ERB), which are a bridge functionally linking circadian rhythms and autophagy. (3) In addition, some molecules and drugs can also affect autophagy and circadian rhythm and play a crucial role in the regulation of rhythmic autophagy. Figures and Tables | References | Related Articles | Metrics

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Synergistic characteristics of lower extremity muscles with unilateral knee flexion limitation An Yishuai, Zhang Junxia, Li Hui, Zhang Yuxiao, Xu Guoliang, Gao Kun, Yu Shuhan, Liu Zelong 2023, 27 (29):  4704-4711.  doi: 10.12307/2023.658 Abstract ( 366 )   PDF (14716KB) ( 39 )   Save BACKGROUND: Limitation of knee motion is a relatively common post-injury feature, but it remains to be understood how muscle synergy under knee motion limitation is affected.   OBJECTIVE: To study the similarities and differences between unilateral knee flexion limitation and normal exercise lower extremity muscle synergy. METHODS: Twenty healthy adults (12 males and 8 females) were recruited as subjects, and the surface electromyogram signals of the lower limbs in natural walking with or without flexion limitation were collected. Muscle synergy was extracted from the surface electromyogram signals of 10 muscles on the restricted side (right leg) by a non-negative matrix factorization algorithm, and one-way analysis of variance was used to study the significant differences in gait parameters of walking in different conditions.   RESULTS AND CONCLUSION: (1) Under flexion limitation, the number of muscle synergies decreased during the walking task after restraint, showing different muscle coordination mode control and recruiting new muscle synergy units. With the decrease of the synergistic module, the activation time of the medial gastrocnemius, lateral gastrocnemius and soleus muscle shifted more obviously from the support phase to the swing phase. After the restriction, it mainly relied on the rectus femoris, vastus medialis, vastus lateralis and tensor fascia lata for compensation, making it abnormally active at the activation level, and at the same time, the restricted side showed movements such as circles and crotches, so after the restriction, the hip joint on the restricted side was mainly used as compensation. (2) Under flexion limitation, there were significant differences in gait parameters (frequency, pace, gait cycle, and support ratio) between the restricted side and the non-restricted side compared with those before restriction (P < 0.05). The single-leg support time was significantly increased (P < 0.01) compared to before the restriction. The proportion of support and the time of single-leg support on the restricted side were significantly smaller than those on the non-restricted side (P < 0.01). (3) Therefore, the weakening of knee flexion movement can be considered as a key factor leading to the impaired coordination of lower extremities. The results of the study have implications for the quantitative analysis of motor function and the guidance of human lower extremity rehabilitation, and provide important insights for understanding the neuromuscular control behind motor function impairment mechanism. Figures and Tables | References | Related Articles | Metrics

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Osteoimmunological effects of macrophages Tian Yuyi, Liu Lihong 2023, 27 (29):  4712-4722.  doi: 10.12307/2023.663 Abstract ( 412 )   PDF (1719KB) ( 64 )   Save BACKGROUND: Macrophages have received extensive attention from scholars for their remarkable osteoimmunological effects, and their functions and applications have become a research hot spot. The current research mainly involves the origin, polarization and osteoimmunological effects of macrophages and their applications in bone repair.   OBJECTIVE: To confirm the outstanding research value and application prospects of macrophages in bone tissue engineering through reviewing research advances in osteoimmunological effects of macrophages and their applications in bone repair. METHODS:  PubMed, Web of Science and CNKI databases were used to search the related articles published from 2010 to 2022. The search terms were “macrophage polarization, bone, osteogenesis, osteoimmunology, biomaterials, tissue engineering”. The searches to English and Chinese language publications were limited. A small number of old classic literature was also included. An initial screening was performed by reading the titles and abstracts to exclude literature that was not relevant to the topic of the article, and 120 papers were finally included for the analysis of the results.   RESULTS AND CONCLUSION: (1) Macrophages include monocyte-derived inflammatory macrophages and tissue-resident macrophages, of which different tissue-resident macrophages have different combinations of developmental origins; most tissue-resident macrophages originate from the yolk sac during the embryonic period. (2) Macrophages, highly pastic cells, undergo M1 or M2 macrophage polarization and release pro- or anti-inflammatory factors in response to different stimuli. Alternatively, macrophage polarization is regulated by multiple signaling pathways, including the AMPK-mTOR, Notch, MAPK, STAT, NF-кB, and Akt signaling pathways. (3) The osteoimmunological effects of macrophages involve the crosstalk between macrophages and skeletal cells. The effective application of osteoimmunological effects of macrophages in bone repair can be realized by modifying the physicochemical properties of biomaterials such as stiffness, roughness, pore size, and hydrophilicity or by combining single or multiple biologically active substances such as drugs, cytokines, metal ions, and microRNAs. Figures and Tables | References | Related Articles | Metrics

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Interleukin-33-mediated bone immunity Shen Mengran, Ren Yansong, Zhou Yu, Yue Debo, Ma Jinhui, Wang Bailiang 2023, 27 (29):  4723-4728.  doi: 10.12307/2023.490 Abstract ( 356 )   PDF (1582KB) ( 33 )   Save BACKGROUND: Osteoimmunology is a hot spot in the research on the mechanism of bone metabolic diseases in recent years. Interleukin-33 is an important new cytokine in bone immunology. It plays an important role in the progression of various bone metabolic diseases such as rheumatoid arthritis and osteoporosis. Its conduction pathway may become a potential target for clinical treatment. OBJECTIVE: To review the research progress of interleukin-33 in osteoimmunology effect during bone metabolism. METHODS: The articles related to interleukin-33, bone metabolism, and osteoimmunology were searched in PubMed, Web of Science, WanFang, and CNKI databases from the establishment of the database to June 2022, and finally 67 articles were included and summarized. RESULTS AND CONCLUSION: (1) Interleukin-33 mediated bone immunity has a regulatory effect on bone metabolism. (2) Regulation of bone metabolism by interleukin-33 can activate the osteoblast Wnt/β-catenin pathway by reducing the expression of sclerostin. This pathway increases bone mass through a variety of mechanisms, including stem cell renewal, stimulation of pre-osteoblast replication, induction of osteoblastogenesis, inhibition of osteoblast and osteocyte apoptosis. Interleukin-33 can inhibit the expression of nuclear factor of activated T cells c1 and osteoclast formation by stimulating the expression of anti-osteoclast genes such as Irf-8, MafB, and Bcl6. Moreover, the expression levels of apoptosis molecules can be induced, resulting in osteoclast apoptosis. (3) Interleukin-33 can inhibit the expression of RANKL in type 2 innate lymphocytes and induce the production of interleukin-13, interleukin-4, and granulocyte-macrophage colony stimulating factor, thereby inhibiting the differentiation of osteoclasts. Interleukin-33 can induce the recruitment of regulatory T cells to inflammatory sites and inhibit Th1 cells, CD8+ T cells, and M1 macrophages to support the differentiation of osteogenic precursor cells and inhibit the expression of osteoclast costimulatory molecules, thereby suppressing osteoclast differentiation and function. Interleukin-33 also can activate naïve T cells to differentiate into a Th2 cells and produce Th2 cytokines, which can induce local recruitment of osteoclasts, resulting in increased local bone resorption and cartilage degeneration. (4) Interleukin-33 also can induce endothelial cell proliferation, migration, and morphological differentiation, promote angiogenesis, and have a certain protective effect against ischemic diseases. Regulatory effects of interleukin-33 on bone metabolism are bidirectional, the causes of bone metabolism disorders are diverse, and the microenvironment in different parts of the body is different. Therefore, controlling the regulatory effect of interleukin-33 is a new direction for the treatment of bone metabolism-related diseases. Figures and Tables | References | Related Articles | Metrics

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Long non-coding RNAs regulate osteoarthritis by mediating chondrocyte-related mechanisms Chen Cai, Zeng Ping, Liu Jinfu 2023, 27 (29):  4729-4735.  doi: 10.12307/2023.489 Abstract ( 248 )   PDF (2275KB) ( 56 )   Save BACKGROUND: As the only kind of cells found in cartilage, the role of chondrocytes in osteoarthritis has received much attention. Increasing studies have found that long non-coding RNAs can participate in the pathogenesis of osteoarthritis by affecting various basic cellular characteristics of chondrocytes. OBJECTIVE: To review the research progress in the role of long non-coding RNAs in chondrocytes of osteoarthritis, thereby finding more diagnostic and therapeutic targets for osteoarthritis. METHODS: CNKI and PubMed were searched for articles addressing long non-coding RNAs in osteoarthritis published from 2007 to 2022. The search terms were “osteoarthritis; long non-coding RNA; chondrocytes; autophagy” in Chinese and “osteoarthritis; non-coding RNAs; long non-coding RNAs; chondrocytes; chondrocytes proliferation; chondrocytes autophagy; chondrocytes inflammation; chondrocytes extracellular matrix” in English. After duplicate studies and articles with low reliability and no reference were excluded, 62 articles were included for analysis, induction, and summary. RESULTS AND CONCLUSION: (1) Long non-coding RNAs can affect the development of osteoarthritis by regulating chondrocyte proliferation, autophagy, inflammatory response, and extracellular matrix synthesis. (2) Long non-coding RNAs may become a potential biomarker for the diagnosis or treatment of osteoarthritis.  Figures and Tables | References | Related Articles | Metrics

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Role and mechanism by which long non-coding RNAs regulate subchondral bone homeostasis in knee osteoarthritis Wei Zongbo, Su Yunyu, Zhang Xiaoyun, Huang Wei, Xu Hang, Liu Rongfa 2023, 27 (29):  4736-4744.  doi: 10.12307/2023.486 Abstract ( 314 )   PDF (2037KB) ( 40 )   Save BACKGROUND: The important role of subchondral bone adjacent to the cartilage layer in the knee osteoarthritis progression has been widely recognized and the factors interfering with subchondral bone homeostasis are gradually becoming a research hotspot. Current studies have revealed that long-stranded non-coding RNAs have highlighted certain advantages and values in regulating bone homeostasis.   OBJECTIVE: To understand the working mechanism of long non-coding RNAs in the subchondral bone homeostasis, thereby providing evidence for exploring new prevention and treatment methods for knee osteoarthritis. METHODS: CNKI, WanFang, VIP, PubMed, Medline, Embase, and Web of Science databases were searched with the search terms of “Long non-coding RNA, Knee osteoarthritis, Subchondral bone, Osteoblasts, Osteoclasts, Mesenchymal stem cells, Signal pathway” in Chinese and English. Literature retrieval time was from inception to July 2022, and a total of 65 articles were included in accordance with the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) Subchondral bone homeostasis is closely related to the proliferation, differentiation, and apoptosis of mesenchymal stem cells, osteoblasts and osteoclasts, and peripheral cytokines, and angiogenesis. (2) Long non-coding RNAs can modulate various factors affecting subchondral bone homeostasis, mainly through the Wnt/β-catenin, TGF-β/BMPs/Smad, PI3K/AKT, and SDF-1/CXCR4 signaling pathways, which thereby promote or inhibit bone formation by modulating the proliferation, differentiation and apoptosis of bone marrow mesenchymal stem cells, osteoblasts and osteoclasts. It can also modulate cytokines and inhibit angiogenesis. These findings provide a theoretical basis for balancing subchondral bone homeostasis and a potential target site for the prevention and treatment of subchondral osteosclerosis in knee osteoarthritis. (3) Long non-coding RNAs are important for modulating bone formation, bone resorption, and angiogenesis. How this type of RNAs can play a role in modulating the abnormal subchondral bone in knee osteoarthritis will be a key research focus in the future. (4) Given that it is difficult to collect samples of normal human subchondral bone, there is no report on the long non-coding RNAs in normal human subchondral bone. There is still a lack of clinical studies on the direct effects of long non-coding RNAs on subchondral bone and the mechanisms of their effects on modulating subchondral bone homeostasis are not fully understood. These remain to be studied in greater depth in the future. (5) This review can preliminarily reveal the mechanism of long non-coding RNAs on subchondral bone homeostasis and summarize the relevant potential targets, which are expected to promote long non-coding RNA as a biomarker and therapeutic target for the regulation of subchondral bone in the future, thus providing new ideas for the prevention and treatment of knee osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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Research advances in animal models of ankle osteoarthritis Zhou Guangzhi, Tai Dongxu 2023, 27 (29):  4745-4750.  doi: 10.12307/2023.675 Abstract ( 357 )   PDF (1682KB) ( 44 )   Save BACKGROUND: As a disease that greatly affects the quality of life of patients, ankle osteoarthritis has been paid more and more attention. The clinical and experimental research of ankle osteoarthritis is not as complete as that of knee joint, and there is a lack of systematic review on animal models.   OBJECTIVE: To explore the methods and characteristics of experimental models of ankle osteoarthritis, and to provide theoretical basis for the improvement of experimental research of ankle osteoarthritis. METHODS: Using the search terms of “ankle joint, osteoarthritis, animal models, post-traumatic osteoarthritis”, CNKI, WANFANG Data Platform, VIP, PubMed, and Embase databases from 2009 to 2022 were searched. Totally 49 articles were included for systematic review.   RESULTS AND CONCLUSION: (1) In the animal model of ankle osteoarthritis, the modeling methods for traumatic arthritis include chronic ankle instability model and intra-articular fracture model. Noninvasive animal models include intraarticular drug injection-induced models, cartilage atrophy models, joint senescence models, and spontaneous osteoarthritis models in specific strains of osteoarthritis susceptible species. (2) Although the incidence of traumatic ankle osteoarthritis is high, the research on ankle osteoarthritis is quite limited compared with knee osteoarthritis. Due to the differences in structure and characteristics between ankle joint and knee joint, the research results of knee joint are not completely applicable to ankle joint. The study of its animal model is more conducive to the in-depth exploration of the blind area of the current research. Figures and Tables | References | Related Articles | Metrics

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Measurement research method and measurement equipment for knee-spine syndrome Yang Qiang, Huang Jian 2023, 27 (29):  4751-4756.  doi: 10.12307/2023.626 Abstract ( 359 )   PDF (1539KB) ( 97 )   Save BACKGROUND: Low back pain and anterior knee pain are very common in clinical work, and they often occur together. Although the concept of knee-spine syndrome has been clearly put forward, which is a significant correlation between lumbar lordosis loss and knee flexion, there are few studies on the mutual compensation between knee and lumbar spine. In particular, there is no report on the research methods and equipment used between the two.  OBJECTIVE: To summarize the relevant literature related to knee-spine syndrome, analyze the measurement methods and equipment in each study, and give tips for the further development of knee-spine syndrome. METHODS: The relevant articles in PubMed database and CNKI database were searched by computer. The Chinese and English search terms were “knee-spine syndrome, low back pain, biomechanics, balance parameters, knee, spine”. Finally, 46 articles were included for review and analysis.   RESULTS AND CONCLUSION:  (1) There is a correlation between the sagittal balance of the lumbar spine and the flexion angle of the knee joint. When the knee joint has a flexion contracture deformity, the center of gravity of the body moves forward, and the human body will re-establish a new balance system, that is, the loss of lumbar curvature and lumbar lordosis. (2) The innovation of science and technology is an important driving force for the in-depth development of knee-spine syndrome. The technical means for the measurement and research of knee-spine syndrome include X-ray plain film, EOS system, SpinalMouse, finite element analysis, and gait analysis to build a multi-dimensional measurement and exploration system from lines of force, stress, kinematics, computer simulation analysis, etc., which will gradually reveal the mutual compensatory connection between the knee joint and the spine. (3) In-depth research on knee-spine syndrome is of great significance to explore the internal changes and mutual compensation relationship of human kinematics and morphology. The human body is a continuous integral movement unit, can provide guidance and theoretical basis for diagnosis and treatment of knee joint and lumbar spine diseases in clinical work by exploring the compensatory mechanism of the knee and waist. Figures and Tables | References | Related Articles | Metrics