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08 November 2023, Volume 27 Issue 31 Previous Issue   

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Finite element analysis of dorsal Kirschner wire for enhancing the stability of the dorsal ulnar fracture fragment in AO C type distal radial fractures Yin Hao, Chen Guang, Li Yan, Zhou Enchang, Ning Rende 2023, 27 (31):  4921-4925.  doi: 10.12307/2023.682 Abstract ( 344 )   PDF (1855KB) ( 98 )   Save BACKGROUND: Distal radial fracture involving dorsal ulnar fragment type belongs to unstable fractures, AO classification of 23C type and the middle column fractures of three-column classification. If dorsal ulnar fragment cannot be effectively fixed, it will affect the stability of radial joints and ulnar radial joints. The fixation effect of dorsal volar plate alone on dorsal ulnar fragment is limited. Although the fixation effect of dorsal volar double plate is effective, it increases the trauma and treatment cost, which is not in line with the current Diagnosis Related Groups policy. The addition of dorsal Kirschner wire fixation may be a relatively feasible plan.   OBJECTIVE: A finite element model of AO/ASIF 23-C1 distal radial fracture was established to compare the differences in biomechanical stability between volar locking plate and volar locking plate plus dorsal Kirschner wire, especially focusing on the fixation effect of dorsal ulnar fragment, providing a reference for clinical application. METHODS: Using reverse modeling technology, the CT data of healthy femur of a 42-year-old male and internal fixation data were imported into relevant software to establish three-dimensional finite element models of AO/ASIF 23-C1 distal radial fractures with volar locking plate and volar locking plate with dorsal Kirschner wire. The models were subjected to 100 N axial stress, or 1 Nm bending or torsional stress, respectively. The maximum displacement, maximum Von Mises stress and stress distribution of dorsal ulnar fragment were compared between the two groups.   RESULTS AND CONCLUSION: (1) The stress on the internal fixation was 2-10 times that on the bone under the two fixation methods, which met the requirements of fracture fixation. (2) Under the three different loads, there was no significant difference between the two groups in the stress peaks of both bone and internal fixation (< 30%). Under an axial load, the peak stress on the internal fixation was 3-4 times that on the bone. However, under bending load, the peak stress of internal fixation was 8-10 times that of bone, while under torsion load, the peak stress of internal fixation was only twice that of bone. (3) Under an axial load, the maximum displacements of the dorsal ulnar fragment between the two groups were very small and the difference was small, only 0.056 mm and 0.047 mm, respectively, indicating good stability of the fragment. Under bending load, the maximum displacement of single plate group was 2.4 times that of Kirschner wire group. Under torsion load, the maximum displacement of the single plate group was 2.7 times that of the Kirschner wire group. (4) It is indicated that the volar locking plate with Kirschner wire can more effectively fix the dorsal ulnar fracture fragment, with more uniform stress distribution, improve the fixation strength, and does not significantly increase the treatment cost. It is more suitable for the treatment of distal radial fractures involving the dorsal ulnar fracture fragment under the current Diagnosis Related Groups policy. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of the influence of lateral ankle collateral ligament injury on ankle joint stability and cartilage contact strain Shi Xu, Zuo Hua, Wang Yuxing, Yao Xiang, Yuan Jishan 2023, 27 (31):  4926-4931.  doi: 10.12307/2023.695 Abstract ( 392 )   PDF (2046KB) ( 86 )   Save BACKGROUND: Of ankle sprains and ankle ligament injuries, nearly 85% involved the lateral collateral ligaments, and the mechanism of injury was ankle varus during plantar flexion. Between 20% and 40% of patients with acute lateral ankle sprains develop persistent pain and chronic lateral ankle instability, resulting in excessive translation and rotation of the talus, accelerated cartilage wear and joint degeneration. OBJECTIVE: To explore the effects of different types of lateral ankle collateral ligament injury models on ankle joint stability and contact strain of talus dome cartilage through finite element modeling.  METHODS: The DICOM file of CT scan data of the ankle joint of a 27-year-old volunteer was imported into the finite element software for three-dimensional reconstruction and surface fitting, and then mesh division was carried out to establish a complete finite element model of the ankle joint containing bones, articular cartilage and ligaments. The changes of the ankle joint stability and talus cartilage contact strain were compared under four different conditions: normal, anterior talofibular ligament injury, calcaneofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury.  RESULTS AND CONCLUSION: (1) In the anterior drawer test, the anterior talar translation of anterior talofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury was significantly greater than that of normal and calcaneofibular ligament injury (P < 0.05), but there was no significant difference between anterior talofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury and between normal and calcaneofibular ligament injury (P > 0.05). (2) In the talus tilt test, the talus tilt angle of calcaneofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury was significantly larger than that of normal and anterior talofibular ligament injury, but there was no significant difference between calcaneofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury, and between normal and anterior talofibular ligament injury. (3) In the unipedal standing test, compared with the normal model, the above three injury models changed the contact strain distribution of talus dome cartilage and shifted the peak value from the anterolateral side to the anteromedial side of the talus dome, resulting in the increase of anteromedial pressure of talus dome cartilage, and the comparison of the peak values was: anterior talofibular ligament + calcaneofibular ligament injury > anterior talofibular ligament injury > calcaneofibular ligament injury > normal, and the peak value of anterior talofibular ligament + calcaneofibular ligament injury was significantly higher than that of anterior talofibular ligament injury and calcaneofibular ligament injury. (4) The results confirmed that the injury of the lateral collateral ligament of the ankle would lead to the loss of ankle stability and the increase of peak contact strain of anterior medial cartilage, revealed the relationship between chronic lateral ankle instability and ankle osteoarthritis, and concluded the necessity of repairing or reconstructing anterior talofibular ligament and calcaneofibular ligament, which provided a theoretical basis for surgical treatment of chronic lateral ankle instability.  Figures and Tables | References | Related Articles | Metrics

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Establishment of Nomogram prediction model for postoperative blood transfusion in elderly hip fractures using R software Niu Feng, Su Baotong, Chen Yulin, Xie Yajuan, Xu Yilang, Li Cong, Cheng Zhian 2023, 27 (31):  4932-4936.  doi: 10.12307/2023.692 Abstract ( 327 )   PDF (1758KB) ( 131 )   Save BACKGROUND: With the gradual aging of the population, the number of elderly patients with hip fractures is increasing. Blood transfusion is very common after hip fracture, but the risk factors of blood transfusion are still under debate. OBJECTIVE: To construct a Nomogram prediction model for evaluating the risk of the allogeneic erythrocyte blood transfusion after hip fracture in elderly patients. METHODS: From June 2016 to June 2020, 392 elderly patients with hip fractures who underwent surgical treatment in the Dade Road General Hospital of Guangdong Provincial Hospital of Chinese Medicine were selected as the research objects. Lasso regression and multivariate Logistic analysis were used to determine the risk factors and R software was utilized to build Nomogram prediction model.  RESULTS AND CONCLUSION: (1) Lasso regression and multivariate Logistic regression analysis showed that age, operation time, American Society of Anesthesiologists classification, hypertension, preoperative anemia, intraoperative blood loss, and fracture type were independent influencing factors of postoperative blood transfusion in elderly hip fractures. The area under the curve of the prediction model constructed by the seven indicators was 0.814. (2) Clinical decision curve analysis showed that the model had good clinical utility. (3) It is concluded that the prediction model established based on seven indicators of age, operation time, American Society of Anesthesiologists classification, hypertension, preoperative anemia, intraoperative blood loss, and fracture type has good performance in predicting the risk of blood transfusion after hip fracture in the elderly, and can provide an important reference for guiding postoperative blood transfusion in elderly hip fractures.  Figures and Tables | References | Related Articles | Metrics

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Correlation analysis of low back pain in middle-aged and elderly people in China and construction of a linear graph prediction mode Zhu Hongliu, Wang Wei 2023, 27 (31):  4937-4942.  doi: 10.12307/2023.537 Abstract ( 298 )   PDF (1690KB) ( 87 )   Save BACKGROUND: At present, there are many treatment methods for low back pain; however, most of them cannot fundamentally solve the problem. How to effectively reduce the incidence of low back pain is worth thinking about by clinical workers. OBJECTIVE: To explore the influencing factors of low back pain in middle-aged and elderly people in China, construct a nomogram prediction model for low back pain and guide exercise and rehabilitation therapy with different intensities and frequencies according to the occurrence probability of low back pain to reduce the incidence of low back pain. METHODS: The follow-up data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 were used to determine whether low back pain occurred or not. Fourteen variables, including age, sex, marriage, place of residence, exercise, education level, smoking, alcohol consumption, depressive symptoms, body mass index, sleep duration, left hand muscle strength, right hand muscle strength and waist circumference, were used as independent variables to analyze the independent influencing factors of the occurrence of low back pain in middle-aged and elderly people and construct the nomogram prediction model. The calibration curve and receiver operating characteristic curve of the model were drawn, and the C index was calculated to evaluate the discrimination and calibration degree of the prediction model.  RESULTS AND CONCLUSION: (1) A total of 6 059 middle-aged and elderly patients were selected. Patients with low back pain were selected as the disease group (n=1 263), and those without low back pain were selected as the control group (n=4 796). The original data set was constructed. The original data set was divided into training set (n=4 243) and verification set (n=1 816) at a ratio of 7:3. (2) According to the results of multivariate logistics regression analysis, four variables, including education level, depressive symptoms, sleep duration and right hand muscle strength, were identified to construct the nomogram prediction model, and the area under the receiver operating characteristic curve of the model was 0.726. The calibration curve fit was good, and the calibration curve generated by bootstrops method was good for the internal verification of the model. The validation set was used for the external verification. The area under the receiver operating characteristic curve of external verification was 0.740 and the calibration graph fit was good, indicating that the model had good discrimination and calibration degree. (3) According to the factors such as education level, depressive symptoms, sleep duration, and right hand grip strength, the probability of occurrence of low back pain can be predicted by using the nomogram prediction model, and early prevention can improve the quality of life of middle-aged and elderly people. Figures and Tables | References | Related Articles | Metrics

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Effect of tourniquet use on perioperative blood loss in total knee arthroplasty in patients with rheumatoid arthritis Wang Hao, Ma Chenghao, Qin Zuohai, Zhou Haibo, Ding Haoyuan, Han Dapeng, Nie Zhixing, Pan Peijun, Gao Chenxin, Ouyang Guilin 2023, 27 (31):  4943-4948.  doi: 10.12307/2023.694 Abstract ( 270 )   PDF (1564KB) ( 41 )   Save BACKGROUND: Without using a tourniquet in total knee arthroplasty can decrease perioperative blood loss. However, patients diagnosed with rheumatoid arthritis may affect the perioperative blood loss in total knee arthroplasty, especially in hidden blood loss.  OBJECTIVE: To evaluate the effect of tourniquet in patients with rheumatoid arthritis on perioperative blood loss in total knee arthroplasty.  METHODS: The clinical data of 80 patients diagnosed with rheumatoid arthritis undergoing unilateral total knee arthroplasty between January 2016 and December 2021 in the Department of Joint Surgery of Shanghai Guanghua Hospital of Integrated Chinese and Western Medicine were retrospectively analyzed. All patients underwent total knee arthroplasty under general anesthesia; 41 patients (control group) received total knee arthroplasty with a tourniquet while 39 patients (trial group) received total knee arthroplasty without a tourniquet. The total blood loss, intraoperative blood loss, overt blood loss, hidden blood loss, percentage of hidden blood loss, blood transfusion rate, operation time, limb swelling ratio at postoperative 3 days, wound dressing changing frequency, and delayed incision healing were recorded and compared between the two groups. RESULTS AND CONCLUSION: (1) The percentage of hidden blood loss was significantly lower in the trial group than that in the control group (P < 0.05). The intraoperative blood loss and operation time in the trial group were significantly higher than those in the control group (P < 0.05). There were no significant differences in total blood loss, hidden blood loss, overt blood loss, or transfusion rate between two groups (P > 0.05). (2) The postoperative limb swelling ratio in the trial group was significantly lower than that in the control group (P < 0.05). There were no significant differences in wound dressing changing frequency or delayed incision healing between the two groups (P > 0.05). (3) It is indicated that without using a tourniquet in patients with rheumatoid arthritis undergoing total knee arthroplasty does not increase the perioperative blood loss or hidden blood loss, and also decreases the postoperative limb swelling. Figures and Tables | References | Related Articles | Metrics

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Effects of relative anatomical position characteristics between the iliac crest and femoral greater trochanter on intramedullary nail placement Li Jing, Ping Ruiyue, Zhang Guoxu, Xie Qijun, Wang Zhonghao, Wang Haizhou, Chen Haiyun, Qi Ji 2023, 27 (31):  4949-4953.  doi: 10.12307/2023.684 Abstract ( 278 )   PDF (1708KB) ( 74 )   Save BACKGROUND: Proximal femoral nail anti-rotation is widely used in the treatment of femoral intertrochanteric fractures. Accurate screw placement angle and position can effectively improve the success rate of surgery and reduce the incidence of internal fixation-related complications.  OBJECTIVE: To investigate the relative anatomical positional relationship between the iliac crest and the greater trochanter of femur on intramedullary nail placement based on radiological measurements. METHODS: 174 hip joints were examined in 87 normal adult pelvic anteroposterior radiographs in Orthopedic Clinic of Guangdong Provincial Hospital of Chinese Medicine. There were 50 males and 37 females at the age of (43.72±14.45) years. The distance between bilateral iliac crest line (La) and bilateral femoral trochanter line (Lb) was measured. The angle with the median pelvic axis (∠1), the angle between the anatomical axis of the femur and the median axis of the pelvis (∠2), and the neck-shaft angle (∠3) were measured. On the pelvic anteroposterior radiograph, the vertical line of the horizontal line of the pelvis was made through the lateral margin of the iliac crest. The exposure of the greater trochanter of the femur was distinguished according to the degree of exposure of the greater trochanter of the femur inside and outside the vertical line. Group I (52 hip joints, with a large degree of exposure) was outside the line, and Group II (122 hip joints, with a small degree of exposure) was inside the line. The iliac crest occlusion angle was Δ1=|∠1-∠2|, and according to the proximal femoral nail anti-rotation with a 5° proximal lateralization angle was grouped, with Δ1≤5° as group IIa (66 hips), and Δ1>5° as group IIb (56 hips).  RESULTS AND CONCLUSION: (1) The values of La, La/Lb and Δ1 in Group I were lower than those in Group II (P < 0.05); the value of La/Lb in Group IIa was higher than that in Group IIb (P < 0.05); the value of Δ1 in Group I was higher than that in Group IIa (P < 0.05) and lower than that in Group IIb (P < 0.05); the value of Lb in Group IIb was lower than that in Group I (P < 0.05) and higher than that in Group IIa (P < 0.05). (2) The results showed that the smaller the distance between the pelvic width and the bilateral femoral trochanters, the smaller the degree of occlusion, and the easier it was to enter the nail. The smaller the degree of iliac crest occlusion, the better for nail insertion was. There are quite a few people with iliac crest occlusion. If it is found that the iliac crest occlusion is obvious before the operation, it can be considered to increase the degree of adduction appropriately to facilitate nail insertion on the premise of maintaining anatomical reduction during positioning, which has guiding significance for clinical operation.  Figures and Tables | References | Related Articles | Metrics

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Percutaneous vertebroplasty under distraction with external spinal fixator for vertebral osteoporotic compression fractures with posterior wall damage Sun Lingjuan, Song Xizheng, Li Daming, Han Zhenxue, Kang Yu, Xiang Hanrui, Sheng Kai 2023, 27 (31):  4954-4958.  doi: 10.12307/2023.618 Abstract ( 243 )   PDF (16135KB) ( 37 )   Save BACKGROUND: Posterior wall damaged vertebral osteoporotic compression fracture with spinal canal occupying is often treated by open surgery or conservative therapy at home and abroad. For elderly patients with osteoporosis, with the external spinal fixation device, the axial distraction of the spinal canal occupying the posterior bone block reduction, expansion of the spinal canal, and percutaneous vertebroplasty to solidify the vertebral body achieved good clinical results.   OBJECTIVE: To observe the clinical effect of percutaneous vertebroplasty of anterior and posterior longitudinal ligaments for osteoporotic compression fracture of vertebral body with posterior wall damage under external spinal fixation. METHODS: A total of 52 aged patients with osteoporotic compression fracture of vertebral body with posterior wall damage were selected, aged from 61 to 86 years (mean 78.62±5.20 years). The patients were treated with external spinal fixation combined with percutaneous vertebroplasty. X-ray and CT were used to observe the anterior margin height loss, kyphosis angulation, vertebral stenosis, and bone cement distribution in the fractured vertebrae before, 1 day and 3 months postoperatively, during final follow-up (12 months postoperatively). Visual analogue scale score and Oswestry dysfunction index were also evaluated.   RESULTS AND CONCLUSION: Fifty-two cases were followed up for 3-12 months. X-ray films exhibited that preoperatively and 1 day, 3 months postoperatively, at final follow-up, the loss rates of anterior vertebral body height were (34.5±2.2)%, (3.5±1.3)%, (4.0±0.6)%, and (4.4±1.1)%; the kyphosis angles were (12.1±1.7)°, (4.0±0.8)°, (3.5±0.5)°, and (4.4±0.2)°. CT showed that the spinal stenosis rates were (40.9±7.2)%, (10.7±2.5)%, (9.7±1.1)%, and (9.8±0.7)%. The distribution range of bone cement filling in fractured vertebral bodies was all ≥75%. There were significant differences in visual analogue scale score and Oswestry disability index before and 1 day after treatment (P < 0.05). There was no significant difference in visual analogue scale score and Oswestry disability index between 3 months after surgery and last follow-up (P > 0.05). The results have shown that percutaneous vertebroplasty under anterior posterior longitudinal ligament stretch of the vertebral body not only significantly improves the clinical effect of osteoporotic vertebral compression fracture repair, but also improves the vertebral body solidification rate and relieves pain, which is a safe and effective minimally invasive combination of new technology. Figures and Tables | References | Related Articles | Metrics

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Preservation of pronator quadratus muscle combined with volar locking plate in the treatment of distal radial fractures Huang Xiaoxia, Jia Qiyu, Erxat•Kerem, Peng Cong, Kong Weiqi, Teng Yong, Zhao Yan 2023, 27 (31):  4959-4964.  doi: 10.12307/2023.678 Abstract ( 318 )   PDF (3725KB) ( 41 )   Save BACKGROUND: The most commonly used approach for distal radial fractures is the traditional Henry approach, but the pronator quadratus muscle needs to be cut off during operation. Failure to repair the pronator quadratus muscle will bring a series of complications.   OBJECTIVE: To investigate the clinical effect of preserving pronator quadratus muscle and volar locking plate in the treatment of distal radial fractures. METHODS: A retrospective case-control study was conducted to analyze the clinical data of 64 patients with distal radial fractures, including 32 patients in the modified group (preserving pronator quadratus muscle). According to AO classification, there were 8 cases of 23-B1 type, 7 cases of 23-B2 type, 7 cases of 23-B3 type, 6 cases of 23-C1 type, and 4 cases of 23-C2 type. In the traditional group (cutting the pronator quadratus muscle via traditional Henry approach), there were 32 cases. According to AO classification, there were 7 cases of 23-B1 type, 9 cases of 23-B2 type, 3 cases of 23-B3 type, 6 cases of 23-C1 type and 7 cases of 23-C2 type. The postoperative internal fixation, fracture healing, postoperative complications and other conditions of the two groups were observed, and the visual analog scale score of wrist pain was compared between the two groups. The wrist function of the patients was evaluated by Dienst joint score standard and the surgical effect was evaluated by imaging indicators.   RESULTS AND CONCLUSION: (1) The average operation time and average intraoperative blood loss were significantly less in the modified group than those in the traditional group (Z=-6.77, P < 0.01; Z=-5.41, P < 0.01). (2) The average healing time in the modified group was shorter than that in the traditional group (Z=-2.08, P < 0.05). (3) At 12 months after operation, the excellent and good rates of the wrist function in the modified group and the traditional group were 94% (30/32) and 88% (28/32) respectively, with no significant difference (χ2= 0.767, P=0.682). (4) There was no significant difference in radial height, palmar inclination and ulnar deviation between the two groups shown by anteroposterior and lateral X-ray examination of wrist joint at 3 days, 1 and 3 months after operation (P > 0.05). (5) The visual analog scale score of the modified group was lower than that of the traditional group at 1 week, 1 and 3 months after operation (P < 0.05), but there was no significant difference in visual analog scale score between the two groups at 12 months after operation (P > 0.05). (6) There was no traumatic arthritis in both groups. In the traditional group, there were two cases of carpal tunnel syndrome (II stage removal of internal fixation device). (7) It is concluded that the modified Henry method with the preservation of pronator quadratus muscle has no significant advantages in the late pronation angle and pain. However, intraoperative surgery can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, and promote early activities. Figures and Tables | References | Related Articles | Metrics

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Quantitative evaluation of bone structure changes in femoroacetabular impingement syndrome by magnetic resonance imaging Li Xiaojuan, Zhang Yuanzhi, Yang Xiaoguang, Gao Yang, Wu Qiong 2023, 27 (31):  4965-4970.  doi: 10.12307/2023.705 Abstract ( 289 )   PDF (3552KB) ( 62 )   Save BACKGROUND: As the main imaging method of femoroacetabular impingement syndrome, MRI can clearly show the structure of hip joint soft tissue. With the help of three-dimensional visualization technology, MRI can be used for three-dimensional imaging of bone tissue. There is currently no report on quantitative evaluation of femoroacetabular impingement syndrome using three-dimensional hip MRI.   OBJECTIVE: Three-dimensional imaging was performed on MRI images of patients with femoroacetabular impingement syndrome, and EE angle and α angle were measured based on three-dimensional images to quantitatively evaluate bone structure changes. METHODS: Totally 24 cases of femoroacetabular impingement syndrome were selected. They were 12 males and 12 females, aged from 36 to 53 years (average, 43.47 years); height from 158 to 190 cm (average, 172.46 cm); weight from 62 to 87 kg (average, 77.79 kg). Each MRI was completed on a GE Discovery MR 750, 3.0T system with the patients in the supine position. An axial three-dimensional gradient-echo was performed. Thickness: 0.6 mm, X/Y resolution: 0.365 mm/0.365 mm. Raw T2 sagittal data in .dicom format were input into Materialise Mimics Innovation Suite 16.0 software. Semi-automatic segmentation method was adopted to visualize and analyze the collision area.   RESULTS AND CONCLUSION: (1) The α angle (62.86±6.36)° and EE angle (13.68±3.42)° could be accurately measured by three-dimensional reconstruction of MRI images. The α angle obtained from three-dimensional MRI images of hip joint could effectively reflect femoroacetabular impingement syndrome. (2) The three-dimensional image of hip MRI stereoscopically displays the morphology of hip cartilage and bone, provides a reference for the choice of treatment options, and has development and application prospects. Figures and Tables | References | Related Articles | Metrics

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Functional correlation between the elasticity of the quadriceps and its tendons and osteoarthritis of the knee based on shear wave elastography measurements Huang Yuying, Guo Yi, Han Xinzuo, Min Hongwei, Li Xuemei, Liu Kemin 2023, 27 (31):  4971-4976.  doi: 10.12307/2023.561 Abstract ( 322 )   PDF (2075KB) ( 50 )   Save BACKGROUND: It has been shown that muscle elasticity changes in patients with knee osteoarthritis, but most of the current studies have focused on the assessment of muscle tone and muscle strength. Changes in the elasticity of the quadriceps and its tendons in patients with knee osteoarthritis have rarely been reported. OBJECTIVE: To investigate the characteristics of the elastic modulus of the quadriceps femoris and its tendons in patients with knee osteoarthritis and to analyze its relationship with knee pain and function, thereby providing some basis for the prevention and treatment of knee osteoarthritis. METHODS: The elasticity of the quadriceps femoris and its tendons was measured by shear wave elastography in 30 patients with clinically confirmed knee osteoarthritis (knee osteoarthritis group) and 28 healthy individuals without knee pain (control group). The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was used for knee pain and function assessments in both groups. Changes in the modulus of elasticity of the quadriceps were compared between the two groups. The correlation between the elastic modulus of the quadriceps muscle and the WOMAC score was statistically analyzed. RESULTS AND CONCLUSION: (1) The thickness of the rectus femoris, middle femoris, medial femoris, lateral femoris and quadriceps tendon was less in the knee osteoarthritis group than in the control group. The elastic modulus of the lateral femoris was significantly higher in the knee osteoarthritis group than in the control group (P < 0.05). (2) The elastic modulus of muscles that was characteristically different from the control group was selected for correlation analysis. The elastic modulus of the lateral femoris in the knee osteoarthritis group showed a low linear correlation with the WOMAC pain scale (r=0.367, P < 0.05). In the self-reported pain scale, the elastic modulus of the lateral femoris in patients with knee osteoarthritis was only moderately linearly positively correlated with pain level during going up/downstairs (r=0.584, P < 0.05). In the self-reported functional impairments scale, patients with knee osteoarthritis showed a moderate linear correlation between the elastic modulus of the lateral femoris and the function when going downstairs and getting up from a seat (r=0.411, P < 0.05; r=0.464, P < 0.05). (3) From the above, an increased stiffness of the lateral femoris may be a characteristic change in the quadriceps muscle of patients with knee osteoarthritis. This in turn reflects the pain and function of the knee joint during increased loading. Further research is needed to investigate the significance of the modulus of elasticity in assessing the condition and outcome of patients with knee osteoarthritis, so as to achieve the precise rehabilitation treatment. Figures and Tables | References | Related Articles | Metrics

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Relationship between anatomical morphology of the tibial plateau and meniscal tears Zhou Hang, Feng Shuo, Zhang Jincheng, Zhang Leshu, Chen Jiahao, Chen Xiangyang 2023, 27 (31):  4977-4983.  doi: 10.12307/2023.689 Abstract ( 316 )   PDF (1787KB) ( 36 )   Save BACKGROUND: The probability of meniscal tears is gradually increasing. However, the relationship between meniscal tears and the anatomical morphology of the tibial plateau has been poorly studied and controversial so far.   OBJECTIVE: To measure the posterior tibial slope, medial tibial plateau depth, and lateral tibial plateau height in patients with meniscal tears and to investigate their association with meniscal tears. METHODS: From September 2019 to June 2022, 164 patients with meniscal tears and undergoing arthroscopic treatment were selected from Affiliated Hospital of Xuzhou Medical University. These patients were divided into medial meniscal tears group (n=92), lateral meniscal tears group (n=45) and medial and lateral meniscal tears group (n=27). Totally 78 patients with knee pain without meniscal tears during the same period were selected as the control group. The medial tibial slope, the lateral tibial slope, the medial tibial plateau depth and the lateral tibial plateau height in each group were carefully measured and compared.   RESULTS AND CONCLUSION: (1) The medial tibial slope in the medial meniscal tears group was significantly steeper than that in the control group (P < 0.05), and the lateral tibial slope in the lateral meniscal tears group was steeper than that in the medial meniscal tears group and the control group (P < 0.05). The medial tibial slope of the medial meniscal tears group and the control group was significantly greater than their lateral tibial slope (P < 0.05). The medial tibial plateau depth in the medial meniscal tears group was significantly shallower than that in the lateral meniscal tears group and control group (P < 0.05), and the lateral tibial plateau height in the lateral meniscal tears group was higher than that in the medial meniscal tears group and control group (P < 0.05). (2) These results indicate that steep posterior tibial slope is a risk factor for meniscal tears. A shallow medial tibial plateau depth and a high lateral tibial plateau height have the potential to cause meniscal tears.  Figures and Tables | References | Related Articles | Metrics

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Sagittal related factors of upper lumbar disc herniation Yuan Haibo, Li Dongya, Pan Bin, Guan Kai, Chen Feng, Yuan Feng, Wu Jibin 2023, 27 (31):  4984-4989.  doi: 10.12307/2023.688 Abstract ( 286 )   PDF (1793KB) ( 28 )   Save BACKGROUND: Compared with the common segment of lumbar disc herniation, upper lumbar disc herniation is rare, but the structure of the high spinal canal is complex, so the clinical manifestations are often serious and varied. Analysis of related imaging parameters can provide a deep understanding of the disease characteristics, and provide ideas for early diagnosis and treatment and postoperative prevention of recurrence.   OBJECTIVE: To analyze the characteristics of sagittal imaging parameters in patients with upper lumbar disc herniation, and to explore the possible influence of different parameters on the incidence of upper lumbar disc herniation. METHODS: A total of 46 upper lumbar disc herniation patients hospitalized from January 2019 to January 2022 were collected as the observation group, including 9 cases of disc herniation at the L1-L2 level, 10 cases at the L2-L3 level, and 27 cases at the L3-L4 level. According to the 1∶1 ratio, 46 patients with L4-L5 lumbar disc herniation during the same period were selected as the control group. Sagittal imaging parameters of the two groups were measured on the anteroposterior and lateral lumbar X-ray films in standing position, including: pelvic tilt, pelvic incidence, sacral slope, lumbar lordosis, thoracolumbar kyphosis, and wedging angle of the vertebrae. Multivariate Logistic regression analysis was used to determine the correlation between the above parameters and the incidence of upper lumbar disc herniation, and receiver operating characteristic curve was used to analyze the influence of risk factors for meaningful results.   RESULTS AND CONCLUSION: (1) Pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis of the observation group were significantly less than those in the control group (P < 0.05). Thoracolumbar kyphosis and wedging angle of the vertebrae in the observation group were larger than those in the control group (P < 0.05). (2) Multivariate Logistic regression analysis showed that high thoracolumbar kyphosis (OR=1.963, 95%CI:1.341-2.874, P=0.001) and high wedging angle of the vertebrae (OR=1.635, 95%CI:1.069-2.499, P=0.023) affected the incidence of upper lumbar disc herniation. Although the differences of pelvic tilt, pelvic incidence, sacral slope, lumbar lordosis and other indicators between the two groups were statistically significant, they could not be used as independent risk factors. (3) Receiver operating characteristic curve analysis showed that thoracolumbar kyphosis and wedging angle of the vertebrae had certain warning significance for the occurrence of upper lumbar disc herniation, and the cutoff values of thoracolumbar kyphosis and wedging angle of the vertebrae were 10.45° and 6.45°, respectively. (4) It is concluded that the anteroposterior and lateral lumbar radiography can better evaluate the sagittal related parameters in patients with upper lumbar disc herniation. The pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis of patients with upper lumbar disc herniation are significantly lower than those of patients with conventional lumbar disc herniation, and the physiological curvature of the lumbar spine decreases or disappears, presenting a relatively straight state as a whole. Thoracolumbar kyphosis and wedging angle of the vertebrae are relatively high, and thoracolumbar kyphosis > 10.45° and wedging angle of the vertebrae > 6.45° are the high-risk alert values of upper lumbar disc herniation. Figures and Tables | References | Related Articles | Metrics

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Effect of inhibitor of Wnt production 2 on osteoclast differentiation Liao Zirui, Chen Jianquan 2023, 27 (31):  4990-4995.  doi: 10.12307/2023.448 Abstract ( 335 )   PDF (1784KB) ( 69 )   Save BACKGROUND: Abnormal activation of osteoclast-mediated bone resorption leads to the loss of bone mass, damage and deterioration of bone microarchitecture, which is an important cause of osteoporosis. Wnt/β-catenin signaling pathway may be a potential target and tool for the prevention and treatment of osteoporosis. Overactivation of Wnt/β-catenin signaling pathway inhibits osteoclast differentiation. However, the physiological role of Wnt/β-catenin signaling pathway in osteoclast formation remains to be clarified. OBJECTIVE: To investigate the effect of inhibitor of Wnt production 2 (IWP-2) on proliferation and differentiation of bone marrow-derived macrophages through inhibiting the Wnt/β-catenin signaling pathway. METHODS: (1) Bone marrow-derived macrophages were extracted. Cell counting kit-8 assay was performed to assess the viability of bone marrow-derived macrophages after being treated with gradient concentrations from 0 to 40 μmol/L IWP-2 for 24, 72, or 120 hours. (2) Bone marrow-derived macrophages induced by 100 μg/L receptor activator of nuclear factor kappa B ligand (RANKL) were treated with 5 or 10 μmol/L IWP-2 and equivalent solvent, and precipitated proteins were collected at 0, 1, 3 and 5 days. The activity of Wnt/β-catenin signaling pathway and the inhibitory effect of IWP-2 on it during osteoclast differentiation were detected by western blot assay. (3) Bone marrow-derived macrophages induced by 100 μg/L RANKL were treated with non-toxic IWP-2 (0, 5, or 10 μmol/L) for 6 days. The effects of IWP-2 on osteoclast differentiation were evaluated by tartrate-resistant acid phosphatase staining. The mRNA expression of osteoclast-related genes including NFATc1, Oscar, CTSK, Acp5, Mmp9, and Dcstamp were detected by real-time fluorescence quantitative PCR. RESULTS AND CONCLUSION: (1) After treatment with different concentrations of IWP-2 for 24 hours, 10 μmol/L IWP-2 promoted the proliferation of bone marrow-derived macrophages. After treatment with different concentrations of IWP-2 for 72 and 120 hours, the viability of bone marrow-derived macrophages was not significantly affected by IWP-2 at a concentration of 10 μmol/L or less, while high concentrations of IWP-2 (20, 30, and 40 μmol/L) inhibited the proliferation of bone marrow-derived macrophages. (2) After 1, 3, and 5 days of RANKL stimulation, the protein expression of active β-catenin in the control group increased gradually, while that in the 5 and 10 μmol/L IWP-2 treatment group was significantly inhibited. (3) Many large and irregular TRAP-positive multinucleated mature osteoclasts were observed in the control group, while the number and size of the cells decreased in a dose-dependent manner in the IWP-2 treatment groups, suggesting that IWP-2 could inhibit osteoclast differentiation. (4) The expression levels of osteoclast-related genes including NFATc1, Oscar, CTSK, Acp5, Mmp9, and Dcstamp were all down-regulated in a dose-dependent manner after IWP-2 treatment. (5) To conclude, IWP-2 can inhibit osteoclast differentiation in vitro and may play a role in the prevention and treatment of osteoporosis by directly or indirectly inhibiting the expression of osteoclast-elated genes. Figures and Tables | References | Related Articles | Metrics

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Distribution law and pathological characteristics of cystic degeneration in steroid-induced femoral head necrosis Tian Jiaqing, He Mincong, Wei Yurou, He Xianshun, Zhong Yuan, Jiang Yulai, Zhan Zhiwei, Wei Tengfei, He Xiaoming, Wei Qiushi 2023, 27 (31):  4996-5001.  doi: 10.12307/2023.580 Abstract ( 298 )   PDF (2202KB) ( 23 )   Save BACKGROUND: The reduction of mechanical bearing capacity of the femoral head is the main cause of femoral head collapse, and cystic degeneration affects the normal mechanical conduction pathway of the hip joint. However, few studies have explored the relationship between the two in the development of femoral head necrosis. OBJECTIVE: To discuss the distribution law and pathological characteristics of cystic degeneration in steroid-induced femoral head necrosis based on heat map model and pathological results. METHODS: Thirty patients (30 hips) who were diagnosed with steroid-induced femoral head necrosis in the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from June to December 2021 were selected as the research objects, and the outline of cystic degeneration of steroid-induced femoral head necrosis was extracted and the contour line was matched to the standard femoral head model to present the contour line as a heat map. Necrosis position and necrosis area of the femoral head were recorded and counted to study the relationship between the two. Hematoxylin-eosin staining was used for histomorphological changes of femoral head specimens. RESULTS AND CONCLUSION: (1) Based on the heat map of the cystic degeneration of steroid-induced femoral head necrosis and the pathological results of the femoral head, we found that cystic degeneration commonly occurred in the medial and lateral columns of the femoral head after steroid-induced femoral head necrosis. Compared with the area of cystic degeneration of the medial column, the area of cystic degeneration of the lateral column was larger, and with the inward movement of cystic degeneration, its area also decreased. (2) In addition, microfracture lines were scattered around cystic degeneration, which may be one of the important factors affecting the mechanical bearing capacity and stability of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Astragalus polysaccharide inhibits Toll-like receptor 4/nuclear factor kappaB p65 pathway in the treatment of knee osteoarthritis in rats Chen Jingtao, Chen You, Li Yujing, Liu Zhigang 2023, 27 (31):  5002-5008.  doi: 10.12307/2023.184 Abstract ( 310 )   PDF (2228KB) ( 60 )   Save BACKGROUND: Astragalus polysaccharide has a certain role in the treatment of arthritis, and abnormal Toll-like receptor 4/nuclear factor κB pathway plays an important role in the pathogenesis of knee osteoarthritis.  OBJECTIVE: To investigate the effect of astragalus polysaccharide on osteoarthritis and its mechanism.  METHODS: Forty SD rats were randomly divided into control group (the same volume of normal saline), model group (the same volume of normal saline), astragalus polysaccharide low-dose group (0.2 mL of 0.1 /L astragalus polysaccharide intervention), astragalus polysaccharide high-dose group (0.2 mL of 0.5 g/L astragalus polysaccharide intervention), and lipopolysaccharide group (0.2 mL of 0.5 g/L astragalus polysaccharide+0.2 mL of 500 µg/kg lipopolysaccharide). Interventions in each group began at 1 week after modeling, once every 3 days, for 6 continuous weeks. After intervention, histopathological changes of the cartilage and synovial membrane were observed by hematoxylin-eosin staining and saffron O-solid green staining. Mankin’s score and Osteoarthritis Research Society International score were performed for histological evaluation. The levels of interleukin-1β, interleukin-6, tumor necrosis factor-α, nitric oxide, malondialdehyde, and superoxide dismutase in synovial tissue were detected by ELISA. The protein levels of Aggrecan, collagen type II, matrix metalloproteinase 3, nuclear factor-κB p65, Toll-like receptors 4 and myeloid differentiation factor 88 in cartilage tissue were detected by western blot assay.  RESULTS AND CONCLUSION: (1) Compared with the model group, the Mankin’s score, Osteoarthritis Research Society International score, the levels of interleukin-1β, interleukin-6, tumor necrosis factor-α, nitric oxide, malondialdehyde, and matrix metalloproteinase 3, and the expressions of nuclear factor-κB p65, Toll-like receptors 4, and myeloid differentiation factor 88 were significantly decreased in the astragalus polysaccharide low- and high-dose groups, while the expression levels of Aggrecan, collagen type II, and superoxide dismutase activity were significantly increased (P < 0.05). Furthermore, the astragalus polysaccharide high-dose group showed better effects than the low-dose group (P < 0.05). (2) Compared with the astragalus polysaccharide high-dose group, the Mankin’s score, Osteoarthritis Research Society International score, the levels of interleukin-1β, interleukin-6, tumor necrosis factor-α, nitric oxide, malondialdehyde, matrix metalloproteinase 3 and the expressions of nuclear factor-κB p65, Toll-like receptors 4, and myeloid differentiation factor 88 were significantly increased in the lipopolysaccharide group, while the superoxide dismutase activity and the expressions of Aggrecan and collagen type II were significantly decreased (P < 0.05). (3) To conclude, astragalus polysaccharide can improve extracellular matrix degradation, inflammatory response, and oxidative stress levels, and alleviate joint injury due to knee osteoarthritis by inhibiting the activation of Toll-like receptor 4/nuclear factor κB p65 pathway.  Figures and Tables | References | Related Articles | Metrics

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Correlation between new sarcopenia index and bone mineral density in postmenopausal patients with type 2 diabetes mellitus Gu Peng, Pu Bin, Chen Junbang, Yue Dan, Xin Qiao, Zeng Zhanpeng, Zheng Xiaohui 2023, 27 (31):  5009-5014.  doi: 10.12307/2023.526 Abstract ( 224 )   PDF (1587KB) ( 65 )   Save BACKGROUND: The prevalence of type 2 diabetes mellitus complicated with osteoporosis is increasing yearly. Early prevention, detection, and treatment of osteoporosis are considered essential in postmenopausal patients with type 2 diabetes mellitus. OBJECTIVE: To investigate the correlation of new sarcopenia index (SI) with bone mineral density and osteoporosis in patients with type 2 diabetes mellitus complicated with osteoporosis.   METHODS: Postmenopausal patients with type 2 diabetes mellitus hospitalized in the First Affiliated Hospital, Guangzhou University of Chinese Medicine from January 2021 to March 2022 were selected and divided into osteoporosis group (n=93) and non-osteoporosis group (n=121) according to whether type 2 diabetes mellitus is combined with osteoporosis. The demographic data, bone mineral density, blood routine, glucose metabolism, lipid metabolism, and renal function indexes were collected and the SI was calculated. The correlation between clinical indexes and bone mineral density of the lumbar spine, left femoral neck and left hip was analyzed by multivariate linear regression, and the risk factors of osteoporosis in postmenopausal patients with type 2 diabetes mellitus were analyzed by multivariate logistic regression. The predictive values of new SI, serum cystatin C level, and creatinine/serum cystatin C ratio (CCR) in predicting osteoporosis in postmenopausal patients with type 2 diabetes mellitus were analyzed by the receiver operating characteristic curve.   RESULTS AND CONCLUSION: (1) The new SI, serum cystatin C level, and CCR value in the osteoporosis group were lower than those in the non-osteoporosis group (P < 0.05). (2) Multivariate linear regression analysis with adjusted covariates showed that the new SI and CCR were significantly positively correlated with bone mineral density of the lumbar spine, left femoral neck and left hip (βCCR=0.003, 0.001, 0.002, P < 0.05; βSI=0.002, 0.001, 0.002, P < 0.05). The cystatin C level was significantly correlated with bone mineral density of the lumbar spine (βcystatin C=0.09, P < 0.05). (3) Multivariate Logistic regression analysis with adjusted covariates showed that serum cystatin C level, CCR, and new SI were protective factors for osteoporosis in postmenopausal patients with type 2 diabetes mellitus (odds ratio=0.149, 0.957, 0.941; P < 0.05). (4) The area under the receiver operating characteristic curve of the new SI for predicting osteoporosis in such patients was the largest (the area under the curve=0.756), with a sensitivity of 67.8% and a specificity of 72.0%. (5) To conclude, renal function is intrinsically related to bone health. An increased new SI is related to the increase of bone mineral density in postmenopausal patients with type 2 diabetes mellitus, and the risk of osteoporosis can be predicted by the new SI in such patients. Figures and Tables | References | Related Articles | Metrics

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Role of pyruvic acid in osteoclast differentiation Liu Guanjuan, Xia Qianxi, Song Na, Huo Hua, Hong Wei, Liao Jian 2023, 27 (31):  5015-5021.  doi: 10.12307/2023.584 Abstract ( 856 )   PDF (3112KB) ( 34 )   Save BACKGROUND: Glycolysis is essential for osteoclast differentiation and bone resorption of mature osteoclasts is mainly dependent on glycolysis. Pyruvic acid, as the end product of glycolysis, plays an important role in the metabolism of the three nutrients. OBJECTIVE: To observe the effect of pyruvic acid on osteoclast differentiation.  METHODS: The toxicity of different concentrations of pyruvic acid (0.1, 1, 10, 20, 30, 50 mmol/L) to RAW264.7 cells was detected by cell counting kit-8 assay, and the safe concentration of pyruvic acid was selected. RAW264.7 cells were grouped into interventions: blank control group was cultured with a complete medium (α-MEM medium containing volume fraction 10% fetal bovine serum and 1% double antibodies); control group was cultured with a complete medium containing nuclear factor κB receptor activating factor ligand, and experimental group was cultured with a complete medium with nuclear factor κB receptor activating factor ligand and different concentrations of pyruvic acid, followed by tartrate-resistant acid phosphatase staining, cytoskeletal F-actin staining, RT-qPCR assay, western blot assay and bone resorption lacuna assay.  RESULTS AND CONCLUSION: (1) The maximum half inhibitory concentration of pyruvic acid on RAW264.7 cells was 8.923 mmol/L, and 0.1, 1, 5 mmol/L were selected as the safe concentrations for subsequent experiments. (2) Tartrate-resistant acid phosphatase staining revealed that 1 mmol/L pyruvic acid promoted the differentiation of RAW264.7 cells into osteoclasts. (3) F-actin staining showed that 1 mmol/L pyruvic acid promoted the formation of osteoclast F-actin ring, while 5 mmol/L pyruvic acid did not interfere with the formation of osteoclast F-actin ring. (4) RT-qPCR assay indicated that pyruvic acid within the safe concentration range had no significant effect on the relative mRNA expression of osteoclast differentiation related genes nuclear factor of activator T-cells and tartrate-resistant acid phosphatase. (5) Western blot assay showed that 0.1 and 1 mmol/L pyruvic acid within the safe concentration range had no significant effect on the protein expression of nuclear factor of activator T-cells, while 5 mmol/L pyruvic acid inhibited the protein expression of nuclear factor of activator T-cells, and 0.1, 1, and 5 mmol/L pyruvic acid promoted the expression of osteoclast differentiation related protein c-Fos. (6) 1 mmol/L pyruvic acid promoted the formation of bone resorption lacunae in osteoclasts. (7) To conclude, 1 mmol/L pyruvic acid can promote the differentiation of receptor activator for nuclear factor-κB induced RAW264.7 cells into osteoclasts in vitro. Figures and Tables | References | Related Articles | Metrics

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Quantitative proteomic analysis of serum TMT markers for the effect of isoflavones extracted from chickpea sprouts in osteoporosis rat models Zheng Jingjie, Huang Jinyong, Tuerxunjiang·Dadihan, Gao Yanhua, Li Zhiqiang, Ma Hairong 2023, 27 (31):  5022-5027.  doi: 10.12307/2023.521 Abstract ( 254 )   PDF (21357KB) ( 29 )   Save BACKGROUND: In previous studies, isoflavones extracted from chickpea sprouts have preventive and therapeutic effects on osteoporosis caused by estrogen deficiency. However, the underlying mechanism has not been clarified. OBJECTIVE: To explore the mechanisms of isoflavones extracted from chickpea sprouts to prevent and treat osteoporosis in ovariectomized rats based on proteomics analysis of differentially expressed proteins in serum.   METHODS: Twenty-seven 10-week-old female Sprague-Dawley rats were randomized into model, chickpea sprout isoflavone, and sham operation groups, with nine rats in each group. Animal models of osteoporosis were prepared by bilateral ovariectomizy in the model and chickpea sprout isoflavone groups. One week after modeling, the chickpea sprout isoflavone group was given 300 mg/kg isoflavones extracted from chickpea sprouts per day by gavage, while the sham operation and model groups were given the same volume of saline by gavage, once a day. After 3 months of continuous administration, serum samples from experimental groups were extracted for proteomic analysis. Tandem mass tag technology was used to screen the differentially expressed proteins. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment analyses were also performed.  RESULTS AND CONCLUSION: (1) Compared with the model group, 21 differentially expressed proteins were found in the isoflavone group, including signal transduction pathway related proteins and lipid metabolism related proteins. (2) GO functional enrichment analysis showed that the differentially expressed proteins were mostly related to the regulation of lipid metabolism and transport. (3) The KEGG enrichment analysis showed the differentially expressed proteins were significantly enriched in cholesterol metabolism and proteasome pathways, which may regulate the differentiation of osteoblasts and osteoclasts via important pathways such as Wnt-β-catenin and RANKL/RANK/OPG. (4) To conclude, isoflavones extracted from chickpea sprout are involved in the expression of numerous lipoproteins and signaling pathway proteins in serum and can play a role in the prevention and treatment of osteoporosis through various signaling pathways. Figures and Tables | References | Related Articles | Metrics

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Effect of Illicium henryi extract on angiogenesis in rats with osteoporotic fractures Shi Guirong, Ren Bowen, Zhang Zhongbo, Wang Lisha, Zhang Qiwei, Shi Dongliang 2023, 27 (31):  5028-5034.  doi: 10.12307/2023.513 Abstract ( 262 )   PDF (2523KB) ( 31 )   Save BACKGROUND: The extract of Illicium henryi is a Chinese herbal preparation with anti-inflammatory and analgesic properties and invigorating blood circulation and stasis. Its ethanol extract has markedly curative effect on rat soft tissue injury. However, there is yet no report on whether Illicium henryi has therapeutic effect on osteoporotic fractures.  OBJECTIVE: To investigate the protective effect of Illicium henryi extract on angiogenesis in osteoporotic fracture rats and to clarify its possible mechanism.  METHODS: (1) In vivo experiments: A rat model of osteoporotic fracture was prepared using castration method and closed fracture method. A total of 36 healthy female Sprague-Dawley rats were selected, 30 of which were randomized into sham, model, and treatment groups, with 10 rabbits in each group, and the remaining 6 were included in the control group. Each rat in the treatment group was given 0.05 mL/kg Illicium henryi extract after modeling. The dual-energy X-ray and three-point bending mechanics methods were used to detect femoral bone mineral density and the end-point load of the femoral elastic segment. Hematoxylin-eosin staining was used to measure the number and area of blood vessels in bone calluses. ELISA was used to detect serum levels of vascular endothelial growth factor, basic fibroblast growth factor, platelet-derived growth factor, and nitric oxide. (2) In vitro experiments: Human microvascular endothelial cells were given drug intervention. Treated cells were divided into control group, Illicium henryi extract (50, 100, or 200 mg/L) groups, Vector+dimethyl sulfoxide group, NRF1 overexpression group, LY294002 (10 μmol/L) treatment group, and NRF1 overexpression+LY294002 treatment group. MTT, Transwell, and angiogenesis assays were used to detect the proliferation, migration rate and angiogenesis of human microvascular endothelial cells, respectively. Western blot assay was used to detect the levels of NRF1, PI3K, p-PI3K, AKT, and p-AKT proteins in human microvascular endothelial cells. ELISA was used to detect the levels of vascular endothelial growth factor, basic fibroblast growth factor, platelet-derived growth factor, and nitric oxide in human microvascular endothelial cells.  RESULTS AND CONCLUSION: (1) Illicium henryi extract significantly improved the bone mineral density and maximum load of the femur in osteoporotic rats (P < 0.05), and increased the number and area of blood vessels in the callus tissue, and the serum levels of angiogenesis-related factors (P < 0.05). (2) Illicium henryi extract promoted the expression of NRF1, p-PI3K and p-AKT proteins in human microvascular endothelial cells (P < 0.05), and increased the proliferation, migration, angiogenesis, and angiogenesis-related factor expressions of human microvascular endothelial cells (P < 0.05). Overexpression of NRF1 had the same effects, but LY294002 treatment reversed the effects of NRF1 overexpression. (3) To conclude, Illicium henryi extract can promote angiogenesis in osteoporotic fracture rats by increasing the expression of NRF1 protein and activating the PI3K/AKT signaling pathway.   Figures and Tables | References | Related Articles | Metrics

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Distribution characteristics of bone mass in different parts of postmenopausal women with knee osteoarthritis Chen Jianchao, Song Huiping 2023, 27 (31):  5035-5039.  doi: 10.12307/2023.440 Abstract ( 243 )   PDF (1539KB) ( 70 )   Save BACKGROUND: There is still a big controversy about the interaction between knee osteoarthritis and osteoporosis. Patients with knee osteoarthritis often present with changes in bone mineral density (BMD). The relationship between the BMD of the knee joint and the BMD of the lumbar spine and hip is unclear. OBJECTIVE: To investigate the distribution and correlation of BMD in the lumbar spine, femoral neck, and knee joint of patients with knee osteoarthritis. METHODS: 150 postmenopausal women with primary knee osteoarthritis were selected to measure the BMD of the lumbar spine, femoral neck, and ipsilateral knee joint. Then the knee joint was divided into six regions of interest (ROI), which were marked as R1-R6, with R1 representing the medial side of proximal tibia, R2 representing the lateral side of proximal tibia, R3 representing the proximal tibia (R3=R1+R2), R4 representing the medial side of distal femur, R5 representing the lateral side of distal femur and R6 representing the distal femur (R6=R5+R4). According to the K-L classification, all the patients were divided into grade 0 group (33 cases), grade I-II group (61 cases), and grade III group (56 cases). The BMD of each ROI was compared with the BMD of the lumbar spine and femoral neck, and then the BMD of different ROIs was compared in pairs. The correlation between the BMD of each ROI and the BMD of the lumbar spine and femoral neck was analyzed. RESULTS AND CONCLUSION: (1) The BMD of R2, R4, R5, and R6 in the grade III group was lower than that in the grade 0 group (P < 0.05). The BMD of the femoral neck, R2, and R3 in the grade III group was lower than that in the grade I-II group (P < 0.05). (2) The BMD of each ROI of the knee joint in the three groups was ranked as R5 > R6 > R4 > (R1, R2, and R3). The BMD of R1 was lower than that of R2 in the grade 0 group (P < 0.05). (3) In grade 0 patients, the BMD of R2, R5, and R6 was positively correlated with the BMD of the lumbar spine and femoral neck (P < 0.05), while the BMD of R1 and R3 was only positively correlated with the BMD of the lumbar spine (P < 0.05). In grade I-II patients, the BMD of each ROI of the knee joint was positively correlated with the BMD of the lumbar spine and femoral neck (P < 0.05). In grade III patients, the BMD of R1 and R3 was positively correlated with the BMD of the lumbar spine and femoral neck (P < 0.05), while the BMD of R2, R4, R5, and R6 was only positively correlated with the BMD of the femoral neck (P < 0.05). (4) All these findings suggest that there are differences in the BMD of different ROIs of the knee joint, and the BMD of the lateral side of distal femur is the highest. With the progression of knee osteoarthritis, the BMD of the femoral neck and the BMD of the knee joint except the medial side of proximal tibia are on the decline, and the BMD of different parts of the knee joint is correlated with the BMD of the lumbar spine and ipsilateral femoral neck. Figures and Tables | References | Related Articles | Metrics

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Correlation of acromial index and acromiohumeral distance with age in middle-aged and elderly patients with degenerative rotator cuff tear Shen Yong, Liu Shizhang, Zhai Tengfei, Hou Shuanghu, Feng Min 2023, 27 (31):  5040-5045.  doi: 10.12307/2023.524 Abstract ( 286 )   PDF (1549KB) ( 37 )   Save BACKGROUND: Degenerative rotator cuff tear is one of the main diseases affecting shoulder joint activities. In clinical work, the number of middle-aged patients has increased significantly and measurements of acromial index and acromiohumeral distance can be completed in shoulder X-ray examinations, both of which are clearly expressed as direct risk factors for rotator cuff injury. Abnormalities in these two indexes indicate impingement, injury, and tear of the rotator cuff are aggravated in different directions during shoulder joint activities (especially abduction and lift). Whether there is a difference between the two indicators of middle-aged patients and elderly patients and whether there is a correlation between the two indicators and the patient’s age remain to be further confirmed. OBJECTIVE: To analyze whether there is a difference between the acromion index and acromiohumeral distance between middle-aged and elderly patients with degenerative rotator cuff tear, and to analyze whether the two indicators are correlated with the patient’s age. METHODS: A total of 64 patients diagnosed with degenerative rotator cuff tear and 63 patients with no non-rotator cuff tear were enrolled, who were admitted at Department of Orthopedics of Shaanxi Provincial People’s Hospital from April 2019 to June 2022. Receiver curve analysis was used to determine acromion index, cut-off value of acromiohumeral distance and area under the curve. Then, enrolled patients were divided into four groups according to age and whether or not rotator cuff tear existed: middle-aged tear group, middle-aged control group, elderly tear group, and elderly control group. We compared acromion index and acromiohumeral distance between groups and investigated the correlation between the two indicators and the age of the patients. RESULTS AND CONCLUSION: (1) The area under the curve of the acromion index and the acromiohumeral distance was 0.710 and 0.706, respectively. The cut-off values were > 0.70 for the acromion index and < 7.9 mm for the acromiohumeral distance. (2) The acromion index in the middle-aged tear group was significantly higher than that in the middle-aged control group (P=0.013), while the acromiohumeral distance was significantly smaller than that in the middle-aged control group (P < 0.001). The acromion index in the elderly tear group was significantly higher than that in the elderly control group (P < 0.001), but there was no significant difference in the acromiohumeral distance between the two groups (P > 0.05). There was no significant difference in the acromion index between the middle-aged and elderly tear groups (P > 0.05); however, the acromiohumeral distance was significantly lower in the middle-aged tear group than that in the elderly tear group (P < 0.001). (3) There was no negative correlation between the acromion index and age (r=-0.015, P=0.83) and was a positive correlation between the acromiohumeral distance and age (r=0.334, P < 0.001). (4) To conclude, the acromion index and acromiohumeral distance are both risk factors for degenerative rotator cuff tear. The middle-aged patients with rotator cuff tear have abnormal acromial index and acromiohumeral distance compared with the middle-aged control group. There is a positive correlation between the acromiohumeral distance and age in patients with rotator cuff tears. Figures and Tables | References | Related Articles | Metrics

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Correlation between platelet count and lumbar bone mineral density in middle-aged and elderly people Zhang Jinpeng, Chen Chang, Pan Qiuyu, Mai Chenyao, Li Yinlong, Hao Yuxi, Hu Jun 2023, 27 (31):  5046-5051.  doi: 10.12307/2023.569 Abstract ( 300 )   PDF (1661KB) ( 31 )   Save BACKGROUND: Recent studies have found that there may be an intrinsic association between platelet count and bone mineral density. However, previous studies have reached different conclusions on the intrinsic association between the two.  OBJECTIVE: To study the correlation between lumbar spine bone density and platelet count in middle-aged and elderly people.  METHODS: A total of 2 571 men and 2 929 women were recruited from the NHANES database. Weighted multiple linear regression models and smooth curve fitting were used to evaluate the association between lumbar bone mineral density and platelet count.  RESULTS AND CONCLUSION: (1) The weighted multiple linear regression model results showed that lumbar bone mineral density was negatively correlated with platelet count in the total population. There was still a negative correlation between lumbar bone density and platelet count after grouping into four groups. When stratified by sex, there was still a negative correlation in men, β=-0.000 2, 95% confidence interval (CI): (-0.000 3, < -0.000 1). When stratified by race, only the three models for Americans of other races showed a positive correlation [model 1: β=0.000 2, 95% CI: (< 0.000 1, 0.000 4); Model 2: β=0.000 1,  95% CI: (-0.000 1, 0.000 3); Model 3: β=0.000 1, 95% CI: (-0.000 1, 0.000 3)], while the three models of Hispanic, non-Hispanic white and non-Hispanic black showed a negative correlation. (2) The smooth curve fitting was used to solve the nonlinear relationship between platelet count and lumbar bone mineral density. It was found that there were two inflection points between platelet count and lumbar bone mineral density within the normal range in men. The piecewise linear regression model was used to identify the two inflection points, which were 141×109/L and 246×109/L. (3) To conclude, there is a negative correlation between lumbar bone mineral density and platelet count in middle-aged and elderly men. There is a positive correlation between lumbar bone mineral density and platelet count in men when platelet count is < 141×109/L in the normal range, a negative correlation when platelet count is (141-246)×109/L, and a positive correlation when platelet count is > 246×109/L. There may be a positive correlation between lumbar bone density and platelet count in women. Figures and Tables | References | Related Articles | Metrics

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Pressure biofeedback training for treating cervical spondylosis Zhou Jinyan, Zhong Yuanming, Li Zhifei, Xu Wei, Zhang Jiali, Liang Ziyang 2023, 27 (31):  5052-5057.  doi: 10.12307/2023.196 Abstract ( 428 )   PDF (2073KB) ( 123 )   Save BACKGROUND: As a new and objective method for the measurement and treatment of muscle training, pressure biofeedback can provide real-time feedback to improve the accuracy and effectiveness of deep neck flexor exercises. However, there are few reports on clinical studies related to pressure biofeedback and neck deep muscle exercise in China.  OBJECTIVE: To investigate the clinical efficacy of pressure biofeedback training combined with deep neck flexor exercises in patients with chronic neck pain.  METHODS: A total of 60 patients with chronic neck pain treated in the Out-Patient Department and Orthopedic Ward of the First Affiliated Hospital of Guangxi University of Chinese Medicine from April to October 2021 were enrolled in this study. These patients were selected and divided into experimental group and control group. The former group used pressure biofeedback to perform deep neck flexor exercises, while the latter group performed regular deep neck flexor exercises. The primary outcome was the peak pressure measured by pressure biofeedback at each follow-up point (1, 2, and 3 months after treatment) and the secondary outcomes were peak pressure maintenance time as well as the Northwick Park Neck Pain Questionnaire score.  RESULTS AND CONCLUSION: (1) There were significant differences in peak pressure value and peak pressure maintenance time before and after exercises in the two groups (P < 0.05). Compared with the control group, the peak pressure value and maintenance time were significantly higher in the experimental group at each time point (P < 0.05). (2) The Northwick Park Neck Pain Questionnaire score in each group was significantly lowered at each time point after exercises (P < 0.05), and the score in the experimental group was significantly lower than that in the control group at 2 and 3 months after exercises (P < 0.05). (3) To conclude, pressure biofeedback combined with deep neck flexor exercises can effectively alleviate the symptoms of chronic neck pain, feedback real-time exercise results for patients, and increase the sustainability of functional exercises, which is a simple, convenient, and low-cost treatment for neck pain and can be a part of the community re-education program for prophylaxis and treatment. Figures and Tables | References | Related Articles | Metrics

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Application of finite element analysis in artificial knee arthroplasty Li Haoran, Huang Jian 2023, 27 (31):  5058-5063.  doi: 10.12307/2023.727 Abstract ( 611 )   PDF (1445KB) ( 46 )   Save BACKGROUND: Artificial knee arthroplasty is widely used in the field of joint surgery as the most effective treatment for various end-stage joint diseases such as knee osteoarthritis and rheumatoid arthritis. Finite element analysis is a biomechanical research method developed gradually with the continuous progress of computer technology, which has a strong modeling function and three-dimensional simulation characteristics. At present, finite element analysis has been widely used in orthopedic biomechanical studies.   OBJECTIVE: To review the current status and progress of finite element analysis in various types of total knee arthroplasty. METHODS: Articles related to finite element analysis and artificial knee arthroplasty published from inception to August 2022 were searched on PubMed, CNKI and WanFang databases by computer. English search terms were “finite element analysis, TKA, UKA, revision total knee arthroplasty, knee osteoarthritis, knee joint, femoral component, tibia component”. Chinese search terms were “finite element analysis, total knee arthroplasty, unicompartmental knee arthroplasty, knee revision, knee, femoral prosthesis, tibial prosthesis”. A total of 53 articles were finally included for review.   RESULTS AND CONCLUSION: (1) In total knee arthroplasty, the mobile bearing reduces the tibiofemoral joint contact surface stress compared with the fixed bearing, thereby reducing the wear of the polyethylene bearing. Compared with mechanical alignment, total knee arthroplasty with kinematic alignment reduces the maximum stress and maximum strain value of femoral prosthesis and polyethylene insert of the artificial joint, and generates lower stress, thus reducing the wear of joint contact surface and prolonging the life of the prosthesis. (2) In unicompartmental knee arthroplasty, the femoral and tibial prostheses of the mobile platform have better conformity and can reduce prosthesis wear; while the fixed platform prosthesis in unicompartmental knee arthroplasty should avoid local stress concentration caused by overconformity and lead to accelerated prosthesis wear. (3) In revision total knee arthroplasty, the design length of the stem extension should maintain the best balance between preserving bone quality and reducing periprosthetic stress after implantation. Press-fit stems showed higher micromotion compared to cemented stems. (4) Compared with traditional mechanical research, finite element analysis can carry out relatively accurate simulations and make up for the shortcomings of traditional mechanics in knee joint research, so it has a high application value in the medical field. Figures and Tables | References | Related Articles | Metrics

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Prevention and treatment of bone-related diseases by regulating macrophages with Chinese medicine Yang Chaoqiang, Zhang Hulin, Wang Xiaomin, Wang Liang, Wang Yican 2023, 27 (31):  5064-5070.  doi: 10.12307/2023.719 Abstract ( 399 )   PDF (1933KB) ( 44 )   Save BACKGROUND: Macrophages play a key role in regulating many physiological and pathological processes in humans and have been shown to be a key factor affecting the development of bone-related diseases. In recent years, studies have found that the prevention and treatment of bone-related diseases by regulating macrophages with traditional Chinese medicine have obvious advantages and considerable curative effects with its multi-target, multi-mechanism, multi-level, simple, convenient, inexpensive, effective, and small side effects.  OBJECTIVE: To review the latest research results of macrophages in orthopedic diseases, the relationship between macrophages and bone-related diseases, and the research progress of Chinese medicine intervention in macrophages to prevent and treat bone-related diseases.  METHODS: PubMed and CNKI databases were searched by the first author for relevant articles published from January 2010 to September 2022 with the keywords of “macrophage, osteoporosis, osteoarthritis, intervertebral disc, traditional Chinese medicine”. A preliminary screening was conducted by reading the title and abstract, and the literature unrelated to the topic of the article was excluded. Finally, 61 articles were included for review analysis.  RESULTS AND CONCLUSION: (1) Macrophages can secrete pro-inflammatory cytokines and are related to the activation of bone resorption. Targeted activation of macrophages may help inhibit or slow down the progression of bone loss in patients with osteoporosis. (2) Macrophages are considered important joint synovial inflammatory cells. The imbalance between pro-inflammatory macrophages and anti-inflammatory macrophages may lead to chronic low-grade inflammation, which in turn induces osteoarthritis development. (3) Macrophages may play a direct role in phagocytosis or through neuro-immune mechanisms to coordinate the regulation of intervertebral disc metabolism; its functional imbalance will lead to more inflammatory factor chemotaxis and aggregation, leading to the degradation of the extracellular matrix of the intervertebral disc, thereby aggravating disc degeneration. (4) Chinese medicine’s intervention of macrophages in the prevention and treatment of bone-related diseases has a remarkable effect and a promising prospect. Figures and Tables | References | Related Articles | Metrics

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Properties, functions and applications of three-dimensional models of bone for drug screening Huang Miao, Wu Xiesheng, Huang Wenshi, Huang Haina, Chen Longyun, Peng Weijie 2023, 27 (31):  5071-5077.  doi: 10.12307/2023.676 Abstract ( 330 )   PDF (1708KB) ( 37 )   Save BACKGROUND: The development of drugs for skeletal-related diseases in clinical settings is a lengthy process, and the effectiveness of traditional two-dimensional models for drug screening no longer meets the needs. Various modified 3D models have their advantages and disadvantages and related applications, but so far there is no ideal experimental model that can be utilized for drug screening of all bone related diseases.   OBJECTIVE: To review relevant literature in recent years, to summarize the basic characteristics of two-dimensional and three-dimensional models of bone and their possible effects on cellular function, and to focus on a review of the current common three-dimensional models of bone and their application for drug screening in actual skeletal system diseases, with a view to providing ideas for future applications and improvements of three-dimensional models of bone in drug screening. METHODS: Relevant English articles were searched on PubMed database with English search terms of “bone, skeleton, three-dimensional models, models, drug screening, drug selection”. Related Chinese articles were searched on Wanfang and CNKI databases, and the Chinese search terms were “bone, skeleton, models, three-dimensional models, drug screening, drug selection”. Some articles were searched with literature retrospective method for review analysis.   RESULTS AND CONCLUSION: (1) The physical properties of the two-dimensional model of bone are different from those of the three-dimensional model of bone; the matrix is generally fixed in the two-dimensional model, whereas the three-dimensional model matrix is adjustable, and the two have different effects on the functional aspects of the cells. (2) Two-dimensional models of bone are easier to construct and produce, but they lack the typical three-dimensional microstructure and interconnections with surrounding cells and the extracellular matrix, and are therefore only suitable for cellular level studies. (3) There are biological differences between two-dimensional and three-dimensional models of cultured bone tissue. In the two-dimensional state, osteocytes or induced osteoblasts are flattened, whereas the three-dimensional model is closer to the natural extracellular matrix of bone tissue and more accurately represents the drug response. (4) Commonly used three-dimensional models of bone include cell spheres, hydrogels, bioreactors and microfluidic chips, which are constructed in different ways and have their own advantages in drug screening. (5) Common three-dimensional models of bone have been used for drug screening in skeletal-related diseases, and the need for different three-dimensional models of bone varies from disease to disease, for example, in the case of osteoporosis, a degenerative disease, where the degradability and sustainability of scaffolds and hydrogels are more effective for drug screening. Figures and Tables | References | Related Articles | Metrics

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Research and advance in intervertebral disc annulus fibrosus repair Liu Xin, Sun Tianze, Zhang Jing, Zhang Wentao, Li Zhonghai 2023, 27 (31):  5078-5084.  doi: 10.12307/2023.593 Abstract ( 575 )   PDF (1551KB) ( 166 )   Save BACKGROUND: Lumbar intervertebral disc herniation is a common clinical disease. Its incidence is increasing year by year, which seriously affects the quality of life of patients and brings huge economic losses to the families of patients and society. At present, it is considered that the destruction of the integrity of intervertebral disc fibrous annulus is an important factor affecting the occurrence and development of lumbar disc herniation. Therefore, it is of great significance to restore the integrity of the annulus fibrosus for the treatment and prevention of lumbar disc herniation.  OBJECTIVE: To review the research advance in intervertebral disc annulus repair in recent years.  METHODS: PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang databases were searched systematically, with the key words “intervertebral disc, annulus fibrosus, repair, regeneration” in Chinese and English. Relevant articles published in each database in the last five years were collected.  RESULTS AND CONCLUSION: In recent years, some progress has been made in the repair and regeneration of annulus fibrosus in and outside China. Although traditional physical repair has some shortcomings, it is still the main way of clinical treatment, while the application of tissue engineering in annulus fibrosus repair is only in the experimental stage and has not been widely used in clinical practice. There are many ways to repair intervertebral disc annulus fibrous, but the best way needs extensive animal and clinical trials to verify its safety and efficacy. The study on tissue engineering of annulus fibrosus repair has broad clinical application prospects.  Figures and Tables | References | Related Articles | Metrics