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28 December 2023, Volume 27 Issue 36 Previous Issue    Next Issue

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Establishment of lumbar-pelvic-hip finite element model and biomechanical analysis Wen Pengfei, Li Yaning, Lu Yufeng, Hao Linjie, Wang Yakang, Ma Tao, Song Wei, Zhang Yumin 2023, 27 (36):  5741-5746.  doi: 10.12307/2023.708 Abstract ( 663 )   PDF (2504KB) ( 68 )   Save BACKGROUND: The increasing incidence of hip-lumbar disorders has posed a great challenge to clinical treatment and requires a well-established lumbar-pelvic-hip model to analyze its biomechanical characteristics. OBJECTIVE: To establish a three-dimensional finite element model of the normal adult lumbar-pelvic-hip for biomechanical analysis to provide the experimental basis and reference for the study of hip and lumbar diseases and surgical treatments. METHODS: Normal adult CT data were collected. Mimics, Geomagic, Hypermesh, and Abaqus software were used to construct a three-dimensional finite element model of the lumbar-pelvic-hip. The model was analyzed for each working condition, and the validity of the model was verified by the range of motion of the vertebral body and the stress distribution of the intervertebral disc and femoral head. The seated model was further constructed to compare the biomechanical distribution characteristics and trends between standing and sitting positions.  RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of the lumbar-pelvic-hip in a normal adult was successfully established. (2) The results of the model in each working condition were within the reference range of previous literature data, which confirmed the effectiveness of the model and could be used for further experimental studies. (3) Mises stresses in the L4-L5 and L5-S1 discs showed an increasing trend after the change of posture from standing to sitting, with the most obvious change in L5-S1 disc. In terms of hip joint stress distribution, the Mises stresses were distributed in the anterior, superior, and posterior parts of the acetabulum in the standing position, while the stresses were mainly concentrated in the anterior part of the acetabulum in the sitting position. Figures and Tables | References | Related Articles | Metrics

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Correlation between three-dimensional measurement of posterior tilt of impacted femoral neck fracture and femoral head necrosis Zhan Hongqi, Ma Jianxiong, Cui Shuangshuang, Sun Lei, Wang Ying, Bai Haohao, Ma Xinlong 2023, 27 (36):  5747-5752.  doi: 10.12307/2023.758 Abstract ( 422 )   PDF (2330KB) ( 60 )   Save BACKGROUND: In clinical practice, impacted femoral neck fractures are usually treated with cannulated screw internal fixation. In previous studies, the preoperative posterior tilt of the femoral head has been shown to be associated with internal fixation failure. However, there are few studies on the occurrence of femoral head necrosis after internal fixation and posterior tilt. OBJECTIVE: To investigate the correlation between femoral head necrosis and posterior tilt measured by three-dimensional reconstruction and its risk factors after internal fixation of impacted femoral neck fractures. METHODS: The clinical data of 150 patients with impacted femoral neck fractures admitted to Tianjin Hospital from 2016 to 2020 were retrospectively analyzed. The posterior tilt of the femoral head was measured by a three-dimensional reconstruction technique according to postoperative femoral head necrosis. The patients were divided into the necrosis group and the non-necrosis group. The clinical data were compared between the two groups using single-factor analysis. Risk factors of femoral head necrosis were analyzed by multivariate logistic regression analysis. The predictive value of posterior tilt for postoperative femoral head necrosis was assessed using receiver operating characteristic curves.   RESULTS AND CONCLUSION: (1) A total of 150 patients were followed up for 18 to 66 months (mean, 29 months) after surgery, and necrosis occurred in 20 patients (13.3%). (2) Multivariate logistic regression analysis exhibited that reduction quality grade C and posterior tilt were risk factors for femoral head necrosis. (3) Receiver operating characteristic curve analysis revealed the predictive value of posterior tilt measured in three dimensions for postoperative femoral head necrosis, with a cut-off value of 20.74°. (4) The results showed that posterior tilt and reduction quality grade C were risk factors for femur head necrosis after closed reduction and internal fixation in patients with impacted femoral neck fractures. The posterior tilt of the femoral head can be accurately measured by three-dimensional reconstruction technology. Patients with posterior tilt ≥20.74° are more likely to experience postoperative femoral head necrosis. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of unstable intertrochanteric fractures repaired with proximal femoral nail anti-rotation combined with anterolateral reconstruction plate Li Guangsheng, Lin Weimin, Zhang Shenshen, Lin Wang, Lin Chengshou 2023, 27 (36):  5753-5759.  doi: 10.12307/2023.722 Abstract ( 328 )   PDF (1709KB) ( 38 )   Save BACKGROUND: At present, there is no unified method to reconstruct the lateral wall after intertrochanteric fractures of femur. It is a common way to place reconstruction plates on the anterolateral side of the femoral intertrochanteric fracture, but there is little research on its biomechanics and clinical application.   OBJECTIVE: To investigate the changes in biomechanical parameters of proximal femoral nail anti-rotation combined with anterolateral reconstruction plate for different types of unstable intertrochanteric fractures. METHODS: CT scanning was used to scan the lower limb bone of a male volunteer. A three-dimensional model of the femur was established through the finite element method. According to whether the fracture line involved the medial wall, the lateral wall, the internal and external walls, and whether it was stably supported on the lateral wall, the model was divided to establish the corresponding fracture model: The lateral wall was unstable, and the medial wall was stable. The lateral wall was stable, and the medial wall was unstable. Both the internal and external walls of the model were unstable. Proximal femoral nail anti-rotation and anterolateral reconstruction plates were assembled at the same time. Ordinary nails or locking nails were used for fixation. The stress and displacement of fracture fragments and internal fixation of multiple models were compared and calculated by Abaqus.   RESULTS AND CONCLUSION: (1) In the three types of unstable femoral trochanter models, the anterolateral reconstruction plate could improve the stability of the proximal femur, and restore the imbalance lever of the proximal femur to a certain extent. In the unstable type of lateral wall and the unstable type of medial wall, the locking nail is superior to the ordinary nail. In the type of unstable internal and external sidewalls, the difference between the locking nail and the ordinary nail could not be detected. (2) It is concluded that the placement of anterolateral reconstruction plate can significantly improve the stability of unstable intertrochanteric fracture of the femur, reduce the possibility of nail withdrawal and failure of internal fixation, and play a role in restoring the lever of proximal femur imbalance. Locking nail is better in mechanics than the ordinary nail. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of three internal fixation methods for distal tibial fractures Wang Yichang, Lin Wenjie, Lin Tao, Zhou Baian, Huang Wenhua, Liang Zhenming, Wei Jinsong, Ouyang Hanbin 2023, 27 (36):  5760-5765.  doi: 10.12307/2023.721 Abstract ( 414 )   PDF (2791KB) ( 35 )   Save BACKGROUND: Few studies are comparing the biomechanical characteristics of three internal fixation techniques in the treatment of distal tibial fractures.   OBJECTIVE: To compare the biomechanical properties of distal tibial fractures fixed by medial distal tibial plate, anterior-grade expert tibial nail and retrograde tibial nail. METHODS: Based on the CT data of a SAWBONES 4th generation artificial composite tibia model, a simulation model of distal tibia fracture (AO/ASIF 43-A3) was constructed by digital 3D reconstruction technology. On this basis, three internal fixation methods including locking plate of the medial tibia, expert grade intramedullary nail and retrograde tibial nail were simulated.  Finite element analysis was carried out for three groups of implanted assembly models under axial compression and axial torsion loading conditions respectively, and the differences in stress distribution, stress peak value and fracture space displacement were compared among the three groups.   RESULTS AND CONCLUSION: (1) When the three groups of internal fixators were loaded under two load conditions, the peak stress of the expert tibial nail group was 283.53 MPa at the unlocked main nail hole under the torsion condition. In the medial distal tibial plate group, the stress peak was located on the third screw, which was 913.07 MPa under the torsional condition. In the retrograde tibial nail group, the stress peak was at the second main nail hole under the torsion condition, which was 435.42 MPa. In the retrograde tibial nail group, the stress peak of the cortical bone around the main nail hole at the medial malleolus appeared under high axial compression condition, which was 55.34 MPa. (2) In terms of fracture gap micromovement, the expert tibial nail group had the highest tangential displacement in the four regions under axial compression load. The axial displacement of the four regions in the medial distal tibial plate group was the highest, and the maximum value was in the lateral region. The peak axial displacement of the expert tibial nail group and retrograde tibial nail group was located in the posterior region. (3) When the axial torsional load was loaded, the peak axial displacement of the medial distal tibial plate group and retrograde tibial nail group was in the lateral region, and the tangential displacement of the four regions in the retrograde tibial nail group was smaller than that in the medial distal tibial plate group and expert tibial nail group. (4) It is indicated that retrograde tibial nail has a biomechanical advantage over the medial distal tibial plate and expert tibial nail in distal tibial fractures in terms of fracture end fretting and internal fixation stress. Figures and Tables | References | Related Articles | Metrics

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Difference in mechanical properties of osteoporotic bone trabecular 3D models with different gray thresholds Wu Minhui, Tang Changye, Dai Yuexing, Zheng Liqin, Li Zhihong, Li Shaobin, Lin Ziling 2023, 27 (36):  5766-5770.  doi: 10.12307/2023.759 Abstract ( 354 )   PDF (1747KB) ( 56 )   Save BACKGROUND: Brittle fractures occur in patients with osteoporosis, and the 3D bone trabecular simulation model compression test is rarely used to elucidate the mechanism of its occurrence and development.   OBJECTIVE: To establish 3D models of osteoporotic bone trabeculae with different gray thresholds, and to compare and analyze the differences in microstructure and mechanical properties of osteoporotic bone trabeculae through mechanical compression experiments. METHODS: A 69-year-old elderly female patient with osteoporotic unilateral intertrochanteric fracture was selected. Three-dimensional bone trabecular models with different gray thresholds were established by GE64 slice spiral CT scanning of bilateral hip joints from the acetabulum to the upper middle femur and micro-CT reconstruction. Its microstructure parameters were obtained. Mechanical properties were obtained by mechanical compression experiment and compared. RESULTS AND CONCLUSION: (1) 3D models of osteoporotic bone trabeculae with different gray thresholds were successfully established. With the increase of gray thresholds, the bone volume fraction decreased; the bone surface area density decreased; the trabecular number decreased, and trabecular separation increased. (2) With the increase of the gray threshold of the bone trabecula, its elastic modulus diminished. It could be seen that the yield strength, compressive strength and maximum pressure also exhibited such a trend. (3) It is indicated that the 3D bone trabecular simulation model printed with different gray threshold values has significant differences in the bone fine structure parameters and mechanical property parameters, which provides a new method for the occurrence and development of brittle fractures in osteoporosis in terms of material mechanics.  Figures and Tables | References | Related Articles | Metrics

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Finite element method for predicting the effect of sports knee brace on knee ligaments under different sports conditions Zeng Lulu, Xie Hong 2023, 27 (36):  5771-5777.  doi: 10.12307/2023.733 Abstract ( 375 )   PDF (4440KB) ( 63 )   Save BACKGROUND: Knee ligaments are an important part of maintaining the stability of knee joint movement, which is very vulnerable to injury during exercise, and sports knee braces are often used to prevent knee injuries, but their protective performance is not clear.   OBJECTIVE: A finite element model of the knee joint of a healthy adult and a sports knee brace model were established. The finite element method was used to predict the effect of the sports knee brace on the knee joint ligament under different movement states so as to observe the protective performance of different knee braces using Von Mises equivalent stress as the observation index. METHODS: Using CT medical images of one male health volunteer as the data source, Mimics, Solidworks, and Abaqus software were used to obtain the finite element model of the knee joint and the sports knee brace model. The median epicenter of the femur and the medial condyle was set as the reference point to apply backward 134 N concentration force to the point, to simulate the preclinical drawer experiment, to obtain the biomechanical response of the femur relative displacement and major ligaments, and to verify the effectiveness of the knee model. The displacement load was applied to the sports knee brace, to simulate the state of wearing the knee brace in an upright position and to compare with the clothing stress test results to verify the effectiveness of the knee joint-knee brace model. The 0°, 30° and 60° movements of knee joint flexion were simulated without knee braces and knee braces of two different materials. The stress strains of the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament were analyzed under different loads.   RESULTS AND CONCLUSION: (1) The peak stress of the four ligaments was changed at 0°, 30°, and 60° angles, and after applying 320 N vertical compressive force and 134 N femur backward thrust, compared with bare knee, the peak stress of the anterior cruciate ligament was reduced at 0° and 30°, but the peak stress in the 60° flexion increased. The peak stress of the posterior cruciate ligament increased at 0° flexion and decreased in the 30° and 60° flexion. Peak stress of the medial collateral ligament and lateral collateral ligament was reduced at 0°, 30°, and 60° angles. (2) Conclusion: Different materials of sports knee braces can protect the knee ligaments to a certain extent, but at specific angles will cause additional loads on the anterior cruciate ligament and posterior cruciate ligament, and the results of this study have the positive significance for the biomechanical research of knee ligaments, sports injury protection and the design and production of sports knee braces. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of knee joint injury under different arm swinging modes and touchdown postures in standing long jump Pan Zhengye, Ma Yong, Zheng Weitao 2023, 27 (36):  5778-5783.  doi: 10.12307/2023.737 Abstract ( 365 )   PDF (2921KB) ( 59 )   Save BACKGROUND: Standing long jump is a standard action often used in human body jumping, and it is also one of the main items of lower limb explosive force training. A large number of studies have shown that the arms swing movement in the take-off process and the use of the toe-out posture of the foot when touching the ground can increase the jumping distance, but few studies have paid attention to the knee joint injury during the touchdown process.  OBJECTIVE: To study the stress distribution characteristics of the bilateral meniscus and femoral cartilage under different arm swinging modes and touchdown postures in standing long jump.  METHODS: Eight male college students were recruited for the standing long jump test. The kinematic data and ground reaction force were collected under the condition of free and limited swing arms, ankle joint normal posture and toe-out posture touching the ground. The knee reaction force was obtained as the boundary condition and load by inverse dynamic calculation. Based on the MRI images of a subject's knee joint, a three-dimensional finite element model of the knee joint was established to simulate the landing process of a standing long jump.  RESULTS AND CONCLUSION: (1) There was an interaction between arm swing and ankle posture on knee kinematics. Limiting the swing arm and changing the contact posture of the ankle joint would have a significant impact on the kinematics characteristics of the knee joint in the sagittal plane and frontal plane (P < 0.001, P < 0.001). (2) When the limited swing arm + normal posture touchdown and the free swing arm + normal posture touchdown, the bilateral cartilage contact was more uniform. The stress concentration of the limited swing arm + toe-out posture touchdown and the free swing arm + toe-out posture touchdown occurred on the inner side of the cartilage and the stress on the outer side was less. The inner cartilage was more impacted than the outer side. The peak contact stresses of femoral cartilage (8.89 MPa) and meniscus (10.71 MPa) were lower when the swing arm combined with toe-out touched the ground, while the peak contact stresses of femoral cartilage (13.11 MPa) and meniscus (11.23 MPa) were higher when the swing arm combined with toe-out was limited. (3) These findings indicate that the correct arm swing and the appropriate toe-out posture landing can reduce the risk of knee joint injury. When the ankle joint touches the ground in toe-out posture and limits the arm swing during jumping, the contact stress of the femoral cartilage will be significantly increased, possibly increasing the risk of knee joint injury. Figures and Tables | References | Related Articles | Metrics

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Balance and gait characteristics of static standing and walking after anterior cruciate ligament reconstruction Ma Shengnan, Ke Jingyue, Dong Hongming, Shen Shuang, Ding Hao, Li Jianping, Li Guqiang 2023, 27 (36):  5784-5789.  doi: 10.12307/2023.738 Abstract ( 404 )   PDF (1834KB) ( 83 )   Save BACKGROUND: Anterior cruciate ligament rupture is one of the common sports injuries, which is generally treated by anterior cruciate ligament reconstruction. Balance and walking abilities are often decreased after surgery, and there is a lack of comprehensive comparative study.   OBJECTIVE: To explore the balance and gait characteristics of patients after anterior cruciate ligament reconstruction during static standing and walking, and make a comprehensive comparative analysis with the healthy group to provide scientific guidance for rehabilitation treatment. METHODS: Totally 23 patients 6-8 weeks after anterior cruciate ligament reconstruction and 23 healthy controls were selected. The plantar pressure plate was used to collect 95% confidence elliptical area, path length, average velocity and major and minor axis length of the plantar center of pressure during static standing. Simultaneously, the center of pressure displacement, gait line length, maximum velocity, gait phase ratio and maximum pressure in the tripod area were collected.   RESULTS AND CONCLUSION: (1) Static standing balance: The center of pressure 95% confidence ellipse area, path length, average moving speed and length of major and minor axes in the anterior cruciate ligament reconstruction group were significantly higher than those in the healthy control group (P < 0.05). Simultaneously, the weight-bearing of the forefoot in the anterior cruciate ligament reconstruction group was higher than that in the healthy control group (P < 0.05). (2) Characteristics of walking balance: Compared with the healthy control group, the medial and lateral displacement of the center of pressure in the anterior cruciate ligament reconstruction group was significantly larger (P < 0.05), and there was no significant difference in anterior and posterior displacement and maximum movement speed. Compared with the affected side and the healthy side in the anterior cruciate ligament reconstruction group, the affected side and the healthy control group, and the healthy side and the healthy control group, the gait line and single support line length of the former in the three groups were smaller than those of the latter (P < 0.05). (3) Gait cycle characteristics: The stride width and double support period of the anterior cruciate ligament reconstruction group were larger than those of the healthy control group (P < 0.05). Stride length was smaller in the anterior cruciate ligament reconstruction group than that in the healthy control group (P < 0.05). Compared with the healthy side, the standing phase, single leg support period, pre-swing period and heel to the forefoot time on the affected side of the anterior cruciate ligament reconstruction group decreased (P < 0.05), while the load-bearing response period and swing period increased (P < 0.05). Compared with the healthy control group, the foot deviation angle, load-bearing response period and pre-swing period increased, and the single leg support period decreased on the affected side (P < 0.05). Compared with the healthy control group, the standing phase, load-bearing response period, pre-swing period and the time from heel to the forefoot were significantly increased, and the swing period decreased on the healthy side (P < 0.05). (4) The maximum pressure of the tripod area: Compared with the healthy side, the maximum pressure of the forefoot, arch and heel of the affected side decreased significantly (P < 0.05). Compared with the healthy control group, the maximum pressure of the tripod area of the affected side also decreased significantly (P < 0.05). Compared with the healthy control group, the maximum pressure of the forefoot of the healthy side decreased significantly (P < 0.05), but there was no significant difference between the arch and the heel. (5) The results showed that the static and dynamic balance ability of the patients 6-8 weeks after anterior cruciate ligament reconstruction was significantly lower than that of the healthy subjects, and the balance function of the healthy side also decreased significantly. During walking, the patients had gait problems such as a shortening of stride length, an increase of stride width, a decrease of support period and increase of swing period. It is suggested that attention should be paid to bilateral balance and gait training during postoperative rehabilitation. Figures and Tables | References | Related Articles | Metrics

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Application of orthopedic robot-assisted screw placement in the correction of adolescent idiopathic scoliosis Xin Xiaoming, Gao Mingxuan, Zhang Fan, Chi Fei, Feng Junchao, Luo Wenyuan 2023, 27 (36):  5790-5794.  doi: 10.12307/2023.775 Abstract ( 310 )   PDF (10684KB) ( 36 )   Save BACKGROUND: It is difficult to insert pedicle screws in the correction of adolescent idiopathic scoliosis. Research shows that robot-assisted surgery for adolescent idiopathic scoliosis can improve the accuracy of pedicle screw placement and reduce intraoperative bleeding. OBJECTIVE: To explore the safety and accuracy of the orthopedic Tianji robot in the correction of adolescent idiopathic scoliosis. METHODS: The clinical data of 40 cases of adolescent idiopathic scoliosis treated with posterior pedicle screw fixation from June 2018 to March 2022 were analyzed retrospectively. According to the difference in auxiliary equipment, the patients were divided into a robot group (C-arm X-ray combined with a robot-assisted screw placement; n=18) and an unarmed group (simple C-arm X-ray-assisted screw placement; n=22). The indexes and imaging data of patients of the two groups during the perioperative period and follow-up period were compared, including the visual analog scale score, the Japanese Orthopaedic Association score, the operation time, the intraoperative blood loss, the number of intraoperative fluoroscopy times, the length of hospital stay, the spinal correction rate, and the accuracy rate of nail placement. RESULTS AND CONCLUSION: (1) The operations of the two groups were completed successfully, and all the patients were followed up for (8.45±1.81) months after the procedure. (2) The number of intraoperative fluoroscopy times and intraoperative blood loss were significantly less and operation time was significantly longer in the robot group compared with the unarmed group (P < 0.05). (3) Compared with the preoperative procedure, the visual analog scale score and Japanese Orthopaedic Association score of the two groups were significantly improved at the last follow-up (P < 0.05). (4) Postoperative imaging examination showed that the Cobb angle of the main bend in both groups was significantly lower than that before the operation (P < 0.05). (5) Three hundred and six screws were placed in the robot group, and the accuracy of placing screws was 95.8%, while the accuracy of grade A screws was 90.2%. Three hundred fifty-four nails were implanted in the unarmed group, and the accuracy of nail implantation was 91.0%, while the accuracy of grade A screw implantation was 81.4%. There was a significant difference in the accuracy of nail implantation between the two groups (P < 0.05), and the accuracy of grade A screw implantation in the robot group was significantly higher than that in the unarmed group (P < 0.05). (6) The C-arm X-ray combined with a robot-assisted screw placement is safer and more accurate than the simple C-arm X-ray-assisted screw placement.  Figures and Tables | References | Related Articles | Metrics

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Effect of pelvic tilt on the stress at the acetabular side in standing position after total hip arthroplasty: finite element analysis Yan Ruizhong, Li Jiahui, Lin Shuzhong, Wu Xiaogang, Guo Zhijian, Liu Wenqi, Liu Qiang 2023, 27 (36):  5795-5800.  doi: 10.12307/2023.732 Abstract ( 602 )   PDF (4210KB) ( 62 )   Save BACKGROUND: In hip arthroplasty, placement of the acetabular cup using only the acetabular anatomy will change the direction of the functional acetabular cup. Computer navigation for hip arthroplasty can improve the accuracy of prosthesis placement.   OBJECTIVE: To simulate the operation, simulate the stress size and area of the acetabular cup, and plan the placement direction of the acetabular cup in hip arthroplasty combined with the pelvic tilt angle to explore the influence of the pelvic tilt angle on the stress distribution of the acetabular prosthesis in hip arthroplasty using finite element model. METHODS: X-ray and CT data of the pelvis in six cases (marked A-F) were collected. The ABAQUS 6.14-4 (SIMULIA Inc., French) was used to construct hip models. Six models were established to simulate hip arthroplasty with the front pelvic plane in the supine position as the coordinate plane. According to the pelvic tilt angle in the standing position, for those with pelvic tilt angle ≤ -10° and pelvic tilt angle > 10°, the reference plane of prosthesis implantation was adjusted to establish nine models, which were divided into pre-adjusted models: A(-14°), B(-29°), C(11°); post-adjusted models: Aa(-7°), Bb(-18°), Cc(1°); normal models: D(-8°), E(-2°), F(-9°). In the finite element solving software, constraint fixation simulated the standing on one foot. Joint loading was loaded at the sacroiliac joint, pubic symphysis and greater trochanter. The maximum Von Mises stress distribution of the acetabulum, acetabular cup, and lining of each model were compared.   RESULTS AND CONCLUSION: (1) Model B showed non-convergence and model A showed non-convergence tendency; model B showed convergence with the supine anterior pelvic plane coordination adjusted. In the nine models, the maximum von Mises stress of the acetabulum was 4.9 MPa in model Cc. The minimum stress was 1.07 MPa in model D. The maximum stress of the acetabular cup was 29.87 MPa in model Bb. The minimum stress was 17.21 MPa in model D. The maximum stress of polyethylene liner weight-bearing was 12.45 MPa in model Bb. The minimum stress was 5.21 MPa in model D. The weight-bearing area was located at the middle and upper parts of the acetabulum. (2) The models of the pelvic tilt angle of -14°, -25°, and 11° in the standing position showed maximum values of von Mises stress than the models of -10° < pelvic tilt angle ≤10°. The stress was near the values of models of -10° < pelvic tilt angle ≤10° after adjusting the anterior pelvic plane coordination in the model pelvic tilt angle of -14°, indicating that pelvic tilt angle beyond the range of -10° and 10° is a risk factor for wear and dislocation after total hip arthroplasty. The reset of the anterior pelvic plane in the case of increased pelvic retroversion can reduce the complication in total hip arthroplasty. Figures and Tables | References | Related Articles | Metrics

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A matched controlled trial of lumbar fusion effect on mid-term outcomes after total hip arthroplasty Guo Zhuotao, Zhang Kai, Zha Guochun, Guo Kaijin 2023, 27 (36):  5801-5805.  doi: 10.12307/2023.774 Abstract ( 299 )   PDF (2267KB) ( 46 )   Save BACKGROUND: In recent years, the number of patients with simultaneous lumbar and hip joint diseases and undergoing surgery has increased. The mid-term prognosis of patients with lumbar fusion after total hip arthroplasty is rarely studied.   OBJECTIVE: To investigate the mid-term effect of total hip arthroplasty in patients with lumbar fusion.    METHODS: Clinical and imaging data of patients who received initial total hip arthroplasty at the Affiliated Hospital of Xuzhou Medical University from January 2014 to January 2019 were retrospectively analyzed. Patients were divided into a fusion group and a non-fusion group according to whether there was lumbar fusion before surgery. There were 41 patients in the fusion group. Among the patients with concurrent total hip arthroplasty, gender, age, body mass index ±5, visual analog scale score ±2, preoperative Harris hip score ±10 maintained 1:2 matching, and 82 patients were selected as the non-fusion group. The complications and Harris hip score of the two groups at the last postoperative follow-up were compared, and the fusion group was divided into a pelvic stiffness group (ΔPT<20°) and a non-pelvic stiffness group (ΔPT≥20°) according to the changes of pelvic tilt angle (ΔPT) between standing and sitting positions before surgery. The difference in curative effect was compared between the two groups.  RESULTS AND CONCLUSION: (1) All patients were followed up for more than 36 months.  The rate of dislocation in the fusion group was higher than that in the non-fusion group (P=0.035).  (2) The range of motion score (P=0.030) and total Harris hip score (P=0.001) in the fusion group were lower than those in the non-fusion group. (3) The Harris hip score of the patients of pelvic stiffness group at the last follow-up was significantly lower than that of the non-pelvic stiffness group (P=0.032). (4) It is concluded that the prognosis of patients with lumbar fusion after total hip arthroplasty was worse than that of patients with general total hip arthroplasty, especially those with pelvic stiffness. Moreover, patients with lumbar fusion have a higher risk of dislocation after surgery. This provides support for routine preoperative spinal imaging in patients with prior lumbar fusion and pre-total hip arthroplasty and provides the patient with postoperative expectations.  Figures and Tables | References | Related Articles | Metrics

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Relationship of preoperative sleep quality and early rehabilitation after unicompartmental knee arthroplasty Zhu Xunpeng, Xu Hui, Wang Lin, Wang Jun, Zhang Hui 2023, 27 (36):  5806-5811.  doi: 10.12307/2023.706 Abstract ( 341 )   PDF (1563KB) ( 77 )   Save BACKGROUND: Unicompartmental knee arthroplasty is an effective treatment for end-stage knee osteoarthritis, and its surgical procedures are relatively standard and uniform. The trauma caused by surgery in different patients is quite similar, but its postoperative recovery rate and degree are not the same. Perioperative sleep disorders have a high incidence in knee arthroplasty; however, there is still a lack of studies on the correlation between preoperative sleep quality and early rehabilitation after unicompartmental knee arthroplasty in China. OBJECTIVE: To investigate the effect of preoperative sleep quality on early rehabilitation after unicompartmental knee arthroplasty. METHODS: A total of 218 patients with knee osteoarthritis who underwent unicompartmental knee arthroplasty in The First Affiliated Hospital of Anhui Medical University from July 2018 to July 2022 were enrolled. Pittsburgh Sleep Quality Index was used to evaluate sleep quality before operation. The study subjects were divided into a high preoperative sleep quality group (Pittsburgh Sleep Quality Index score ≤ 5, n=102) and a low preoperative sleep quality group (Pittsburgh Sleep Quality Index score > 5, n=116) according to the results. The visual analog scale score of pain at 12, 24, 48 and 72 hours after operation, the number of days required for 90° of knee flexion after operation (knee flexed at least 90° without applying external force and without unbearable pain) and the length of postoperative hospital stay were compared between the two groups. The postoperative opioid analgesic use (converted to oral morphine equivalent) was also recorded between the two groups. RESULTS AND CONCLUSION: (1) There was no significant difference in age, height, body mass index, joint side, preoperative knee range of motion, preoperative visual analog scale score, preoperative Hospital for Special Surgery score and preoperative hemoglobin concentration, and albumin concentration between the two groups (P > 0.05). (2) Compared with the low preoperative sleep quality group, the high preoperative sleep quality group had significantly lower postoperative visual analog scale scores at 12, 24, 48, and 72 hours, opioid analgesic use, hemoglobin difference and albumin difference before and after operation, the number of days required for 90° of knee flexion, the length of postoperative hospital stay, and the differences were statistically significant (P < 0.05). (3) The results show that improving preoperative sleep quality is of great significance in improving prognosis, reducing the use of analgesics, improving patient satisfaction, and reducing social burden, and can directly or indirectly accelerate early rehabilitation after unicompartmental knee arthroplasty from multiple aspects and dimensions.  Figures and Tables | References | Related Articles | Metrics

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Efficacy and safety of tranexamic acid and aminocaproic acid in perioperative period of total knee arthroplasty Alimujiang•Yusufu, Abuduwupuer•Haibier, Qin Qi, Liu Yuzhe, Zhang Qianlong, Ran Jian 2023, 27 (36):  5812-5817.  doi: 10.12307/2023.761 Abstract ( 324 )   PDF (1568KB) ( 70 )   Save BACKGROUND: Antifibrinolytic drugs are widely used to reduce blood loss in total knee arthroplasty. Although the hemostatic effect of tranexamic acid and aminocaproic acid in total knee arthroplasty has been confirmed, which is superior or inferior is still controversial.   OBJECTIVE: To compare the safety and effectiveness of tranexamic acid and aminocaproic acid in the perioperative period of total knee arthroplasty. METHODS: 102 patients undergoing unilateral total knee arthroplasty in the Sixth Affiliated Hospital of Xinjiang Medical University from April 2021 to June 2022 were retrospectively screened. These patients were divided into two groups according to different antifibrinolytic hemostatic agents applied during the perioperative period. Of these, 49 patients used aminhexic acid and 53 patients used tranexamic acid. Both groups received intravenous and topical combinations. The blood loss and coagulation indexes, postoperative hospital stay and postoperative complications in the perioperative period of total knee arthroplasty were compared between the two groups. RESULTS AND CONCLUSION: (1) Preoperative data: No significant differences in age, gender composition, body mass index, hypertension, diabetes mellitus, operation time, erythrocytes, hemoglobin, hematocrit, albumin, prothrombin activity, international standard ratio, or D-dimer index were found between the two groups (P > 0.05). (2) Blood loss and coagulation indexes: There were significant differences in total blood loss and recessive blood loss between the tranexamic acid group and the aminocaproic acid group (P < 0.05). There was no significant difference in estimated blood volume, dominant blood loss and postoperative drainage between the two groups (P > 0.05). There was no significant difference in erythrocyte, hemoglobin, hematocrit, albumin, serum ferritin, D-dimer, prothrombin activity and international standard between the two groups at 1 and 5 days after operation (P > 0.05). (3) Blood transfusion: The amount of blood transfusion in the tranexamic acid group was significantly less than that in the aminocaproic acid group (P < 0.05), but there was no significant difference in blood transfusion rate between the two groups (P > 0.05). (4) There was no significant difference in postoperative hospital stay and postoperative complications between the two groups (P < 0.05). (5) The results showed that the hemostatic effect of tranexamic acid in the perioperative period of total knee arthroplasty was stronger than that of aminocaproic acid, and the safety of the two drugs was basically the same. Therefore, the authors suggest that tranexamic acid should be the first choice as an antifibrinolytic hemostatic drug in the perioperative period of total knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Total disc replacement for cervical spondylosis with sympathetic symptoms Ma Hui, Jia Xiangyuan, Yang Haotian, Yuan Lin, Li Yafeng, Zhao Xueqian, Jia Yusong 2023, 27 (36):  5818-5822.  doi: 10.12307/2023.757 Abstract ( 323 )   PDF (7502KB) ( 31 )   Save BACKGROUND: The treatment of cervical spondylosis with total disc replacement can retain the range of motion of the cervical lesion segment and can effectively improve the symptoms of cervical spondylosis with sympathetic symptoms.  OBJECTIVE: To investigate the clinical efficacy of total disc replacement for cervical spondylosis with sympathetic symptoms.  METHODS: Retrospective analysis was made on 56 patients with cervical spondylosis with obvious sympathetic symptoms such as dizziness and headache who were operated on from December 2018 to December 2021. The sagittal parameters of the cervical spine before, 3 months after surgery and at the last follow-up were observed and compared, including cervical sympathetic symptom score and Japanese Orthopaedic Association Scores, operation segment angle, C2-C7 Cobb angle, C2-C7 sagittal vertical axis and T1 slope. The correlation between the changes in sympathetic symptoms and Japanese Orthopaedic Association Scores before and after surgery and the changes in cervical sagittal parameters before and after surgery was analyzed.  RESULTS AND CONCLUSION: (1) All patients showed improvement in sympathetic symptoms after surgery, and the sympathetic symptom scores and Japanese Orthopaedic Association Scores were significantly improved at 3 months and at the last follow-up compared with those before surgery (P < 0.05), but Japanese Orthopaedic Association Scores did not show significant differences at the last follow-up compared with those at 3 months after surgery (P > 0.05). (2) The cervical sagittal parameters increased at 3 months and at the last follow-up compared with those before surgery, but not at the last follow-up compared with those at 3 months after surgery (P > 0.05). (3) The pre- and post-operative change values of sympathetic symptom scores significantly correlated with the pre- and post-operative change values of operation segment angle and C2-7 Cobb angle (P < 0.05). (4) The results indicate that total disc replacement has a good effect in the treatment of cervical spondylosis with sympathetic symptoms, which is conducive to restoring the sagittal parameters of the cervical spine and alleviating the sympathetic symptoms of patients.  Figures and Tables | References | Related Articles | Metrics

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Comparison of femoral neck internal fixation system and simple cannulated screw internal fixation in the treatment of femoral neck fractures in patients under 65 years old Zhao Jun, Chen Changsheng, Xu Zhonghua, Chen Hongfeng, Zhang Feng, Wang Qiuping, Zhou Jinlong, Que Yunduan 2023, 27 (36):  5823-5827.  doi: 10.12307/2023.746 Abstract ( 278 )   PDF (4542KB) ( 61 )   Save BACKGROUND: For many years, the choice of internal fixation for femoral neck fractures in young adults has been controversial. No matter what treatment is chosen, the goal is the anatomical reduction and stable internal fixation. Although there are many internal fixation methods for the treatment of femoral neck fractures in young adults, the therapeutic effects have their advantages and disadvantages, and there is no unified treatment plan at present.   OBJECTIVE: To observe the effect of a new type of femoral neck internal fixation system in the treatment of femoral neck fractures. METHODS: From January 2019 to June 2020, the relevant data of 21 patients with femoral neck fractures fixed by femoral neck internal fixation system (observation group) and 32 patients with femoral neck fractures fixed by three hollow nails (control group) were included in this study. The patient age was ≤ 65 years old. All patients had closed fractures. All patients underwent anteroposterior radiography of the affected side before the operation, and all patients underwent a CT plain scan plus three-dimensional reconstruction. Fracture healing and necrosis of the femoral head were evaluated by X-ray film of the hip joint after the operation. MRI examination was performed in some cases when necessary. The hip function was assessed at the last follow-up.   RESULTS AND CONCLUSION: (1) All 21 patients in the observation group were followed up for an average of 19 months. The average operation time was 58.09 minutes. The average number of fluoroscopy was 23.19 times. The average intraoperative blood loss was 109.29 mL. The average clinical healing time was 3.86 months. The mean time of complete weight bearing after the operation was 6 months. The complication rate was 14.3%. The excellent and good rate of hip joint function was 85.7%. (2) In the control group, 32 patients were followed up for an average of 18 months. The average operation time was 74.06 minutes. The average number of fluoroscopy was 33.41 times. The average intraoperative blood loss was 81.56 mL. The average clinical healing time was 4.69 months. The mean time of complete weight bearing after the operation was 6.72 months. The complication rate was 28.1%. The rate of excellent and good hip function was 71.9%. (3) The results show that compared with the simple cannulated screw internal fixation, the femoral neck internal fixation system can shorten the operation time and clinical healing time of patients with femoral neck fractures under 65 years old, and reduce the frequency of fluoroscopy. Figures and Tables | References | Related Articles | Metrics

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Comparison of short-term follow-up results between femoral neck system and cannulated compressive screws in the treatment of femoral neck fracture in the elderly Wang Tianhao, Liang Xiaolong, Zheng Kai, Li Rongqun, Zhou Jun, Geng Dechun, Xu Yaozeng, Zhu Feng 2023, 27 (36):  5828-5833.  doi: 10.12307/2023.730 Abstract ( 289 )   PDF (1957KB) ( 40 )   Save BACKGROUND: Femoral neck fracture is a common fracture in the elderly. As one of the mainstream treatment methods, internal fixation is still needed to further pursue strong fixation and reduce the incidence of complications as much as possible.   OBJECTIVE: To compare the short-term effectiveness of the femoral neck system and cannulated compressive screws for femoral neck fracture in elderly patients. METHODS: The clinical data of 35 elderly patients with femoral neck fractures who met the research criteria from April 2020 to June 2021 were retrospectively analyzed. They were divided into the femoral neck system group (16 cases) and cannulated compressive screw group (19 cases) according to different treatment methods. There were no statistical differences between the two groups in gender, age, injured side, injury mode, fracture classification and other general data. The operation time, blood loss, postoperative hospitalization days, reduction quality, healing time, Harris score and postoperative complications of the two groups were recorded and compared. The curative effect was analyzed between the two groups.   RESULTS AND CONCLUSION: (1) 16 patients with femoral neck system were followed up for 8-25 months (mean 11.9 months), except for 1 case of internal fixation failure. 19 patients treated with cannulated compressive screws were followed up for 7-26 months (mean 16.3 months). (2) There was no significant difference between the two groups in operation time, blood loss, postoperative hospitalization days, reduction quality, healing time, last Harris score and postoperative complications. (3) The Harris score of the femoral neck system group was significantly better than that of cannulated compressive screw group 1 month after operation (P=0.039). (4) In the femoral neck system group, there was 1 case of internal fixation failure receiving total hip arthroplasty 2 months after operation and 1 case of femoral neck shortening. In the cannulated compressive screw group, there was 1 case of femoral neck shortening with the loosening of the screw. (5) It is indicated that in the treatment of femoral neck fractures in elderly patients, the femoral neck system and cannulated compressive screws have the advantages of being minimally invasive, rapid and easy to operate. In early rehabilitation, the femoral neck system has stronger fixation strength, allowing early weight-bearing and showing better hip joint function. Figures and Tables | References | Related Articles | Metrics

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Kyphoplasty via different approaches for osteoporotic vertebral compression fractures Lu Zhaohua, Sun Tianze, Zhang Jing, Zhang Wentao, Yang Ming, Li Zhonghai 2023, 27 (36):  5834-5839.  doi: 10.12307/2023.792 Abstract ( 285 )   PDF (1676KB) ( 57 )   Save BACKGROUND: Osteoporotic vertebral compression fracture is the most common complication of osteoporosis. Percutaneous kyphoplasty is an effective treatment for osteoporotic vertebral compression fractures. Its operative approaches include unilateral and bilateral pedicle approaches. The two approaches have their advantages and disadvantages.   OBJECTIVE: To explore the clinical effect and value of the unipedicular and bipedicular approaches to percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture. METHODS: 383 patients with osteoporotic vertebral compression fractures of the thoracic and lumbar spine were operated on from March 2014 to April 2020 via bipedicular approach (bipedicular group, 208 cases) and unipedicular approach (unipedicular group, 175 cases) percutaneous kyphoplasty. All patients were followed-up using the Oswestry dysfunction index, visual analog scale score and X-ray inspection preoperatively and postoperatively. The operation time, blood loss, amount of bone cement injected, frequency of X-ray exposure, Cobb angle of vertebral kyphosis, vertebral body leading edge height, intermediate height, cement leakage rate, and incidence of adjacent vertebral body re-fracture were measured and compared between the two groups.   RESULTS AND CONCLUSION: All patients were followed up for 25-98 months (averaged 43.3 months). (1) Operation time, intraoperative blood loss, amount of bone cement injected, and intraoperative frequency of X-ray exposure were all significantly shorter in the unipedicular group than that in the bipedicular group (P < 0.05). (2) Visual analog scale score, Oswestry dysfunction index, Cobb angle of vertebral kyphosis, vertebral leading edge height and intermediate height were statistically different preoperatively and 1 month postoperatively between the two groups (P < 0.05), but there was no statistical difference between the last follow-up and 1 month postoperatively (P > 0.05); no statistical difference was found between the two groups at the last follow-up (P > 0.05). (3) The leakage rate of bone cement was 7.7% (15/194) in the unipedicular group and 8.1% (19/234) in the bipedicular group and no statistical difference was found between the two groups (P > 0.05). (4) No statistical difference could be found in the incidence of adjacent non-surgical vertebral fractures in the unipedicular (9.1%, 16/175) and bipedicular groups (6.3%, 13/208) (P > 0.05). (5) It is concluded that compared with the bipedicular approach to percutaneous kyphoplasty, the unipedicular approach for osteoporotic vertebral compression fracture has satisfactory clinical effects, can effectively reduce the operation time, intraoperative blood loss, bone cement injection volume and risk of bone cement leakage. Figures and Tables | References | Related Articles | Metrics

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Effect of internal fixation of ulnar styloid process base fracture on wrist function Cheng Shuai, Jiang Shanyong, Lu Jianshu, Ji Xubin 2023, 27 (36):  5840-5844.  doi: 10.12307/2023.735 Abstract ( 269 )   PDF (1725KB) ( 84 )   Save BACKGROUND: Fractures of the distal radius and the base of the styloid process of the ulna are common in clinical practice. Because of the double destruction of the fracture and the surrounding ligaments and cartilage, the distal radioulnar joint is unstable. In the past, insufficient attention was paid to the fracture of the base of the styloid process of the ulna, which often led to complications such as wrist joint pain and limited range of motion after surgery, and the treatment plan was controversial.   OBJECTIVE: To investigate the effect of internal fixation on the function of the wrist joint with fracture of ulnar styloid process base in distal radius fracture. METHODS: Clinical data of 40 patients with traumatic distal radius fractures accompanied by ulnar styloid process base fractures treated with concurrent surgical treatment in Dongying People’s Hospital from June 2018 to December 2020 were retrospectively analyzed. All distal radius fractures were operated by open reduction and internal fixation. According to whether the fracture of the base of ulnar styloid process was treated surgically or not, the patients were divided into the internal fixation group and control group, with 20 cases in each group. The measured data of X-ray films were collected before and 6 and 12 months after operation, and the ulnar inclination, palmar tilt and radial height of the two groups were compared. The ranges of motion of the wrist joint in dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination directions were recorded 1 year after operation. The effect was evaluated with the Gartland-Werley scoring standard.   RESULTS AND CONCLUSION: At the follow-up after operation, palmar tilt, ulnar inclination and radial height of the wrist joint of the two groups were all better than those before operation (P < 0.05), but the difference was not statistically significant between the two groups (P > 0.05). The ranges of motion of the wrist joint in dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination directions were better in the internal fixation group than those in the control group 1 year after operation (P < 0.05). The excellent and good rate of the internal fixation group (90%) 1 year after the operation was significantly higher than that of the control group (55%) (P < 0.05). These findings conclude that one-stage internal fixation of ulnar styloid process base fracture during the operation of distal radius fracture is conducive to further recovery of wrist function. Figures and Tables | References | Related Articles | Metrics

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Predictive value of five thrombotic risk assessment scales for deep vein thrombosis after intertrochanteric fracture of the femur Xiang Feifan, Fan Wei, Wei Daiqing, Liang Jie, Ye Junwu, Yang Yunkang 2023, 27 (36):  5845-5849.  doi: 10.12307/2023.729 Abstract ( 293 )   PDF (1539KB) ( 87 )   Save BACKGROUND: Once the deep vein thrombosis of the lower extremities caused by intertrochanteric fracture falls off, pulmonary embolism will be fatal. At this stage, there are many deep vein thrombosis evaluation scales available in clinical practice, but their application value in patients with intertrochanteric fractures of the femur is not clear.   OBJECTIVE: To compare the predictive value of five different thrombosis risk assessment scales for lower extremity deep vein thrombosis in patients with intertrochanteric fractures of the femur. METHODS: The data of 254 patients with intertrochanteric fractures admitted to the Department of Orthopedics, Affiliated Hospital of Southwest Medical University from July 2016 to July 2021 were retrospectively analyzed. According to the examination results of the lower extremity venous ultrasound, the patients were divided into the deep vein thrombosis group and the non-deep vein thrombosis group. Capprini, RAPT, Autar, Pauda and Wells scales were used to evaluate the possible risk of deep vein thrombosis in patients. The scores of five thrombosis risk assessment scales were compared between the two groups. Simultaneously, the receiver operating characteristic curve was drawn and the area under the curve was calculated to analyze the predictive value of five thrombosis risk assessment scales for lower extremity deep vein thrombosis in patients with intertrochanteric fracture.   RESULTS AND CONCLUSION: (1) The Wells score, Autar score and RAPT score in the deep vein thrombosis group were significantly higher than those in the non-deep vein thrombosis group (P < 0.05). (2) The areas under the curve of Wells, Capprini, RAPT, Autar and Pauda were 0.916, 0.751, 0.767, 0.544 and 0.575, respectively. (3) The sensitivities of Wells, Capprini, RAPT, Autar and Pauda in the diagnosis of deep vein thrombosis in patients with intertrochanteric fracture were 93.22%, 77.97%, 74.01%, 58.76% and 36.16%, respectively. The specificities were 64.94%, 59.74%, 35.06%, 49.35% and 74.03%, respectively. (4) All the above five thrombosis risk assessment scales have certain predictive values for the occurrence of deep vein thrombosis in the lower extremity of hospitalized patients with intertrochanteric fracture, but the Wells risk assessment scale has a relatively high predictive value, followed by Capprini and RAPT assessment scale. The risk assessment value of Wells scale is relatively accurate for whether the patients with intertrochanteric fracture have thrombus. The RAPT scale is applicable to the risk assessment of possible thrombosis in all orthopedic trauma patients. Figures and Tables | References | Related Articles | Metrics

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Effects of sevoflurane combined with propofol on pain mediators and neuronal activity in rats with spinal cord fracture Guo Yongjuan, Zhang Li, Lu Huamei 2023, 27 (36):  5850-5855.  doi: 10.12307/2023.520 Abstract ( 282 )   PDF (1962KB) ( 63 )   Save BACKGROUND: Both sevoflurane and propofol have analgesic effects and exert neuroprotective effects by inhibiting neuronal apoptosis, but the specific mechanisms are not fully understood. OBJECTIVE: To study the effects of sevoflurane combined with propofol on pain mediators, nerve cell activity and mitogen activated protein kinase (MAPK)/cAMP response element binding peotein (CREB) in rats with spinal cord fracture.  METHODS: Of 80 SPF male Sprague-Dawley rats, 15 rats were randomly selected as healthy group and the remaining rats were used to make animal models of spinal cord fracture. During the modeling, five rats were dead unexpectedly. After successful modeling, 60 model rats were randomized into model group, sevoflurane group, propofol group, and combined group (sevoflurane+propofol), with 15 rats in each group. The rats in the sevoflurane group were placed in a closed experimental box, given an oxygen flow of 2 L/min, and inhaled 2% sevoflurane for 0.5 hours; the rats in the propofol group were injected with 2 mL/kg/h propofol through the tail vein for 4 hours; the rats in the combined group were given both propofol and sevoflurane interventions; and the rats in the healthy group and model group inhaled pure oxygen for 0.5 hours. Von Frey filament method was used to measure mechanical withdrawal threshold values. Hematoxylin-eosin staining was used to observe the pathological morphology of spinal cord tissue of rats. TUNEL was used to detect the apoptosis of neurons in spinal cord tissue of rats. Real-time PCR was used to detect the expression of p38MAPK and CREB mRNA. Western blot assay was used to detect the expression of p38MAPK, CREB, p-p38MAPK, and p75NTR proteins in spinal cord tissue of rats. RESULTS AND CONCLUSION: (1) Compared with the healthy group, the mechanical withdrawal threshold value was decreased in the other four groups at different time points (P < 0.05). Compared with the model group, the mechanical withdrawal threshold value was significantly increased in the sevoflurane, propofol, and combined groups at different time points (P < 0.05), especially in the combined group (P < 0.05). (2) In the model group, the white matter and central gray matter fused into a large cavity, and the white matter had a large number of vacuoles. In the sevoflurane and propofol groups, there were many cracks in the white matter and central gray matter and massive small vacuoles in the white matter. In the combined group, there were a few cracks in the white matter and central gray matter and a few vacuoles in the white matter. (3) The apoptosis rate of neurons in the model group was significantly higher than that in the sevoflurane, propofol, and combined groups (P < 0.05). The apoptosis rate of neurons was lowest in the combined group (P < 0.05). (4) Compared with the healthy group, the mRNA and protein levels of p38MAPK and CREB were significantly increased in the other four groups (P < 0.05), while the expression of p75NTR was significantly decreased (P < 0.05). Compared with the model group, the expression of p38MAPK mRNA and protein as well as the expression of p-p38MAPK protein decreased in the sevoflurane, propofol, and combined groups, while the expression of CREB mRNA and protein and the expression of p75NTR protein increased (P < 0.05). Changes in the expression of above mRNAs and proteins were most significant in the combined group (P < 0.05). (5) To conclude, sevoflurane combined with propofol can effectively improve neuropathic pain and inhibit neuronal apoptosis in rats with spinal cord fracture, which may be related to inhibiting the expression of p38MAPK and promoting the expression of CREB. Figures and Tables | References | Related Articles | Metrics

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Measurement and clinical significance of acetabular parameters in the Guizhou population Li Qizhe, Kong Yao, Fan Jiannan, Wu Yeting, Yang Hua, Xiao Yinlong, Sun Hong 2023, 27 (36):  5856-5863.  doi: 10.12307/2023.776 Abstract ( 279 )   PDF (3336KB) ( 41 )   Save BACKGROUND: There are some differences in acetabular anatomical parameters among different regions and different populations, which are very important for the diagnosis and treatment of acetabular diseases. However, the characteristics of acetabular imaging parameters in the Guizhou population are still unclear.  OBJECTIVE: To analyze the imaging parameters of acetabular plain radiographs, so as to provide a reference for the diagnosis and treatment of acetabular diseases and the design and installment of the acetabular prosthesis.  METHODS: Adult patients who underwent anteroposterior radiography of both hip joints at the Affiliated Hospital of Guizhou Medical University from January 2015 to February 2017 were collected. The acetabular radiographic parameters were measured using the medical imaging software SIEMENS Syngo.Plaza PACS. The data were grouped and analyzed according to age, sex and left and right sides. Pearson correlation analysis was performed between acetabular parameters. The data in the current study were compared with domestic and foreign studies containing the same type of data.  RESULTS AND CONCLUSION: (1) Sharpe angle, center edge angle, anteversion angle, abduction angle, acetabular depth, acetabular diameter, modified acetabular index, and acetabular head index were (39.70±3.65)°, (31.10±6.03)°, (19.17±4.26)°, (39.71±3.67)°, (1.16±0.22) cm, (6.45±0.52) cm, (0.33±0.03), and (84.72±4.19)%, respectively. (2) There were statistical differences in Sharp angle between males and females at different age groups (P < 0.05); statistical differences in abduction angle were found in males among different age groups (P < 0.05). (3) There were differences in Sharp angle, center edge angle, anteversion angle, abduction angle, acetabular depth and acetabular diameter between genders. Sharp angle, anteversion angle and abduction angle were smaller in males than those in females (P < 0.05). The center edge angle, acetabular depth, and acetabular diameter were greater in males than that in females (P < 0.05). (4) There were no significant differences in acetabular parameters between the sides. (5) There were differences in the acetabular imaging parameters of the population in the Guizhou district when compared with the same type of data from domestic and foreign studies. Taken together, the acetabular imaging parameters of the population in Guizhou have certain characteristics. The regional features of acetabular imaging parameters should be fully considered in the clinical diagnosis and treatment of acetabular diseases to achieve greater clinical benefits. Figures and Tables | References | Related Articles | Metrics

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Changes in microcirculatory perfusion of femoral head necrosis assessed by dynamic contrast-enhanced magnetic resonance imaging Huan Dawei, Yuan Zhaofeng, Dou Weiqiang, Xia Tianwei, Qiu Yue, Zhang Chao, Shen Jirong 2023, 27 (36):  5864-5869.  doi: 10.12307/2023.760 Abstract ( 352 )   PDF (2469KB) ( 50 )   Save BACKGROUND: At present, digital subtraction angiography is used in the clinical observation of blood supply of femoral head necrosis, and the patency of the nutrient blood vessels of the femoral head is evaluated by observing the in and out of the contrast agent. Although digital subtraction angiography can visually observe the feeding vessels of the femoral head, it cannot quantify the perfusion. In addition, the collapse of the femoral head is closely related to the prognosis of the disease, but there are few studies on the changes in blood supply in the femoral head during the peri-collapse period. OBJECTIVE: To compare the differences in microcirculation perfusion in different regions and different stages of femoral head necrosis, summarize the changes in microcirculation perfusion characteristics of femoral head necrosis, and observe the effect of dynamic contrast-enhanced magnetic resonance imaging in evaluating the microcirculation perfusion of the femoral head. METHODS: From February 16 to September 1, 2022, a total of 37 patients (69 hips) who visited a doctor for femoral head necrosis were retrospectively collected, including 29 males and 8 females; the age was (35.35±12.19) years (range 18-65 years). The patient’s bilateral femoral head and proximal femur were scanned by dynamic contrast-enhanced magnetic resonance imaging, and gadoteric acid meglumine was intravenously injected during the scanning. After scanning, Geniq software was used to post-process the data to obtain femoral head microcirculation perfusion parameters. Regions of interest were drawn at the necrotic zone, repair reaction zone, and greater trochanter, and time-signal intensity curves of the regions of interest were obtained and classified. Paired t-tests were used to evaluate differences between necrotic area, repair reaction area, and greater trochanter perfusion parameters, as well as differences in femoral head perfusion in different stages of necrosis. Differences in necrotic area, repair reaction area and greater trochanter time-intensity curve classification were evaluated using the χ2 test. RESULTS AND CONCLUSION: (1) Comparing the perfusion parameters in different regions, the peak value of enhanced signal intensity, area under the curve, maximum slope, volume transfer constant, and the median volume fraction of extravascular extracellular space in the necrotic region were lower than those of the greater trochanter, and the differences were statistically significant (P < 0.05). There was no statistically significant difference in the volume rate constant (P > 0.05). (2) The signal peak value, area under the curve, maximum slope, volume transfer constant, rate transfer constant, and the median ratio of extravascular to extracellular space in the repair reaction area were higher than those in the necrotic area and the greater trochanter, and the differences were statistically significant (P < 0.05). (3) The median signal peak value and maximum slope of the necrotic area in ARCO stage II were greater than those in ARCO stage III, and the difference was statistically significant (P < 0.05). There were no significant differences in area under the curve, rate transfer constant, volume transfer constant and the median ratio of extravascular to extracellular space (P > 0.05). (4) The signal peak value, area under the curve, maximum slope, volume transfer constant, rate transfer constant, and ratio of extravascular to extracellular space in the repair reaction zone of the ARCO Stage II were lower than those of the ARCO Stage III, and the difference was statistically significant (P < 0.05). (5) It is concluded that the microcirculation perfusion velocity, blood flow and capillary permeability in the necrotic area of the femoral head were significantly reduced, while the microcirculation perfusion velocity, blood flow and vascular permeability in the repair reaction area were significantly improved compared with those in the normal area. With the occurrence of collapse, the perfusion velocity and blood flow were further reduced, and the perfusion in the repair reaction zone was enhanced. Figures and Tables | References | Related Articles | Metrics

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Serum pentosidine level and trabecular bone score affect the severity of vertebral fractures in type 2 diabetes patients Qian Guang, Yu Yueming, Dong Youhai, Hong Yang, Wang Minghai 2023, 27 (36):  5870-5874.  doi: 10.12307/2023.709 Abstract ( 273 )   PDF (1941KB) ( 41 )   Save BACKGROUND: Type 2 diabetes patients have been shown to experience fractures in the normal range or even higher bone mineral density. Therefore, bone quality plays a more important role in predicting fracture risk than bone mineral density in type 2 diabetes patients. OBJECTIVE: To evaluate the correlation of serum pentosidine level and trabecular bone score with the severity of vertebral fractures in type 2 diabetes patients. METHODS: Eighty patients with with osteoporotic thoracolumbar fractures were selected from Shanghai Fifth People’s Hospital, Fudan University from January 2021 to June 2022, including 40 patients with type 2 diabetes and 40 patients without diabetes. General information about all patients, including gender, age, body mass index, and biochemical markers of bone metabolism, was collected. Bone mineral density was measured by dual-energy X-ray absorptiometry, and the trabecular bone fraction of the spine was calculated using TBS Insight® software from the images obtained from the measurement. The concentration of pentosidine in serum of patients was determined by high performance liquid chromatography. The degree of spinal fracture compression in all patients was graded using the Genant semi-quantitative classification. The correlation between various variables and the degree of vertebral fracture compression was analyzed.   RESULTS AND CONCLUSION: (1) Compared with the non-diabetes group, the serum pentosidine level was significantly increased (P < 0.05) and the trabecular bone score was significantly decreased in the diabetes group (P < 0.05). There was no significant difference between the two groups in the lumbar bone mineral density, hip bone mineral density, and the proportion of severe fracture compression (P > 0.05). (2) Spearman correlation analysis showed that the severity of vertebral fracture was positively correlated with glycosylated hemoglobin and serum pentosidine levels (r=0.310, 0.796, P=0.005, 0.000). There was a significant negative correlation between vertebral fracture severity and trabecular bone score (r=-0.915, P=0.000). (3) These findings suggest that trabecular bone score and serum pentosidine levels, which can be used as a measure of bone quality, are significantly associated with the severity of osteoporotic vertebral fractures. Figures and Tables | References | Related Articles | Metrics

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Effects of whole-body vibration training on anterior cruciate ligament reconstruction: a meta-analysis Chen Peng, Wang Ling, Dong Shiyu, Ding Yue, Jia Shaohui, Kou Xianjuan, Zheng Cheng 2023, 27 (36):  5875-5883.  doi: 10.12307/2023.703 Abstract ( 413 )   PDF (16117KB) ( 64 )   Save OBJECTIVE: Whole-body vibration training has been widely used in the postoperative rehabilitation after anterior cruciate ligament reconstruction. However, its efficacy remains controversial. In this study, meta-analysis was conducted to systematically evaluate the effect of whole-body vibration training on anterior cruciate ligament reconstruction, in order to provide evidence-based medicine evidence for the clinical use of whole-body vibration training.  METHODS: Randomized controlled trials about effects of whole-body vibration training on anterior cruciate ligament reconstruction were electronically searched from PubMed, Embase, The Cochrane Library, Web of Science, EBSCO, CNKI, WanFang, and VIP databases, from inception to July 16, 2022. The outcome measures included five continuous variables: quadriceps peak torque, hamstring peak torque, knee angle recurrence error, Biodex migration index, and Lysholm knee score. The Cochrane Risk Bias Assessment Tool and Jadad Scale were used to evaluate the quality of the included literature, and RevMan 5.3 software was used for meta-analysis. RESULTS: (1) Ten randomized controlled trials involving 372 patients with anterior cruciate ligament reconstruction were finally included. The overall quality of the included literature was high. (2) The results of meta-analysis: Compared with the control group, whole-body vibration training significantly improved quadriceps peak torque (SMD=0.75, 95%CI: 0.20 to 1.30, P=0.008) and hamstring peak torque (SMD=0.90, 95%CI: 0.03 to 1.77, P=0.04), reduced knee angle recurrence error (SMD=−0.60, 95%CI: −1.04 to −0.17, P=0.007) and Biodex migration index (SMD=−0.93, 95%CI: −1.46 to −0.41, P=0.0005), and improved Lysholm knee score (MD=4.69, 95%CI: 0.79 to 8.60, P=0.02). CONCLUSION: Whole-body vibration training may help to improve quadriceps peak torque and hamstring peak torque, proprioception and balance function, and knee joint function scale score in patients after anterior cruciate ligament reconstruction.  Figures and Tables | References | Related Articles | Metrics

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Roles of ferroptosis in intervertebral disc degeneration and osteoarthritis Xiong Zhilin, Sun Hong, Liu Miao, Zhuang Yong 2023, 27 (36):  5884-5890.  doi: 10.12307/2023.720 Abstract ( 430 )   PDF (2299KB) ( 123 )   Save BACKGROUND: Ferroptosis is a new type of programmed cell death, distinguished from apoptosis, autophagy and pyroptosis, which is characterized by the iron-dependent accumulation of polyunsaturated fatty acid peroxidation. Studies in recent years have shown that ferroptosis is closely associated with the development of intervertebral disc degeneration and osteoarthritis. OBJECTIVE: To review the action mechanism of ferroptosis and its role in intervertebral disc degeneration and osteoarthritis progression, and provide new therapeutic strategies for intervertebral disc degeneration and osteoarthritis. METHODS: PubMed, WanFang and CNKI databases were used as the literature sources. The search terms were “intervertebral disc degeneration; osteoarthritis; nucleus pulposus; chondrocytes; articular cartilage; ferroptosis” in English and Chinese. Finally, 67 articles were screened for this review. RESULTS AND CONCLUSION: (1) Ferroptosis is a newly discovered programmed cell death, whose mechanism is closely related to the factors such as abnormal iron ion accumulation, polyunsaturated fatty acid peroxidation, abnormal amino acid metabolism, mitochondrial dysfunction, and ferritin autophagy. (2) Various stimulation factors such as homocysteine, tert-buty1 hydroperoxide and ferric ammonium citrate mainly through inhibiting glutathione peroxidase 4 activity cause ferroptosis of nucleus pulposus cells, annulus fibrosus cells, and chondrocytes of the endplate chondrocytes, thus promoting intervertebral disc degeneration. In addition, the role of ferroptosis in intervertebral disc degeneration is regulated by miRNA. (3) Ferroptosis promotes the progression of osteoarthritis by participating in chondrocyte loss, extracellular matrix lysis, and synovitis. Chondrocyte ferroptosis is inhibited by stigmasterol, D-mannose, astaxanthin, metformin and icariin, while it is exacerbated by interleukin-1β, ferric ammonium citrate and RNA binding protein SND1. (4) The therapeutic effects of some drugs targeting ferroptosis, such as deferoxamine, ferroptosis inhibitor, on intervertebral disc degeneration and osteoarthritis, have been verified by experiment, but have not been applied clinically. With the deepening of research, inhibiting the occurrence of ferroptosis can provide a new and effective strategy for the treatment and prevention of intervertebral disc degeneration and osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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Relationship between the degeneration of paraspinal muscle and sagittal alignment Liu Ziwen, Yang Yuming, Xie Hongru, Zhang Zepei, Xu Haoxiang, Miao Jun 2023, 27 (36):  5891-5897.  doi: 10.12307/2023.718 Abstract ( 241 )   PDF (1704KB) ( 51 )   Save BACKGROUND: The parameters of the spine and pelvis are interrelated. The changes in their values are closely related to the occurrence, development and symptoms of degenerative spinal diseases. At the present stage, clinical workers focus on the changes in postoperative coronal and sagittal parameters to evaluate the overall balance of the spine after operation, while ignoring the relationship with paraspinal muscle and the role of paraspinal muscle in the process of spinal degeneration.  OBJECTIVE: To summarize the previous studies on the relationship between the degeneration of paraspinal muscle and sagittal alignment, and analyze the interaction between changes in the relative position of skeleton structures and degeneration of paraspinal muscle during spinal degeneration. METHODS: A computer-based online retrieval of CNKI, WanFang, and VIP was conducted with the Chinese key words “sagittal spinal deformity, sagittal alignment, spinal-pelvic parameter, paraspinal muscle, degeneration, human cadaver model, imaging, MRI”. The retrieval of Medline, PubMed, and Web of Science databases was performed with the English key words “sagittal spinal deformity, sagittal alignment, spinal-pelvic parameter, paraspinal muscle, degeneration, imaging, MRI”. The preliminary screening was carried out by reading the title and abstract, and the literature was screened according to the inclusion and exclusion criteria. Finally, a total of 78 articles were included for result analysis. RESULTS AND CONCLUSION: (1) In recent years, researchers have noticed that paraspinal muscles play a corresponding role in maintaining sagittal alignment, and spinal degeneration can be delayed by protecting and improving paraspinal muscle function. (2) The researchers used different methods to detect the degree of paraspinal muscle degeneration, and selected different kinds of sagittal parameters to describe the sagittal alignment. After analyzing the degeneration of paraspinal muscles and the changes in sagittal parameters, we found that there was a correlation between them, and the correlation was affected by age, race and other factors. (3) Poor sagittal alignment is an important anatomic factor determining paraspinal muscle degeneration. A high pelvic incidence of anatomical parameters has often been reported as a risk factor for sagittal alignment. However, the smaller pelvic incidence is more prone to sagittal imbalance due to the smaller compensatory capacity of paraspinal muscles. (4) The paraspinal muscles continue to affect the sagittal alignment through a compensatory mechanism continuously. To combat spinal imbalance during spinal degeneration, the paraspinal muscles are in a state of high muscle load, causing pain, fatigue, atrophy and degeneration. Figures and Tables | References | Related Articles | Metrics

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PTGS2 and STAT3 in steroid-induced osteonecrosis of the femoral head: ferroptosis-related potential diagnostic biomarkers Liang Xuezhen, Luo Di, Li Jiacheng, Wen Mingtao, Zhang Jian, Xu Bo, Li Gang 2023, 27 (36):  5898-5904.  doi: 10.12307/2023.734 Abstract ( 433 )   PDF (3284KB) ( 73 )   Save BACKGROUND: Previous experimental studies have shown that ferroptosis might be involved in the pathological process of steroid-induced osteonecrosis of the femoral head, but the pathogenesis of ferroptosis in steroid-induced osteonecrosis of the femoral head remains unclear.   OBJECTIVE: To analyze the key potential ferroptosis-related genes involved in steroid-induced osteonecrosis of the femoral head to further clarify the biological mechanism of ferroptosis in steroid-induced osteonecrosis of the femoral head by bioinformatics. METHODS: The GSE123568 mRNA expression profile dataset, including 10 non-steroid-induced osteonecrosis of the femoral head (following steroid administration) samples and 30 steroid-induced osteonecrosis of the femoral head samples, was downloaded from the Gene Expression Omnibus (GEO) database. Ferroptosis-related genes were obtained from the Human Ferroptosis Database (FerrDb). The ferroptosis-related genes involved in steroid-induced osteonecrosis of the femoral head were screened by intersecting the GSE123568 dataset with the set of ferroptosis genes. The differentially expressed ferroptosis-related genes involved in steroid-induced osteonecrosis of the femoral head were identified with R software. In addition, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses of the differentially expressed ferroptosis-related genes involved in steroid-induced osteonecrosis of the femoral head were conducted by “clusterProfiler” R package. Spearman correlations between the expression levels of the differentially expressed ferroptosis-related genes involved in steroid-induced osteonecrosis of the femoral head were confirmed with “corrplot” R package. Moreover, the protein-protein interaction (PPI) network was analyzed by using the Search Tool for the Retrieval of Interacting Genes (STRING); significant gene cluster modules were identified with the MCODE Cytoscape plugin, and hub genes among the differentially expressed ferroptosis-related genes involved in steroid-induced osteonecrosis of the femoral head were screened by CytoHubba plugin. The ROC curves of the final specifically expressed hub genes were analyzed by “pROC” R package. Finally, the expression levels of the hub genes of the differentially expressed ferroptosis-related genes involved in steroid-induced osteonecrosis of the femoral head were validated by using the GSE74089 dataset.   RESULTS AND CONCLUSION: (1) A total of 30 differentially expressed ferroptosis-related genes were identified between the peripheral blood samples of steroid-induced osteonecrosis of the femoral head patients and non-steroid-induced osteonecrosis of the femoral head patients based on the defined criteria of adjusted P value <0.01 and |log2 FC| >log21.5, including 20 upregulated genes and 10 downregulated genes. (2) The GO and KEGG pathway enrichment analyses revealed that these differentially expressed ferroptosis-related genes were particularly enriched in oxidative stress, hypoxia-inducible factor-1 signaling pathway and ferroptosis. Spearman correlation analysis revealed significant correlations among the differentially expressed ferroptosis-related genes. (3) The PPI results demonstrated that the differentially expressed ferroptosis-related genes interacted with each other. Two significant gene cluster modules were identified through the MCODE plugin, and seven hub genes were identified by using the intersecting results within the MCC, MNC, DMNC, Degree and EPC algorithms of CytoHubba. (4) ROC curve suggested that compared to non-steroid-induced osteonecrosis of the femoral head samples, these seven overlapped ferroptosis-related hub genes had higher diagnostic value in the steroid-induced osteonecrosis of the femoral head samples. (5) The GSE74089 dataset showed that PTGS2 and STAT3 were significantly upregulated in the hip cartilage specimens, which was consistent with the GSE123568 dataset. (6) It is concluded that thirty potential ferroptosis-related genes were identified via bioinformatics analysis. The PPI network was constructed to select the Hub genes in which PTGS2 and STAT3 might serve as potential diagnostic biomarkers because they regulated ferroptosis. These results provide a target and new insight for further exploring the ferroptosis-related action mechanism and diagnosis of steroid-induced osteonecrosis of the femoral head. Figures and Tables | References | Related Articles | Metrics