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    28 March 2024, Volume 28 Issue 9 Previous Issue    Next Issue
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    Finite element analysis of the correlation between tilt angle of titanium cage and postoperative subsidence of titanium cage after anterior subtotal cervical corpectomy, decompression and fusion
    Li Zhifei, Yang Yin, Chen Hualong, Liang Qinqiu, Zhong Yuanming, Zhang Yisheng
    2024, 28 (9):  1313-1319.  doi: 10.12307/2023.919
    Abstract ( 182 )   PDF (2773KB) ( 58 )   Save
    BACKGROUND: Anterior subtotal corpectomy, decompression and fusion is a conventional method to treat cervical degenerative diseases. A titanium cage is an important implant to maintain the stability of the cervical spine after subtotal corpectomy. In recent years, many patients have complications such as titanium cage sinking, which are highly controversial.
    OBJECTIVE: To investigate the internal biomechanical relationship between the tilt angle of the titanium cage and postoperative titanium cage subsidence after anterior subtotal cervical corpectomy, decompression and fusion.
    METHODS: A three-dimensional finite element model of the C4-C6 segment was established by CT images of a normal human cervical spine, in which the anterior subtotal resection, decompression and fusion of the C5 vertebral body were simulated, and titanium cages with different tilt angles (-6° to -1° negative angle, that is, the front edge of titanium cage is shorter than the rear edge of titanium cage; 1° to 6° positive angle, that is, the front edge of titanium cage is longer than the rear edge of titanium cage) were placed. After setting the boundary conditions, preloads of 50, 100 and 150 N were applied respectively on the C4 vertebral body. The stress value of each contact point between the titanium cage and C4 lower-end plate and C6 lower-end plate (seven stress contact points on the contact surface of titanium mesh) was recorded and statistical analysis was conducted. 
    RESULTS AND CONCLUSION: (1) The tilt angles of the titanium cage of the positive angle group and negative angle group under 50, 100 and 150 N stress respectively were found by Mann Whitn test, with P < 0.05, which was statistically significant. The dispersion coefficients of the positive angle group were smaller than those of the negative angle group under 50, 100 and 150 N stress conditions. (2) Under 50, 100 and 150 N stress conditions, the Wilcoxon sign rank test in the positive angle group of titanium cage tilt angle found that when the angle was set to 1° to 5°, the difference was not statistically significant (P > 0.05). However, when the tilt angle of the titanium cage was set to 6°, the difference was statistically significant (P < 0.05). (3) Under 50, 100 and 150 N stress conditions, the Wilcoxon sign rank test in the negative angle group of titanium cage tilt angle found that when the tilt angle was set to -1° to-6°, the difference was not statistically significant (P > 0.05). (4) It is concluded that in the sagittal position, the titanium cage with a positive tilt angle is more stable than with a negative tilt angle, which is more suitable for clinical use. The tilt angle of the titanium cage is relatively stable in the range of 1° to 5°. When the tilt angle is 6°, the stability starts to decline, which is easy to cause complications of titanium cage sinking after surgery. It is more suitable to select the titanium cage with a tilt angle of 1° to 5° according to the clinical situation during surgery to improve the efficacy.
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    Three-dimensional finite element analysis of a new horizontal screw-screw crosslink in posterior atlantoaxial internal fixation
    Ouyang Beiping, Ma Xiangyang, Luo Chunshan, Zou Xiaobao, Lu Tingsheng, Chen Qiling
    2024, 28 (9):  1320-1324.  doi: 10.12307/2023.926
    Abstract ( 213 )   PDF (4697KB) ( 16 )   Save
    BACKGROUND: The addition of traditional rod-rod fixation for atlantoaxial joint disease to C1-C2 pedicle screw-rod fixation (C1-C2 PSR) can provide stronger anti-rotation stability for screw/rod fixation, but there is a risk of installation difficulties, impact on bone graft bed, and spinal cord injury. The new horizontal screw-screw crosslink (hS-S CL) designed by the authors can effectively overcome the above shortcomings, but its biomechanical properties are unclear.  
    OBJECTIVE: To analyze biomechanical properties of new horizontal screw-screw crosslink in C1-C2 PSR by three-dimensional finite element analysis. 
    METHODS: CT thin layer scanning data were collected from the occipital base to the axis (C0-2) of one adult healthy male volunteer. The atlantoaxial finite element models were established respectively: the normal group, the unstable group, the non-crosslink group (unstable+C1-C2 PSR), and the crosslink group (C1-C2 PSR+hS-S CL). Range of motion and Von Miss Stresses in flexion and extension, lateral flexion and rotation of the four groups were calculated by applying 1.5 Nm torque to each finite element model, and the stress cloud was extracted. 
    RESULTS AND CONCLUSION: (1) Range of motion of the unstable group was increased by 43.8%-78.7% compared with the normal group, and the range of motion of the internal fixation groups was 90.2%-98.7% lower than that of the unstable group under six conditions. The range of motion of the crosslink group and the non-crosslink group was basically the same in flexion and extension states, but in lateral flexion and rotation states, the range of motion of the crosslink group decreased 34.3%-43.8% and 78.6%-79.1%, respectively, compared with the non-crosslink group, and range of motion decreased most obviously in rotation state. (2) The stress peak of the internal plant model: The maximum stress of the crosslink group was generally smaller than that of the non-crosslink group, and the stress peak value of all the internal fixation groups was the lowest when the extension was carried out. (3) The stress cloud of internal plants showed that there was no obvious stress concentration phenomenon in the internal fixation, and the main stress distribution areas were the screw root and bone joint, and the crosslink ends were the screw tail groove or the joint rod joint. (4) The new horizontal screw-screw crosslink can obviously improve the anti-rotation stability of internal fixation and it can share part of the pressure in the three-dimensional motion direction of the internal fixation system and reduce the maximum stress of the internal plants. However, the stress distribution is obvious at both ends of the crosslink, and this part may be prone to fracture of the crosslink. 
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    Biomechanical characteristics of a novel interspinous distraction fusion device BacFuse for the repair of lumbar degenerative disease
    Chen Mengmeng, Bao Li, Chen Hao, Jia Pu, Feng Fei, Shi Guan, Tang Hai
    2024, 28 (9):  1325-1329.  doi: 10.12307/2023.912
    Abstract ( 174 )   PDF (4882KB) ( 15 )   Save
    BACKGROUND: Interspinous distraction fusion device BacFuse was used for the management of lumbar degenerative disease and obtained good clinical efficacy in recent years. However, the related biomechanical study was lacking.  
    OBJECTIVE: To explore the related biomechanical characteristics of BacFuse, a novel interspinous distraction fusion device, which was used in lumbar degenerative disease.
    METHODS: After constructing the goat spinal models (L1-L6), they were grouped into four groups based on different simulated surgeries: the control group, the BacFuse group (L3/4), the screw-rod fixation group (L3/4) and the Topping-off group (L3/4 screw-rod fixation + L2/3 BacFuse fixation). The goat lumbar spine surgical model was assembled into a biomechanical testing system. A biomechanical machine was used for mechanical loading, simulating lumbar spine movement of flexion, extension, lateral flexion and rotation with a 4 Nm moment. A visual tracking system was used for positioning and capturing. Finally, mechanical and optical calibration was completed to calculate the range of motion of the L2/3, L3/4 and L4/5 segments.  
    RESULTS AND CONCLUSION: (1) Compared with the control group, the range of motion of the L3/4 segment in the BacFuse group decreased 27.27%, 70%, 38.1% and 23.08% in the flexion, extension, lateral bending and rotation directions, respectively (P < 0.05). The range of motion of L3/4 segment in the screw-rod fixation group decreased 72.73%, 80%, 71.43% and 73.08% in the flexion, extension, lateral bending and rotation directions, respectively (P < 0.05). (2) Compared with the control group, the range of motion of the adjacent segment L2/3 increased by 33.33%, 25% and 23.81% in the extension, lateral bending and rotation directions, respectively in the BacFuse group (P < 0.05), with no significant change in flexion. In the screw-rod fixation group, there was a 50%, 44.44%, 50% and 58.96% increase in the adjacent segment L2/3 in the flexion, extension, lateral calibration and rotation directions, respectively (P < 0.05). (3) Compared with the control group, the BacFuse group showed an increase in range of motion in proximal segment L4/5 in the extension and rotation directions by 27.3% and 17.39% (P < 0.05) respectively, with no significant change in flexion or lateral bending. In the screw-rob fixation group, the proximal segment L4/5 demonstrated 38.89%, 22.73% and 26.09% (P < 0.05) increases in range of motion in the flexion, extension and rotation directions, respectively, with no significant change in lateral bending. (4) In the Topping-off group, the range of motion of L2/3 was reduced by 37.04%, 73.08%, 56.67% and 38.46% in flexion, extension, lateral flexion and rotation, respectively, compared to the screw-rob fixation group (P < 0.05). Compared with the screw-rob fixation group, the Topping-off group showed a 20% reduction in the range of motion of the L4/5 in the flexion direction (P < 0.05), with no significant differences seen in extension, lateral bending and rotation. (5) It is concluded that the interspinous distraction fusion device BacFuse significantly reduces the range of motion of the implanted segment and provides some stability. It still retains more mobility and reduces the impact on the adjacent segment compared to screw-rob fixation, while the Topping-off tip, which can be used for intervertebral fusion fixation, significantly reduces the range of motion of the adjacent segment and reduces the risk of adjacent segment degeneration.
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    Changes in lumbosacral sagittal plane parameters of L5/S1 disc herniation reabsorption
    He Xinyu, Zhou Honghai, Jiang Hong, Ma Zhijia, Su Shaoting, Lin Zehong, Tian Junming, Chen Longhao, Liu Baijie
    2024, 28 (9):  1330-1335.  doi: 10.12307/2024.020
    Abstract ( 224 )   PDF (1911KB) ( 36 )   Save
    BACKGROUND: Previous studies have shown the correlation between lumbosacral sagittal plane parameters and natural absorption of lumbar disc herniation. However, the lumbosacral sagittal plane parameters included lumbar lordosis angle, lumbosacral joint angle, sacral inclination angle and many other parameters. The effects of each parameter on the natural absorption of the herniated disc were different. In addition, there are few studies on the reabsorption of a specific segment of intervertebral disc herniation at present, and most of the measured data are obtained from digital radiography or CT, while the correlation between lumbosacral sagittal plane parameters measured from MRI and reabsorption after L5/S1 intervertebral disc herniation is rarely reported.  
    OBJECTIVE: To study the corresponding changes of lumbar sagittal plane parameters after L5/S1 intervertebral disc herniation reabsorption and to screen out the lumbosacral sagittal plane parameters with the most significant changes during intervertebral disc reabsorption.
    METHODS: Totally 57 patients with lumbar disc herniation who had complete MRI image data were selected and met the diagnostic criteria for lumbar disc herniation and only received non-surgical treatment for reabsorption of L5/S1 protrusion segments. MRI measured the protrusion area of the maximum protrusion plane in the coronal plane, lumbosacral sagittal plane parameters [lumbar curvature index, lumbar lordosis (α), L5/S1 disc angle (β), intervertebral height measurement, lumbosacral joint angle, sacral platform angle, sacral inclination angle, and lower lumbar lordosis angle]. Besides, lumbosacral sagittal plane parameters were ranked in the importance of variables by random forest model in R software, and then significant variables were fitted with multiple linear regression. The changes between parameters before and after treatment were analyzed and compared by paired sample t-test.
    RESULTS AND CONCLUSION: (1) A total of 57 patients with L5/S1 lumbar disc herniation were included in this study, and the symptoms and imaging features of the patients were significantly relieved to a large extent. (2) Before treatment, there were 4 cases of grade 1, 29 cases of grade 2 and 24 cases of grade 3 according to the Classification of Michigan State University. After treatment, there were 48 cases of grade 1 and 9 cases of grade 2. (3) The random forest model suggested that intervertebral height, lumbar curve index, sacral inclination angle, and lower lumbar lordosis angle changed significantly in L5/S1 disc herniation reabsorption, and the order of their change significance was lumbar curve index > intervertebral space height > sacral inclination angle > lower lumbar lordosis angle. (4) Lumbar curve index, lumbar lordosis and sacral platform angle increased, with statistical significance (P < 0.05). There were no significant differences in disc angle, intervertebral height, lower lumbar lordosis angle, sacral inclination angle or lumbosacral joint angle (P > 0.05). (5) Lumbar curvature index was the most significant parameter of the lumbosacral sagittal plane in herniated disc reabsorption. In addition, lumbar curve index, sacral inclination angle, and lower lumbar lordosis angle are commonly used clinically to describe the change of lumbar curvature, suggesting that L5/S1 disc herniation reabsorption is correlated with the change of lumbar curvature. It is indicated that in the treatment of lumbar disc herniation, a clinical cure can be achieved by improving or restoring the disordered lumbar curvature.
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    Finite element and biomechanical analysis of different implants in repair for unilateral unstable pelvic posterior ring injury
    Liang Cheng, Zhang Linqi, Wang Guan, Li Wen, Duan Ke, Li Zhong, Lu Xiaobo, Zhuo Naiqiang
    2024, 28 (9):  1336-1341.  doi: 10.12307/2024.003
    Abstract ( 192 )   PDF (4630KB) ( 24 )   Save
    BACKGROUND: The stability of the pelvis is mainly determined by the posterior pelvic ring and the sacroiliac joint. The posterior pelvic ring injury and the dislocation of the sacroiliac joint caused by high energy impacts such as car accidents increase year by year. Surgical treatment is the best method, and there are many kinds of endophytorepair methods in clinical practice, but which treatment method has the best biomechanical properties is still controversial.  
    OBJECTIVE: To compare the biomechanical properties of three kinds of internal implants: anterior double plates, posterior bridging plate and tension nail in the repair of unilateral unstable pelvic posterior ring injury, to provide a reference for the clinical treatment and development of a new pelvic tension screw.
    METHODS: (1) Finite element simulation: Mimics, Wrap and SolidWorks were used to establish normal pelvic model, unilateral injured pelvis model, and three kinds of internal implant repaired models (anterior double plates, posterior bridging plate and tension nail). Ansys was used to analyze the stress and deformation of the models. (2) Biomechanical test: A total of 15 intact pelvic specimens were randomly grouped into five groups, normal pelvic model, unilateral injured pelvis model, anterior double plates, posterior bridging plate and tension nail groups. The mechanical test was performed using an Instron E10000 testing machine.  
    RESULTS AND CONCLUSION: (1) Simulation: In the normal pelvic model, the average displacement of the sacrum was 0.174 mm, and the maximum stress of the sacral iliac bone was 10.51 MPa, and the stress distribution was uniform. The mean sacral displacement of the unilateral injured pelvis model was 0.267 mm, and the stress concentration of the model was obvious. The mean displacement of the sacrum in the three repaired models was close to that in the normal pelvic model, and the stress distribution of the sacral iliac bone in the tension nail repaired model was uniform. (2) Mechanical test: The stiffness of the normal pelvic model was (226.38±4.18) N/mm, and that of the unilateral unstable pelvic model was the smallest (130.02±2.19) N/mm. The deviation of the normal pelvic model stiffness and the three repaired models’ stiffness were all within (±10%), and the repair effect was obvious. (3) The simulation results were in agreement with the experimental results. (4) The biomechanics of the tension nail repaired model was the most similar to that of the normal pelvis, and this method was the best. The repairing stiffness of the anterior double plate was too large, and the stress shielding effect was more significant. The posterior bridging plate repair could not solve the compensatory effect of the normal side soft tissue and had defects. This study provides an optimal basis for clinical surgery. (5) The new type of pelvic tension nail should be improved from the point of view of the tension nail to retain the good biomechanical properties of the tension nail, while adding other advantages, such as being used for the osteoporotic pelvis.
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    Construction and finite element analysis of normal and osteoporotic hip models
    Guo Sutong, Feng Dehong, Guo Yu, Wang Ling, Ding Yujian, Liu Yi, Qian Zhengying, Li Mingyang
    2024, 28 (9):  1342-1346.  doi: 10.12307/2023.911
    Abstract ( 232 )   PDF (2212KB) ( 24 )   Save
    BACKGROUND: Bone mineral density is the clinical gold standard for determining bone strength, but bone mineral density is less sensitive to changes in bone mass, with large changes in bone mineral density only occurring when bone mass is significantly reduced, so bone mineral density has limited ability to predict changes in bone strength and fracture risk.  
    OBJECTIVE: A model of the normal and osteoporotic hip joint was developed to analyze the stresses and deformation in the hip of normal and osteoporotic patients under single-leg standing conditions.
    METHODS: A healthy adult female volunteer at the age of 36 years was selected as the study subject. The CT data of the hip joint of this volunteer were obtained and saved in DICOM format. The hip joint model was reconstructed in three dimensions, and the material properties were assigned by the gray value assignment method to obtain the normal and osteoporotic hip joint models according to the empirical formula. The same boundary conditions and loads were set to simulate the stresses and deformation in the normal and osteoporotic hip joints in the single-leg standing position.  
    RESULTS AND CONCLUSION: (1) In the finite element model of the normal and osteoporotic hip, the stress distribution was more concentrated in the medial region of the femoral neck. (2) In the hip bone, the stress distribution was mainly concentrated in the upper part of the acetabulum. (3) The stress peaks in the medial femoral neck and upper acetabulum were larger in the normal hip model than in the osteoporotic hip model, probably due to the reduced bone strength of the osteoporotic bone. (4) The peak Von Mises of both normal and osteoporotic hip models were concentrated on the medial femoral neck, and the peak Von Mises of the hip bone was smaller, indicating that the overall effect of osteoporosis on hip bone stresses was relatively small. (5) In terms of deformation in the single-leg standing position, the maximum deformation in the normal hip model was located at the acetabulum and femoral head, and the maximum deformation was located at the upper part of the greater trochanter of the femur. (6) It is suggested that the finite element analysis method to model the values of parameters related to bone tissue in osteoporosis may improve clinical prediction of bone strength changes and fracture risk. It is explained from the biomechanical view that the intertrochanteric femur and femoral neck are good sites for osteoporotic hip fractures.
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    Three-dimensional finite element analysis of effects of partial anterior cruciate ligament rupture on knee joint stress
    Yang Junliang, Lu Tan, Xu Biao, Jiang Yaqiong, Wang Fucheng
    2024, 28 (9):  1347-1353.  doi: 10.12307/2023.920
    Abstract ( 262 )   PDF (2503KB) ( 27 )   Save
    BACKGROUND: Anterior cruciate ligament injury tends to lead to secondary meniscus injury and osteoarthritis. At present, there are few studies on the mechanics of meniscus and articular cartilage injury caused by anterior cruciate ligament injury. 
    OBJECTIVE: To study the effect of partial rupture of the anterior cruciate ligament on the stress of medial and lateral meniscus and articular cartilage of knee joint by finite element analysis.
    METHODS: The CT and MRI images of the knee joint of a healthy volunteer were selected, and the scan data were imported into Mimics, Geomagic and SolidWorks software. After registration and fusion, four kinds of three-dimensional knee joint models were established: models of intact anterior cruciate ligament, rupture of the posterior external tract of anterior cruciate ligament, rupture of the anterior internal tract of anterior cruciate ligament, and absence of anterior cruciate ligament. Finally, data were imported into Ansys software to apply four different modes of loads to the knee joint: Longitudinal loads of 750 N were applied to the top of the femur; longitudinal load of 750 N to the top of the femur and forward thrust of 134 N behind tibia; a longitudinal load of 750 N and a varus moment of 10 Nm were applied to the top of the femur to simulate genu varus; 750 N longitudinal load and 4 Nm internal rotation moment were applied to the proximal end of the femur to simulate knee internal rotation. The finite element analysis of biomechanical stress changes of the meniscus and articular cartilage of the knee joint was carried out.  
    RESULTS AND CONCLUSION: (1) In the straight position of the knee joint, when the anterior medial tract of the anterior cruciate ligament was broken and the anterior cruciate ligament was missing under longitudinal loads of 750 N at the top of the femur, the total stress and peak value of meniscus increased significantly, but the stress distribution of the meniscus and the stress of articular cartilage did not change significantly. In longitudinal load of 750 N to the top of the femur and forward thrust of 134 N behind tibia, the fracture of the anterior internal tract of the anterior cruciate ligament increased the tibia forward, the compressive stress of posterior angle of the meniscus increased, and the stress of the articular cartilage did not change significantly. During simulating genu varus, the posterior angular stress of the lateral meniscus decreased, the stress of the medial meniscus increased, and the stress of articular cartilage slightly decreased when anterior cruciate ligament injuries were complete. When the anterior internal tract of the anterior cruciate ligament was broken or absent under knee internal rotation, the equivalent stress peak value of femoral cartilage and tibia cartilage shifted from medial cartilage to lateral cartilage, and the stress peak value of meniscus increased significantly. At this time, the anterior internal tract of the anterior cruciate ligament played a leading role in the rotational stability of the knee joint. (2) These results indicate that the risk of secondary meniscus injury in patients with anterior and medial anterior cruciate ligament band rupture was much higher than that in patients with posterior and external anterior cruciate ligament band rupture when the knee was in the upright standing position, varus and pronation, and there was no significant difference in the impact on articular cartilage.
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    Correlation of knee extensor muscle strength and spatiotemporal gait parameters with peak knee flexion/adduction moment in female patients with knee osteoarthritis
    Li Yongjie, Fu Shenyu, Xia Yuan, Zhang Dakuan, Liu Hongju
    2024, 28 (9):  1354-1358.  doi: 10.12307/2023.902
    Abstract ( 250 )   PDF (1590KB) ( 18 )   Save
    BACKGROUND: Previous studies have shown that knee joint moment changes in patients with knee osteoarthritis, but there are few reports on the correlation of moment changes with knee extensor muscle strength and gait spatiotemporal parameters.
    OBJECTIVE: To explore the correlation of knee extensor muscle strength and gait spatiotemporal parameters with peak knee flexion moment and knee adduction moment in female patients with knee osteoarthritis. 
    METHODS: Twenty knee osteoarthritis female patients with single knee disease hospitalized in Guizhou Hospital, Beijing Jishuitan Hospital from February to August 2022 were selected as the knee osteoarthritis group, and an additional 20 healthy females without musculoskeletal disease were selected as the control group. The knee extensor force at 60 (°)/s was measured with the Biodex isokinetic instrument. The gait spatiotemporal parameters and peak knee flexion moment and knee adduction moment were collected with the Italian BTS infrared motion capture system and force measuring platform. Pearson correlation analysis was used to explore the correlation of muscle strength and gait spatiotemporal parameters with peak knee adduction moment and knee flexion moment, and the variables significantly related to knee joint moment were further included in the multiple stepwise regression analysis. 
    RESULTS AND CONCLUSION: (1) Compared with the control group, the knee osteoarthritis group had significantly lower knee extensor force, step speed, step frequency, step length, step width, peak knee adduction moment and knee flexion moment at 60 (°)/s (P < 0.05). (2) Pearson correlation analysis showed that the 60 (°)/s centripetal extensor force, step speed, step frequency and step length were positively correlated with the peak knee flexion moment, and negatively correlated with the peak knee adduction moment, with a statistically significant difference (P < 0.05). (3) The results of multiple stepwise regression showed that step speed and 60 (°)/s knee extensor force were the strongest predictors of peak knee flexion moment, and the total R2 value of the two factors was 0.426, indicating that 42.6% of the total variance of this parameter could be explained. Step length and 60 (°)/s centripetal extensor force were the strongest predictors of peak knee adduction moment. The total R2 value of the two factors was 0.602, indicating that 60.2% of the total variance of this parameter could be explained. (4) It is concluded that knee extensor strength, step speed and step length are the main variables affecting peak knee adduction moment and knee flexion moment. Therefore, these variables can be used for clinical gait monitoring and guidance to change knee joint load during knee osteoarthritis rehabilitation. 
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    Finite element analysis of medial patellofemoral ligament reconstruction at different flexion angles
    Li Chaojie, Gulati•Maitirouzi, Aierxiding•Abulaiti, Zheng Hui, Tu Hudi
    2024, 28 (9):  1359-1364.  doi: 10.12307/2024.001
    Abstract ( 223 )   PDF (2977KB) ( 45 )   Save
    BACKGROUND: The medial patellofemoral ligament reconstruction is the most commonly used method for the treatment of lateral dislocation of patella at present. The ultimate goal is to adjust the patella to the normal anatomical position and restore the patella track. Currently, the main core problem of medial patellofemoral ligament reconstruction is the selection of its femoral end fixation point.  
    OBJECTIVE: Finite element method was used to analyze the limiting effect of the reconstructed medial patellofemoral ligament on the patella at different flexion angles of the knee joint, and to simulate the limiting effect of medial patellofemoral ligament reconstruction at different fixation points of the femoral end on the patellofemoral end, so as to provide help for the selection of fixation points of the femoral end during the reconstruction of the medial patellofemoral ligament.
    METHODS: A finite element model of knee including bone and soft tissue was established according to the extracted CT and MRI data of knee joint. When the knee flexion angle of 30° and 60° was simulated, the medial patellofemoral ligament was constructed by selecting different fixation points of femur end. The contact stress and contact area between patellofemoral joints at different points were compared, as well as the transverse binding force on patella. The equilength of the medial patellofemoral ligament constructed from the same fixation point of the femoral end at different flexion angles was verified to study the effect of various reconstruction positions of the medial patellofemoral ligament.  
    RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of the knee joint at 30° and 60° flexion angles was established to construct the medial patellofemoral ligament at different fixation points of the femur end. The medial patellofemoral ligament constructed at the same position of the femur end had usable isometric length at different flexion angles. (2) After the lateral displacement of the patella, in the transverse direction, the medial patellofemoral ligament constructed at different fixed points of the femur end produced different transverse binding force on the patella, and the transverse binding force was maximum at the anterior 10 mm and minimum at the proximal 5 mm. In the longitudinal direction, the location and size of stress concentration points on the patella cartilage were roughly the same, and the contact pressure did not change much. However, the contact area between the patella cartilage and the femoral cartilage was significantly different, with the maximum contact area at 10 mm at the front end and the minimum contact area at 5 mm at the proximal end. (3) The medial patellofemoral ligament constructed at the center of the saddle region has a good lateral restriction on the patella, but does not cause excessive restriction on the patella in the longitudinal restriction, and can achieve a good restriction on the patella.
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    Intervention of muscle strength training combined with neuromuscular electrical stimulation on lower limb function and biomechanical changes in patients with patellofemoral pain
    Wu Jing, Yao Yingce, Yang Xiaowei, Xue Boshi, Zhao Jianbin, Yang Chen, Luan Tianfeng, Zhou Zhipeng
    2024, 28 (9):  1365-1371.  doi: 10.12307/2024.036
    Abstract ( 294 )   PDF (1589KB) ( 51 )   Save
    BACKGROUND: Lower limb peri-knee muscle strength training and neuromuscular electrical stimulation are generally safe and effective rehabilitation methods for patellofemoral joint pain, but the mechanism of their intervention is still unclear. 
    OBJECTIVE: To determine the effect of muscle strength training combined with neuromuscular electrical stimulation on pain, lower extremity function and biomechanical characteristics in patients with patellofemoral pain. 
    METHODS: Thirty-seven patients with patellofemoral pain were randomly divided into muscle strength training combined with electrical stimulation group (trial group, n=19) and muscle strength training group (control group, n=18). Both groups underwent intervention training for 6 weeks, three times a week. The visual analog scale and anterior knee pain scale were used to evaluate the pain level and functional level of the knee. Kinematic and kinetics data during running were collected by using an infrared motion capture system and a three-dimensional force platform simultaneously. A two-way analysis of variance with repeated measures (group*time) was applied to analyze the data.  
    RESULTS AND CONCLUSION: (1) After the intervention, the visual analog scale scores of the trial group and the control group were significantly decreased (P < 0.001), and the anterior knee pain scale scores were significantly increased (Ptrial group < 0.001, Pcontrol group=0.001) in the trial group and control group. The anterior knee pain scale scores of the trial group were significantly higher compared to the control group after the intervention (P=0.001). (2) The peak knee flexion angle (P=0.011), peak knee extension moment (P < 0.001), the peak knee internal rotation moment (P=0.008), the peak patellofemoral stress (P < 0.001) and the peak patellofemoral contact force (P < 0.001) were significantly decreased in the trial and control groups during running after the intervention compared with those before the intervention. (3) In conclusion, both muscle strength training and muscle strength training combined with electrical stimulation training are helpful to improve the subjective pain and lower limb function of patellofemoral pain patients, enhance the movement pattern during running and reduce the stress of the patellofemoral joint. Compared with muscle strength training alone, muscle strength training combined with electrical stimulation can improve lower limb function more significantly. 
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    Role and significance of artificial intelligence preoperative planning in total hip arthroplasty
    Min Meipeng, Wu Jin, URBA RAFI, Zhang Wenjie, Gao Jia, Wang Yunhua, He Bin, Fan Lei
    2024, 28 (9):  1372-1377.  doi: 10.12307/2023.798
    Abstract ( 206 )   PDF (2393KB) ( 69 )   Save
    BACKGROUND: The preoperative planning of traditional X-ray films is often inaccurate, which can lead to some intraoperative and postoperative complications, increase the operation time and intraoperative blood loss, and to some extent affect the surgical outcome of total hip arthroplasty.  
    OBJECTIVE: To investigate the accuracy and effectiveness of artificial intelligence preoperative planning in total hip arthroplasty.
    METHODS: Sixty patients who underwent primary total hip arthroplasty on the affected side were selected. 30 of them used artificial intelligence 3D preoperative planning (trial group) and 30 used conventional X-ray film 2D preoperative planning (control group), and there were no statistically significant differences between the two groups in terms of gender, age, condition and other general data (P > 0.05). The actual intraoperative prosthesis placement and preoperative planning prosthesis matching, intraoperative operation time, intraoperative blood loss, bilateral femoral eccentric distance difference, bilateral joint eccentric distance difference and bilateral lower limb length difference, and Harris score at 3 months after operation were compared between the two groups, and the accuracy and application effect of the two preoperative plans were analyzed. 
    RESULTS AND CONCLUSION: (1) Patients in both groups were followed up for 4-6 months postoperatively. One patient in the control group had a posterior dislocation of the prosthesis at 5 days postoperatively, which recovered after performing manual repositioning without re-dislodgement. The rest of the patients did not have postoperative complications or postoperative death. (2) Complete matching rate of the prosthesis on the acetabular side and femoral side was significantly better in the trial group than that in the control group (P < 0.05). (3) Operation time and intraoperative blood loss were significantly less in the trial group than those in the control group (P < 0.05). (4) The difference in bilateral lower limb length between the two groups was statistically significant (P < 0.05), and the difference in bilateral femoral eccentric distance and bilateral joint eccentric distance was not statistically significant (P > 0.05). (5) Harris score of patients in the trial group was significantly higher than that in the control group 3 months after operation (P < 0.05). (6) These results confirm that compared with traditional film planning, artificial intelligence preoperative planning can predict the prosthesis type more accurately, shorten the operation time, reduce intraoperative blood loss, diminish the occurrence of postoperative bilateral lower limb inequality, and accelerate postoperative recovery.
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    Changes in muscle strength and pain in patients receiving Jianpi Yiqi Huoxue Formula after total knee arthroplasty
    Shan Jiaxin, Zhang Yilong, Wu Hongtao, Zhang Jiayuan, Li Anan, Liu Wengang, Xu Xuemeng, Zhao Chuanxi
    2024, 28 (9):  1378-1382.  doi: 10.12307/2023.924
    Abstract ( 227 )   PDF (3948KB) ( 62 )   Save
    BACKGROUND: Some patients still have unsatisfactory improvement of operative limb fatigue and pain after total knee arthroplasty. Clinical findings show that Jianpi Yiqi Huoxue Formula can promote recovery after total knee arthroplasty, but the specific efficacy remains to be studied. 
    OBJECTIVE: To observe the effect of Jianpi Yiqi Huoxue Formula on the muscle strength and pain of the operated limb after the primary unilateral total knee arthroplasty. 
    METHODS: A total of 74 patients undergoing primary unilateral total knee arthroplasty were randomly divided into a trial group and a control group with 37 patients in each group. All patients received the same prostheses and surgical methods during the operation. Patients in the control group were treated with routine analgesics, anticoagulant drugs and functional exercise after the operation. The trial group received Jianpi Yiqi Huoxue Formula after the treatment in the control group. Both groups were treated continuously and followed up for 1 month. The changes in isokinetic muscle strength (peak torque and total work amount of extensor and flexor), visual analog scale score and the hospital for special surgery score of the two groups were analyzed. 
    RESULTS AND CONCLUSION: (1) The trial group had better improvement in peak torque and total work amount of extensor and flexor and the hospital for special surgery score than the control group 14 days and 1 month after surgery (P < 0.05). (2) In contrast to the control group, the visual analog scale score of the trial group improved better at 7 and 14 days and 1 month after surgery (P < 0.05). (3) It is indicated that Jianpi Yiqi Huoxue Formula can effectively improve the muscle strength of the operated limb, enhance the degree of postoperative joint pain, and promote functional rehabilitation after total knee arthroplasty. 
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    Effect of diabetes mellitus on perioperative blood loss and pain after primary total knee arthroplasty
    Qi Haodong, Lu Chao, Xu Hanbo, Wang Mengfei, Hao Yangquan
    2024, 28 (9):  1383-1387.  doi: 10.12307/2023.928
    Abstract ( 205 )   PDF (1494KB) ( 60 )   Save
    BACKGROUND: Total knee arthroplasty is the main therapeutic regimen for end-stage osteoarthritis. However, diabetes mellitus can affect the treatment effect and prognosis.  
    OBJECTIVE: To explore the effect of diabetes mellitus on perioperative blood loss and postoperative pain in patients undergoing primary total knee arthroplasty.
    METHODS: A retrospective study was conducted on 154 patients who underwent primary total knee arthroplasty and met the inclusion criteria in the Osteonecrosis and Joint Reconstruction Ward of Xi’an Honghui Hospital Affiliated to Xi’an Jiaotong University from January to April 2021. Patients were divided into a non-diabetic group and a diabetic group according to their diagnosis, with 32 cases in the diabetic group, 9 males and 23 females, aged 55 to 80 (66.58±7.16) years and 122 cases in the non-diabetic group, 34 males and 88 females, aged 44 to 83 (66.69±6.63) years. Perioperative blood loss (including total blood loss, hidden blood loss, the falling value of hemoglobin and hematocrit) was calculated for both groups. Visual analog scale scores, hospital for special surgery knee score, and Caprini scores were recorded preoperatively and postoperatively.  
    RESULTS AND CONCLUSION: (1) Total blood loss was significantly lower in the non-diabetic group (729.93±233.83 mL) than that in the diabetic group (853.69±184.91 mL) (P < 0.05). Latent hidden blood loss was also significantly lower in the non-diabetic group (624.40±233.19 mL) than that in the diabetic group (749.08±179.49 mL) (P < 0.05). (2) In the non-diabetic group, the visual analog scale scores preoperatively and 1 month postoperatively were significantly lower than those in the diabetic group (P < 0.05). The differences in visual analog scale scores at 3 days and 3 months postoperatively between the non-diabetic group and the diabetic group were not statistically significant (P > 0.05). (3) The hospital for special surgery knee score at 1 month postoperatively was significantly higher in the non-diabetic group than that in the diabetic group (P < 0.05). There was no significant difference in hospital for special surgery knee score between the two groups at 3 months postoperatively (P > 0.05). (4) There was no statistically significant difference in preoperative and postoperative Caprini scores between the two groups (P > 0.05). (5) It is concluded that having diabetes increases total and occult hidden blood loss in primary total knee arthroplasty. In the short term after total knee arthroplasty, diabetes increases the patient’s pain and affects the recovery of joint function, but the negative effects fade with time.
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    Value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty
    Li Xiaoqiang, Chen Wei, Li Mingyue, Shan Tianchi, Shen Wen
    2024, 28 (9):  1388-1393.  doi: 10.12307/2023.900
    Abstract ( 162 )   PDF (1635KB) ( 85 )   Save
    BACKGROUND: Total knee arthroplasty is one of the effective methods to treat end-stage knee osteoarthritis. However, some patients still experience chronic post-surgical pain. It is significant to find out the influencing factors of chronic post-surgical pain. Demographic factors, social psychological factors and perioperative pain were the focus of previous studies, but muscle factors closely related to the occurrence and development of knee osteoarthritis were rarely reported. 
    OBJECTIVE: To evaluate the value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty. 
    METHODS: A total of 250 patients with knee osteoarthritis who underwent the first unilateral total knee arthroplasty under elective general anesthesia from January to August 2022 in the Affiliated Hospital of Xuzhou Medical University were selected. All patients were treated with the same anesthesia and operative methods. Before the surgery, clinical data were recorded, and the thickness and echo intensity of quadriceps femoris on the operated side were measured by ultrasound imaging, which could quantify the degree of quadriceps femoris atrophy. Multivariate logistic regression was used to analyze the independent factors affecting the occurrence of chronic post-surgical pain, and receiver operating characteristic curves were used to evaluate its predictive value. 
    RESULTS AND CONCLUSION: (1) 250 subjects were involved in the result analysis, and 91 of them had chronic post-surgical pain, with an incidence of 36.4%. (2) There were significant differences between the chronic pain and non-chronic pain groups in preoperative pain score during movement, preoperative Western Ontario and McMaster University Osteoarthritis Index, preoperative anxiety and depression scale score, preoperative muscle thickness and echo intensity of quadriceps femoris, and postoperative acute pain score (P < 0.05). (3) Multivariate logistic regression analysis showed that preoperative thickness of quadriceps femoris was an independent protective factor for chronic post-surgical pain and preoperative pain score during movement was an independent risk factor for chronic post-surgical pain. (4) Receiver operating characteristic curves showed that the area under the curve of the preoperative thickness of quadriceps femoris was 0.625 (95%CI: 0.555-0.695), and the critical value was 2.78 cm, sensitivity was 0.802, specificity was 0.415. (5) It is concluded that the preoperative thickness of quadriceps femoris is an independent protective factor for chronic post-surgical pain, but its predictive efficacy is low, and its clinical application needs to be further verified or modified. 
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    Risk factors for cage retropulsion following transforaminal lumbar interbody fusion
    Xi Jintao, Lu Qilin, Wang Yang, Wang Xiaojuan, Lyu Peng, Chen Long, Shi Zhen, Xie Wei, Zhu Yiliang, Li Xugui
    2024, 28 (9):  1394-1398.  doi: 10.12307/2023.785
    Abstract ( 199 )   PDF (2145KB) ( 61 )   Save
    BACKGROUND: Previous literature reported that the fusion cage moved more than 2 mm from its original position, which means that the fusion cage moved backward. At present, clinical observation has found that the factors leading to the displacement of the fusion cage are complex, and the relationship between these factors and the cage retropulsion is not clear. 
    OBJECTIVE: To explore the risk factors related to cage retropulsion after lumbar interbody fusion. 
    METHODS: Retrospective analysis was conducted in 200 patients who underwent transforaminal lumbar interbody fusion surgery with a polyetheretherketone interbody fusion from February 2020 to February 2022. According to the distance from the posterior edge of the vertebral fusion cage to the posterior edge of the vertebral body after the operation (the second day after the removal of the drainage tube) and 1, 3, 6 and 12 months after the operation, patients were divided into cage retropulsion group (≥ 2 mm) and cage non-retropulsion group (< 2 mm). The factors that may affect cage retropulsion, such as age, gender, body mass index, bone mineral density, operation time, bleeding, endplate injury, preoperative and postoperative interbody height, cage implantation depth, cage size, and segmental anterior convexity angle, were analyzed by univariate and logistic regression analysis.  
    RESULTS AND CONCLUSION: (1) Posterior displacement of the fusion cage occurred in 15 cases (15/200). The differences in basic information such as age and body mass index between the two groups were not statistically significant. (2) The results of the univariate analysis were that gap height difference, time to wear a brace, segmental anterior convexity angle difference, bone mineral density, and age were related to posterior migration of the cage. (3) The results of logistic regression analysis were that cage size, endplate injury condition, and depth of cage implantation were risk factors for cage retropulsion. (4) These findings suggest that cage retropulsion after lumbar interbody fusion is caused by multiple factors, including segmental anterior convexity angle difference, bone mineral density, cage size, endplate damage, time to wear a brace, and depth of cage implantation. 
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    Design of a new posterior atlas fracture reduction and internal fixation system
    Niu Hegang, Yang Kun, Zhang Jingjing, Yan Yizhu, Zhang Yinshun
    2024, 28 (9):  1399-1402.  doi: 10.12307/2023.925
    Abstract ( 198 )   PDF (2096KB) ( 18 )   Save
    BACKGROUND: At present, there is a lack of an internal fixation system with good reduction and simple operation for the treatment of atlas burst fracture by posterior single-segment fixation.
    OBJECTIVE: Based on the atlas CT measurement data, a new posterior atlas fracture reduction and internal fixation system was designed and optimized, which was in line with the characteristics of human local anatomical structure, easy to operate and with good reduction.
    METHODS: CT images of 347 adults were analyzed retrospectively. In the images, the length of pedicle screw track with a medial inclination of 0°, the angle of the maximum medial inclination angle and the length of pedicle screw track at this time, the height of vertebral artery groove, the distance between the entry points of bilateral pedicle screws and the midline, the radius of the posterior arch of atlas, the distance between the posterior tubercle of the atlas and the posterior edge of the foramen magnum, and the distance between the posterior tubercle of the atlas and the upper surface of the axial arch were measured. The imaging data were analyzed and a reduction and internal fixation system was designed and optimized for atlas fracture in line with human anatomical characteristics. 
    RESULTS AND CONCLUSION: (1) There was no statistically significant difference in the the length of pedicle screw track with a medial inclination of 0°, the maximum medial inclination angle and the length of pedicle screw track at this time, the height of vertebral artery groove, the distance between the entry points of bilateral pedicle screws and the midline, the radius of the posterior arch of atlas, the distance between the posterior tubercle of the atlas and the posterior edge of the foramen magnum, and the distance between the posterior tubercle of the atlas and the upper surface of the axial arch measured on the left and right sides of all subjects (P > 0.05). There were statistically significant differences in each index measured between the male and female groups (P < 0.05). (2) The new posterior atlas fracture reduction and internal fixation system has been successfully designed and obtained the national patent. The internal fixation system is suitable for the anatomical characteristics of the posterior arch of the atlas. It can not only effectively treat the atlas burst fracture, but also retain the movement function of the occipital atlantoaxial joint.  
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    Three kinds of 3D printed models assisted in treatment of Robinson type II B2 clavicle fracture
    Wang Menghan, Qi Han, Zhang Yuan, Chen Yanzhi
    2024, 28 (9):  1403-1408.  doi: 10.12307/2024.040
    Abstract ( 209 )   PDF (1848KB) ( 78 )   Save
    BACKGROUND: With the application and development of 3D printing technology in medicine, orthopedic internal fixation surgery has become precise and individualized. The equal-scale fracture model obtained by 3D printing technology was simulated and planned before surgery, realizing the leap from traditional 2D images to more vivid and detailed three-dimensional objects. It allows the surgeon to understand the fracture type in advance and rehearse the reduction sequence, so as to realize the individualized implementation of fracture surgery, optimize the surgical process, bring better postoperative recovery and less surgical complications.  
    OBJECTIVE: To compare clinical efficacy of three 3D printed models combined with computerized virtual repositioning technology to assist incision reduction bone plate internal fixation and traditional incision reduction bone plate internal fixation in the treatment of Robinson II B2 clavicle fracture. 
    METHODS: Eighty patients with Robinson II B2 clavicle fracture were randomly divided into trial group (n=40) and control group (n=40). In the trial group, three kinds of 3D printing models (affected clavicle fracture model, computer simulation clavicle fracture reduction model, clavicle mirror model of healthy side) combined with computer virtual reduction technology were used for preoperative in vitro surgery rehearsal. Finally, 3D printing was used for clavicle mirror model of healthy side to advance bending and select bone plates for internal fixation. In the control group, open reduction plate internal fixation was applied. The time from admission to surgery, intraoperative blood loss, operation time, frequency of fluoroscopy, number of bends of the bone plate, fracture healing time, complications, and visual analog scale score and Constant score before and after surgery were compared between the two groups. 
    RESULTS AND CONCLUSION: The time from admission to operation in the trial group was greater than that in the control group (P < 0.05). Operation time, intraoperative fluoroscopy frequency and bending times of the bone plate in the trial group were lower than those in the control group (P < 0.05). The trial group had faster fracture healing and fewer complications (P < 0.05). There was no significant difference in intraoperative blood loss between the two groups (P > 0.05). Constant score of the two groups had an increasing trend with time (F=613.50, P < 0.001), but the difference between the groups was not statistically significant (F=0.08, P=0.78), and there was no interaction between the measurement times and the group assignment (F=0.27, P=0.66). The visual analog scale score decreased with time (F=1 149.55, P < 0.001), but there was no significant difference between groups (F=0.02, P=0.88), and there was no interaction between the number of measurements and the group assignment (F=1.02, P=0.36). The results show that the use of 3D printed model combined with computer virtual reduction technology for preoperative rehearsal can shorten the operation time, reduce the number of intraoperative fluoroscopy frequency and the times of bone plate bending, and have the advantages of faster fracture healing, fewer complications, and similar functional recovery to the traditional incision reduction bone plate internal fixation.
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    Efficacy and safety of different applications of tranexamic acid in high tibial osteotomy
    Du Changling, Shi Hui, Zhang Shoutao, Meng Tao, Liu Dong, Li Jian, Cao Heng, Xu Chuang
    2024, 28 (9):  1409-1413.  doi: 10.12307/2023.914
    Abstract ( 199 )   PDF (2144KB) ( 24 )   Save
    BACKGROUND: High tibial osteotomy results in massive blood loss during the perioperative period. Tranexamic acid can effectively reduce perioperative blood loss. However, the method of tranexamic acid application has not been unified.  
    OBJECTIVE: To investigate the effect and safety of different methods of tranexamic acid on perioperative blood loss in the high tibial osteotomy.
    METHODS: A total of 160 patients who underwent primary unilateral high tibial osteotomy in the Binzhou Medical University Hospital from January 2019 to December 2021, including 69 males and 91 females, were randomly divided into four groups (n=40 per group). Among them, 40 patients were given an intravenous infusion of saline containing 2 g tranexamic acid 10 minutes before tourniquet release (venous group); 40 patients were given an intravenous infusion of 1 g tranexamic acid and 1 g tranexamic acid was injected through a drainage tube after the closure of the incision (combined group); 40 patients were given 2 g tranexamic acid infusion into drainage tube after the closure of the incision (perfusion group); an additional 40 patients were given an intravenous infusion of the same amount of normal saline (blank group). The general information was compared among the four groups of patients. The hemoglobin, hematocrit, intraoperative blood loss, drainage volume, blood transfusion rate, incision complication, and the incidence of deep vein thrombosis were recorded on days 1, 3 and 5 after operation in the four groups. The total blood loss and hidden blood loss were calculated.  
    RESULTS AND CONCLUSION: (1) There was no statistically significant difference in general information among the four groups. (2) No significant difference was found in intraoperative blood loss among the four groups. (3) The maximum decreased values of hemoglobin and hematocrit on days 1, 3 and 5 after operation, drainage volume, total blood loss and hidden blood loss were all ranked as the combined group < venous group < perfusion group < blank group. (4) The postoperative blood transfusion rate of the blank group was significantly higher than that of the other three groups, and there was no significant difference in the postoperative blood transfusion rate among the combined group, the venous group and the perfusion group. (5) There was no significant difference in the incidence of venous thrombosis and incision complications among the four groups. (6) It is indicated that the application of tranexamic acid in high tibial osteotomy can reduce perioperative bleeding and postoperative blood transfusion rate, and the effect of intravenous infusion combined with drainage tube perfusion is better, which does not increase the incidence of venous thrombosis and incision complications.
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    Relationship between degeneration of paraspinal muscle and refractures in postmenopausal women treated by percutaneous vertebroplasty
    Yang Cekai, Cai Zhuoyan, Chen Ming, Liu Hao, Weng Rui, Cui Jianchao, Zhang Shuncong, Yao Zhensong
    2024, 28 (9):  1414-1419.  doi: 10.12307/2023.923
    Abstract ( 192 )   PDF (3463KB) ( 51 )   Save
    BACKGROUND: There are few studies on the effect of degeneration of paraspinal muscle on osteoporotic vertebral compression refractures treated by percutaneous vertebroplasty in postmenopausal women. This paper intends to reveal the relationship between them.
    OBJECTIVE: To investigate the relationship between degeneration of paraspinal muscle and osteoporotic vertebral compression refractures in postmenopausal women treated by percutaneous vertebroplasty.  
    METHODS: The medical records of 81 postmenopausal female patients who were admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2018 to March 2021 for osteoporotic vertebral compression fracture and received percutaneous vertebroplasty were retrospectively analyzed. The patients were divided into an osteoporotic vertebral compression refracture group (n=39) and a control group (n=42) according to whether they had osteoporotic vertebral compression refracture after percutaneous vertebroplasty. General data, vertebral bone mineral density, paravertebral cross-sectional area and mean CT value (Hu) of the two groups were analyzed. 
    RESULTS AND CONCLUSION: (1) Univariate analysis showed that there was no significant difference in age and mean CT value of psoas major between the two groups (P > 0.05). The body mass index, vertebral bone mineral density, paravertebral cross-sectional area and the mean CT value of the posterior vertebral muscle group in the control group were significantly higher than those in the osteoporotic vertebral compression refracture group (P < 0.05). (2) Multivariate logistic regression analysis showed that low vertebral bone mineral density (OR=0.004, 95%CI: 0.000-0.555, P < 0.05) and low mean CT value of posterior vertebral muscle group (OR=0.940, 95%CI: 0.894-0.988, P < 0.05) were independent risk factors for postmenopausal osteoporotic vertebral compression refracture. (3) It is indicated that degeneration of paraspinal muscle will increase the risk of osteoporotic vertebral compression refractures in patients treated by percutaneous vertebroplasty, especially in postmenopausal women with a low mean CT value of low posterior vertebral muscle group.  
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    Interpretation of key points of International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy (OMT) Intervention: International IFOMPT Cervical Framework
    Feng Tianxiao, Bu Hanmei, Wang Xu, Zhu Liguo, Wei Xu
    2024, 28 (9):  1420-1425.  doi: 10.12307/2023.922
    Abstract ( 203 )   PDF (1636KB) ( 65 )   Save
    BACKGROUND: The evaluation and management of cervical vascular pathologies before orthopedic manual therapy have great significance for reducing risks, ensuring patients’ interests and promoting optimal clinical decision-making. However, the research and exploration of this field in China are still in its infancy. In 2020, the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) released the International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy (OMT) Intervention: International IFOMPT Cervical Framework (2020). This framework has important references and guiding values for the clinical practice of cervical manipulation in China.
    OBJECTIVE: To integrate and interpret the core content of the framework, to provide a reference for the clinical practice of cervical manual therapy in China.
    METHODS: On the basis of a full study of the framework, the authors interpret the core content of the framework from eight aspects including clinical reasoning, patient history, planning the physical examination, physical examination, risk and benefit. Meanwhile, seven databases including PubMed, EMbase, Cochrane Library, CNKI, WanFang, VIP and China Biomedical Literature Service System databases were searched by computer to screen clinical practice guidelines and expert consensus on neck pain. Through longitudinal comparison of multiple high-quality guidelines and consensus, the authors combine with the clinical practice in China to carry out discussion and analysis.
    RESULTS AND CONCLUSION: This framework expounds the management strategy and implementation path of cervical vascular disease evaluation before cervical manipulation from multiple dimensions, suggesting that we should improve clinicians’ attention to cervical vascular disease evaluation before manipulation, and construct evaluation criteria and implementation path with Chinese clinical characteristics. Meanwhile, we should further carry out basic scientific research with multidisciplinary techniques and promote shared decision-making and teaching model innovation to achieve the best clinical decision.
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    Advantages and application strategies of machine learning in diagnosis and treatment of lumbar disc herniation
    Yu Weijie, Liu Aifeng, Chen Jixin, Guo Tianci, Jia Yizhen, Feng Huichuan, Yang Jialin
    2024, 28 (9):  1426-1435.  doi: 10.12307/2023.904
    Abstract ( 278 )   PDF (1661KB) ( 87 )   Save
    BACKGROUND: Based on different algorithms of machine learning, how to carry out clinical research on lumbar disc herniation with the help of various algorithmic models has become a trend and hot spot in the development of intelligent medicine at present.  
    OBJECTIVE: To review the characteristics of different algorithmic models of machine learning in the diagnosis and treatment of lumbar disc herniation, and summarize the respective advantages and application strategies of algorithmic models for the same purpose.
    METHODS: The computer searched PubMed, Web of Science, EMBASE, CNKI, WanFang, VIP and China Biomedical (CBM) databases to extract the relevant articles on machine learning in the diagnosis and treatment of lumbar disc herniation. Finally, 96 articles were included for analysis.   
    RESULTS AND CONCLUSION:  (1) Different algorithm models of machine learning provide intelligent and accurate application strategies for clinical diagnosis and treatment of lumbar disc herniation. (2) Traditional statistical methods and decision trees in supervised learning are simple and efficient in exploring risk factors and establishing diagnostic and prognostic models. Support vector machine is suitable for small data sets with high-dimensional features. As a nonlinear classifier, it can be applied to the recognition, segmentation and classification of normal or degenerative intervertebral discs, and to establish diagnostic and prognostic models. Ensemble learning can make up for the shortcomings of a single model. It has the ability to deal with high-dimensional data and improve the precision and accuracy of clinical prediction models. Artificial neural network improves the learning ability of the model, and can be applied to intervertebral disc recognition, classification and making clinical prediction models. On the basis of the above uses, deep learning can also optimize images and assist surgical operations. It is the most widely used model with the best performance in the diagnosis and treatment of lumbar disc herniation. The clustering algorithm in unsupervised learning is mainly used for disc segmentation and classification of different herniated segments. However, the clinical application of semi-supervised learning is relatively less. (3) At present, machine learning has certain clinical advantages in the identification and segmentation of lumbar intervertebral discs, classification and grading of the degenerative intervertebral discs, automatic clinical diagnosis and classification, construction of the clinical predictive model and auxiliary operation. (4) In recent years, the research strategy of machine learning has changed to the neural network and deep learning, and the deep learning algorithm with stronger learning ability will be the key to realizing intelligent medical treatment in the future.
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    Abnormal types of intervertebral disc structure and related mechanical loading with biomechanical factors
    Weng Rui, Lin Dongxin, Guo Haiwei, Zhang Wensheng, Song Yuke, Lin Hongheng, Li Wenchao, Ye Linqiang
    2024, 28 (9):  1436-1442.  doi: 10.12307/2024.002
    Abstract ( 216 )   PDF (1661KB) ( 39 )   Save
    BACKGROUND: The problem of intervertebral disc injury and degeneration has been studied in many ways. Many studies have shown that intervertebral disc injury and degeneration is driven by mechanical loading factors. However, the potential relationship between common phenotypes of intervertebral disc injury and degeneration and mechanical loading factors has been rarely summarized.  
    OBJECTIVE: To summarize the types of common structural abnormalities exhibited by intervertebral disc injury and degeneration in the published literature, and sum up the potential links to the types of mechanical loading that lead to these structural abnormalities in in vitro and ex vivo experimental studies.
    METHODS: Using the terms “intervertebral disc failure, intervertebral disc injury, mechanical load, mechanical factor, load factor, biomechanics” as Chinese and English key words in PubMed, CNKI, and WanFang databases, articles related to intervertebral disc injury degeneration and mechanical load factors were retrieved. Literature screening was performed according to the inclusion and exclusion criteria, and 88 articles were finally included.  
    RESULTS AND CONCLUSION: (1) Common structural abnormalities of intervertebral discs include decreased intervertebral disc height, disc bulge, osteophyte formation, annulus fibrosus tear, intervertebral disc herniation or disc prolapse, endplate damage, Schmorl nodes and intervertebral disc calcification. Intervertebral discs are susceptible to mechanical load types such as compression, bending, axial rotation, and compound loads. (2) The compressive load mainly causes the decrease of the proteoglycan content and the water-binding ability of the intervertebral disc, leading to the decrease or swelling of the intervertebral disc and further damage and degeneration of the intervertebral disc. In addition, the excessive compressive load causes greater damage to the endplate. (3) Bending load and axial rotation load damage the annulus fibrosus more than the endplate, and prolonged or repeated bending loads can cause tearing of the fibrous annulus and herniation or prolapse of the intervertebral disc, while pure axial rotation loads can induce less damage to the intervertebral disc and only cause the tear of the annulus fibrosus. (4) However, when different load types act in combination, it is more likely to result in high stress on the disc and a greater risk of disc injury. (5) Injury and degeneration of the intervertebral disc present progressive structural damage, and early prevention and protection are particularly important in clinical practice. Future tissue engineering research can start with early repair of the intervertebral disc.
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    Application and prospects of erythropoietin in bone tissue engineering
    Yang Yufang, Yang Zhishan, Duan Mianmian, Liu Yiheng, Tang Zhenglong, Wang Yu
    2024, 28 (9):  1443-1449.  doi: 10.12307/2024.014
    Abstract ( 233 )   PDF (3123KB) ( 46 )   Save
    BACKGROUND: Bone defects are caused by many factors, such as inflammation, tumor, trauma or bone diseases. Erythropoietin can promote the differentiation of mesenchymal stem cells into osteoblasts and osteoclasts and act on vascular endothelial cells to induce angiogenesis and accelerate the repair of bone and cartilage defects. Erythropoietin is a growth factor with potential application in bone tissue engineering construction.
    OBJECTIVE: To expound the application and potential mechanism of erythropoietin in bone tissue engineering.
    METHODS: The first author searched the related articles published in CNKI, WanFang, VIP, and PubMed databases from 2004 to 2022 by computer. Search terms were “erythropoietin, bone defect, bone regeneration, angiogenesis, osteogenesis, osteoblast, osteoclast, bone tissue engineering” in Chinese and English. Finally, 64 articles were included for review. 
    RESULTS AND CONCLUSION: (1) Erythropoietin can directly act on osteoblasts and osteoclasts in the bone marrow microenvironment by promoting the differentiation of mesenchymal stem cells into osteoblasts, osteoclasts, adipocytes, nerve cells and stromal cells. The activation of Wnt/β-catenin, hypoxia-inducible factor 1α/vascular endothelial growth factor, p38 MAPK and EphrinB2/EphB4 signaling pathways mediates the osteogenic differentiation of mesenchymal stem cells. (2) Erythropoietin can not only regulate the production of erythrocytes to alter the oxygen-carrying capacity of blood but also stimulate vascular endothelial cells to promote angiogenesis. The new blood vessels can carry oxygen, nutrients, growth factors, and bone progenitor cells necessary for osteogenesis to the osteogenic site, thereby promoting bone formation and fracture healing. (3) Currently, erythropoietin is being used as a growth factor with osteogenic and angiogenic effects in various types of scaffold materials such as chitosan, polycaprolactone, bioceramics, and nanofibers through various drug delivery methods. Erythropoietin, along with other growth factors such as bone morphogenetic protein-2 and bone morphogenetic protein-9, has been applied to the surface of scaffold materials to participate in the repair of bone defects. Erythropoietin has demonstrated excellent practicality in the construction of new tissue-engineered bone and has potential clinical application value. 
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    Application and prospect of tissue engineering in treatment of osteonecrosis of the femoral head
    Chen Kaijia, Liu Jingyun, Cao Ning, Sun Jianbo, Zhou Yan, Mei Jianguo, Ren Qiang
    2024, 28 (9):  1450-1456.  doi: 10.12307/2024.041
    Abstract ( 170 )   PDF (1597KB) ( 53 )   Save
    BACKGROUND: Osteonecrosis of the femoral head is a common orthopedic disease, and hip preservation surgery with bone grafting is commonly used in the early stage, in which autologous bone and allograft bone are commonly used as bone grafting materials. However, autologous bone transplantation is highly traumatic and bone supply is limited, and allograft bone is rich in sources, but there are serious risks of immune rejection and absorption. In recent years, the tissue engineering technique based on mesenchymal stem cells is a new method for the treatment of femoral head necrosis, which is gradually widely used after basic experiments and clinical application.
    OBJECTIVE: To review the application and prospect of tissue engineering in the treatment of osteonecrosis of the femoral head to provide a new choice for the clinical treatment of osteonecrosis of the femoral head.
    METHODS: The PubMed database and CNKI database from 2013 to 2023 were searched by the first author with Chinese and English search terms “tissue engineering, mesenchymal stem cells, biological scaffolds, cytokines, osteonecrosis of the femoral head, bone graft, hip preservation”. The articles on the treatment of osteonecrosis of the femoral head with tissue engineering technology were selected, and 55 representative articles were included for review after the initial screening of all articles according to the inclusion and exclusion criteria.
    RESULTS AND CONCLUSION: (1) With the continuous development of biotechnology and materials science, great progress has been made in the treatment of osteonecrosis of the femoral head by bone tissue engineering, such as the application of gene-modified mesenchymal stem cells to repair osteonecrosis, the combination of gene recombination technology and surface modification technology with bone tissue engineering in the treatment of osteonecrosis of the femoral head. (2) When applied to the necrotic femoral head, tissue engineering technology can promote the regeneration of necrotic bone tissue and the repair of the vascular system, provide biomechanical stability for the necrotic area, and use bioactive factors to accelerate the repair of seed cells to complete the regeneration of new bone in necrotic area. (3) However, most of these studies are still in the animal experiment stage, and there are still many unsolved problems and challenges in bone tissue engineering research. With the rapid development of nanotechnology, tissue engineering and clinical medicine, biomimetic replacement bone grafting materials with perfect performance are expected to come into being. (4) In the future, bone tissue engineering for osteonecrosis of the femoral head is expected to be a satisfactory treatment for patients with hip preservation.
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    Strategies for repairing injured anterior cruciate ligament and promoting graft healing
    Bai Chen, Yang Wenqian, Meng Zhichao, Wang Yuze
    2024, 28 (9):  1457-1463.  doi: 10.12307/2024.013
    Abstract ( 280 )   PDF (1597KB) ( 131 )   Save
    BACKGROUND: In recent years, the treatment of anterior cruciate ligament injury has become more and more mature. However, there are still disputes about the timing of surgery, the choice of surgical methods, the choice of grafts, and the methods to promote graft healing after anterior cruciate ligament injury.
    OBJECTIVE: To summarize the latest research progress of surgical timing, surgical methods, graft selection and methods to promote graft healing after anterior cruciate ligament injury, and to find new treatment directions for anterior cruciate ligament injury. 
    METHODS: Relevant articles concerning anterior cruciate ligament injury were retrieved from PubMed, CNKI, WanFang Date, VIP, SinoMed, ScienceDirect, Springer and Cochrane Library. After the screening, 72 related articles were finally included.
    RESULTS AND CONCLUSION: (1) Surgical timing: Compared with delayed anterior cruciate ligament reconstruction, early reconstruction can reduce meniscus injury, elevate quality of life, and improve functional recovery. However, it is still uncertain whether the different operation timing will accelerate cartilage injury. (2) Surgical methods: Arthroscopic anterior cruciate ligament reconstruction is a common surgical method for anterior cruciate ligament injury. Dynamic internal stabilization repair of anterior cruciate ligament can bring similar results to traditional anterior cruciate ligament reconstruction in short-term and long-term effects. (3) Graft selection: Autogenous hamstring tendon is the first choice of anterior cruciate ligament graft, while bone-patellar tendon-bone grafts and allografts are the secondary choices. (4) Among the methods to promote graft healing, suture band strengthening can increase knee joint stability and ensure graft healing. Stem cells promote the tendon-bone healing of grafts through anti-inflammatory action, angiogenesis, inhibition of osteolysis and promotion of chondrocyte differentiation. Preserving the residual end of the anterior cruciate ligament can maintain the stability of the knee joint, promote the recovery of proprioception, and provide a prerequisite for the healing of the graft. The effectiveness of platelet-rich plasma in promoting graft healing remains to be discussed. However, biomaterials, gene therapy, stem cell application and other methods to promote tendon healing remain in the stage of molecular and animal researches. Clinical transformation is also needed in the future.
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    Signaling pathway of dexmedetomidine against ischemia-reperfusion injury
    Yang Yifeng, Ye Nan, Wang Lin, Guo Shuaicheng, Huang Jian
    2024, 28 (9):  1464-1469.  doi: 10.12307/2024.004
    Abstract ( 301 )   PDF (1542KB) ( 52 )   Save
    BACKGROUND: Dexmedetomidine has the effect of anti-ischemia-reperfusion injury, but the comprehensive and systematic review of its signaling pathway is less.  
    OBJECTIVE: To focus on the review of dexmedetomidine’s signaling pathway in the mechanisms of antioxidant stress, inhibition of inflammation, anti-apoptosis, autophagy, and so on.
    METHODS: The relevant articles on PubMed, CNKI, WanFang, and VIP databases were searched by computer with the key words “ischemia-reperfusion inquiry; dexmedetomidine; signal path; oxidative stress; inflammation; apoptosis” in Chinese and English. After excluding repetitive research and some basic articles with low correlation, 57 articles were finally included for review.  
    RESULTS AND CONCLUSION: (1) Dexmedetomidine plays an important role in organ protection through many mechanisms, such as anti-oxidative stress injury, anti-inflammation, anti-apoptosis and autophagy. This involves many pathways, including Nrf2 and its downstream protein antioxidant stress pathway, Toll-like receptor 4 family and nuclear factor-κB-related anti-inflammatory pathway, JAK2/STAT3-related anti-inflammatory pathway, and cholinergic anti-inflammatory pathway, and the cholinergic pathway is the upstream mechanism of many nuclear factor-κB signaling pathways. (2) PI3K/Akt pathway plays different roles according to its activated downstream signals, inhibiting the activation of NLRP3 inflammatory body, activating signal molecules endothelial nitric oxide synthase, mammalian target of rapamycin, and hypoxia-inducible factor 1α to play an anti-inflammatory role, and activate Bad or Bax residues to play an anti-apoptotic role, and PI3K/Akt activates glycogen synthetase kinase-3β. It can also play an anti-inflammatory and anti-apoptotic role. (3) Dexmedetomidine activates SIRT3 to mediate anti-apoptosis and inhibit endoplasmic reticulum stress to produce anti-apoptosis. (4) The detailed review of the anti-ischemia-reperfusion injury signaling pathway of dexmedetomidine can provide a basis for future mechanism research and diagnosis and treatment decisions.
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    Network meta-analysis of different anatomical repair strategies to improve chronic lateral ankle instability
    Zhong Jun, Wang Wen
    2024, 28 (9):  1470-1476.  doi: 10.12307/2023.910
    Abstract ( 216 )   PDF (7356KB) ( 19 )   Save
    OBJECTIVE: At present, there are various surgical repair strategies for the lateral stability of chronic ankle instability after the injury of the lateral collateral ligament of the ankle, but the specific repair strategy to maximize the recovery of lateral stability of the ankle still lacks of evidence-based medical evidence. Based on this, for the first time, this paper systematically evaluated the effects of four popular repair strategies to restore the lateral stability of chronic ankle instability using the network meta-analysis method.
    METHODS: Computer retrieval was conducted on CNKI, WanFang, VIP, PubMed, Embase, Web of Science and Cochrane Library. The retrieval time was from the establishment of each database to December 2022. The randomized controlled trials or clinical controlled trials on different repair strategies to recover chronic ankle instability after injury of the lateral ligament of the ankle were included. The literature was screened and extracted. The literature quality was evaluated and data were analyzed using RevMan 5.4, R4.2 and Stata 14.2 software.
    RESULTS: Twelve studies (including 10 randomized controlled trials and 2 cohort studies) were included. A total of 673 patients with chronic ankle instability were involved in 4 repair strategies. The observation indicators were: anterior talar translation distance and talar tilt angle of ankle joint stress X-ray film (hereinafter referred to as anterior talar translation distance and talar tilt angle). The results of network meta-analysis showed that: (1) In terms of anterior talar translation distance, the sequence of reticular meta-analysis results from inferior to superior was anatomical repair > anatomical repair + enhancement of inferior extensor retinaculum > internal brake anatomical reconstruction > autologous/allogeneic tendon anatomical reconstruction. (2) In terms of talar tilt angle, the sorting results of reticular meta-analysis from inferior to superior were as follows: anatomical repair > anatomical repair + inferior extensor retinaculum enhancement > internal brace anatomical reconstruction > autologous/allogeneic tendon anatomical reconstruction. 
    CONCLUSION: Anatomical reconstruction strategy of autologous/allogeneic tendon is the first in improving anterior talar translation distance and talar tilt angle, suggesting that this strategy may have the best effect in restoring the stability of chronic joint instability after injury of the lateral ligament of ankle, but more large sample, multicenter, double-blind randomized controlled trials are still needed in the future to further confirm.
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