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28 April 2024, Volume 28 Issue 12 Previous Issue    Next Issue

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Biomechanics of reconstruction of total calcaneus defect using fibular flap based on finite element method Chen Modi, Sun Qibo, Xu Tianyu, Tai Guoliang, Zhao Yuxiang, Pan Zhaohui 2024, 28 (12):  1805-1809.  doi: 10.12307/2024.019 Abstract ( 282 )   PDF (2028KB) ( 17 )   Save BACKGROUND: Calcaneal defects are common in clinical practice. It is difficult for surgeons to evaluate the effect of calcaneal reconstruction due to the complex anatomical structure and motor function of the heel. Finite element analysis has become an effective method for biomechanical behavior simulation and numerical analysis.   OBJECTIVE: To compare the clinical effect and biomechanical characteristics of total calcaneal reconstruction with the II-shaped and V-shaped fibular flap. METHODS: CT images of one left foot of a healthy 50-year-old male were acquired. Mimics software was used to obtain the preliminary three-dimensional model. Geomagic software was used to trim and curve the model. The model was imported into Solidworks software to simulate calcaneal reconstruction and complete the pre-processing of finite element calculation. Finally, Ansys software was used to solve the problem. The simulation results were compared with previous literature results to verify the effectiveness of the model. The surgical effect and biomechanical characteristics of the foot in different gait phases based on the simulated stress results were analyzed.   RESULTS AND CONCLUSION: (1) Both II-shaped and V-shaped fibular flaps could be used to reconstruct completely missing calcaneus, which could restore the length, width and height of normal calcaneus, and fill up the missing calcaneus bone. (2) Compared with the normal calcaneus, both configurations of fibular flaps showed a tendency for over-concentration of stress after loading. The normal calcaneus stress was mostly concentrated around the calcaneus nodule, the subtalar process and the calcaneus groove, while the stress of the two fibular flaps was mostly concentrated at the junction between the bone flap with the talus and cuboid bones. (3) The maximum stress of calcaneus was different between the two models and normal calcaneus under different simulation conditions, with statistically significant differences (P < 0.05). Compared with the V-shaped fibular flaps, II-shaped fibular flaps had less force change in different gaits and were closer to the normal calcaneus. The V-shaped fibular flap bore excessive stress during the period of push-off, and the grafted bone material may yield under this condition and have the risk of fractures. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of optimal fixation method for femoral neck fracture with different reduction conditions Han Biao, Li Ji, Li Bin, Sun Bo, Zong Shuangle, Wang Hongrun, Li Dongmei, Li Ligeng, Wang Bin 2024, 28 (12):  1810-1814.  doi: 10.12307/2024.045 Abstract ( 287 )   PDF (1356KB) ( 13 )   Save BACKGROUND: The traditional fixation method for femoral neck fractures is three hollow screws inverted triangle fixation, and the optimal fixation method for femoral neck fractures that have not achieved anatomical reduction is inconclusive. OBJECTIVE: To compare the biomechanical properties of cannulated screws internal fixation for sub-capitated femoral neck fracture with different reduction qualities based on finite element analysis.  METHODS: The three-dimensional digital model was reconstructed using CT data of the proximal femur from a healthy male volunteer. The femur was modeled to sub-capitated femoral neck fractures. Fracture models were divided into anatomical reduction group, coxa vara group, and coxa valgus group. All fracture model groups were transferred using the standard group, screw depression group, and screw elevation group. A vertical downward stress of 1 400 N was applied to the femoral head at the top of the acetabulum. The displacement and stress distribution of the femur and internal fixator under different fixation methods were observed, and the maximum stress and displacement of the femur and fixator were compared.  RESULTS AND CONCLUSION: (1) For anatomical reduction femoral neck fracture, the peak stress of fixation in the standard group, screw depression group and screw elevation group was 41.35, 31.27 and 43.32 MPa, respectively. The maximum peak stress of the femur was found on the screw elevation group (28.58 MPa), and the standard group had the maximum peak displacement. (2) During hip varus, the stresses in the three subgroups were relatively dispersed and even. The peak stress of the femur in the standard group was the smallest, but the peak displacement was the largest. The stability of fixation might be poor. The peak displacement of the femur in the screw depression group was the smallest. (3) In the hip valgus, obvious screw stress concentration appeared in the screw depression group, and the peak displacement was the largest among the three subgroups, and an in-out-in phenomenon appeared. The peak stress of the screws in the screw elevation group was the largest among the three subgroups, but the peak displacement was the smallest. (4) It is concluded that for sub-capitated femoral neck fractures that are completely anatomically reduced, it is recommended to use standard inverted triangular nails for fixation. When the hip varus and hip valgus occur within the allowable range of the reduction standard, it is recommended to use the inverted triangle screw to fix it by rotating the corresponding angle in the same direction as the hip varus or valgus. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of lumbar vertebra biomechanics after transforaminal lumbar interbody fusion combined with bilateral transpedicular transdiscal lumbar screw fixation Chen Liuxu, Yang Han, Yang Jian, Yang Linyu, Kang Jianping 2024, 28 (12):  1815-1822.  doi: 10.12307/2024.030 Abstract ( 191 )   PDF (2887KB) ( 19 )   Save BACKGROUND: Transpedicular transdiscal lumbar screw is a new type of spinal minimally invasive internal fixation technology. Compared with traditional bilateral pedicle screws, only one screw is needed to fix one segment on one side. It has the characteristics of being more economical, less trauma and easy to operate. However, studies on the application of transpedicular transdiscal lumbar screws combined with transforaminal lumbar interbody fusion (TLIF) and fixation are still rare. OBJECTIVE: To evaluate the effect of TLIF combined with various surgery methods on stress distribution of cage, fixation, disc lower and endplate and range of motion of lumbar vertebrae by constructing three kinds of finite element models including modified TLIF (cage alone) model, modified TLIF combined with bilateral pedicle screw (cage+BPS) model and modified TLIF combined with bilateral transpedicular transdiscal lumbar screw (cage+BTPTDS) model. METHODS: The CT images of the adult lumbar spine were used to establish the three kinds of TLIF finite element models: cage alone, cage+BPS and cage+BTPTDS using software Mimics, Geomagic and SolidWorks. ANSYS Workbench was used to simulate the application of six different motion loads of human body flexion and extension, left and right bending, and left and right rotation to calculate stress distribution and the changes in the range of motion of the lumbar spine of the cage, fixation, endplate and disc of the three lumbar spine surgery models and to compare the effects of three surgical options on the biomechanical effects of the lumbar spine. RESULTS AND CONCLUSION: (1) The cage alone model, cage+BPS model and cage+BTPTDS model were constructed successfully. (2) In flexion and lateral bending conditions, the maximum stress of the cage of cage+BTPTDS model was smaller than that of the cage alone model and a little greater than that of the cage+BPS model. In the extension condition, the maximum stress of the cage of the cage+BPS model was obviously smaller than that of the other two models. When it came to rotating condition, the maximum stress of the cage in the cage+BPS model and the cage+BTPTDS model presented no obvious difference, which was both smaller than the cage alone model. (3) The maximum stress of fixation of the cage+BTPTDS model was obviously bigger than the cage+BPS model in flexion and extension conditions, close to the cage+BPS model in lateral bending conditions, and smaller than the cage+BPS model in rotation conditions. (4) The maximum stress of the lower endplate of the fusion segment of the cage+BPS model was between the two other models. (5) In terms of the range of motion, the cage+BTPTDS model presented no obvious difference with that of the cage+BPS model at flexion and extension, left and right bending, and left and right rotation. (6) It is concluded that modified TLIF combined with transpedicular transdiscal lumbar screw provides stable support for the vertebral body of the fusion segment, ensures the motion range of the lumbar spine and has a good biomechanical effect.  Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of thumb thrust in lumbar fixed-point rotation manipulation Su Shaoting, Zhou Honghai, Hou Zhaomeng, Lu Yan, Wang Wei, Chen Yixin, Chen Longhao, Tian Cong 2024, 28 (12):  1823-1828.  doi: 10.12307/2024.022 Abstract ( 181 )   PDF (1271KB) ( 19 )   Save BACKGROUND: Lumbar fixed-point rotation operation needs collaborative operation of the doctor’s hands, and outputs rotation and thumb thrust. Lumbar disc herniation can be treated through disc displacement and adjusting stress distribution. However, the mechanical effects of thumb thrust and the biomechanical effects of loading direction on manipulative effects remain unclear.   OBJECTIVE: To compare the biomechanical difference of lumbar fixed-point rotation manipulation for treating lumbar disc herniation under different thrust directions. METHODS: The L3-5 normal three-dimensional finite element model was constructed and validity was verified. According to the intervertebral disc degeneration Pfirrmann grade, intervertebral disc degeneration was simulated by modifying the L4/5 intervertebral space height, the volume of the nucleus pulposus, as well as the material parameters of the annulus fibrosus, nucleus pulposus, and ligament. Finally, the pathological model of L4/5 moderate disc degeneration with left para-central herniation was constructed, and then the pathological models were used as research objects. Simulation technique: spinning to the right; taking the condition on changing the direction of the thumb thrust to establish three modes of operation (M1: thumb push to the left; M2: thumb push to the right; M3: no thrust push). The protrusion displacement and the disc stress, and the stress and strain of the facet joint cartilage were compared in the three operating modes. RESULTS AND CONCLUSION: (1) Maximum displacement value of L4/5 disc herniation: displacement was 2.672 3 mm for M1, 1.156 1 mm for M2, 1.826 4 mm for M3, M1 > M3 > M2. (2) The maximum Von Mises stress of L4/5 discs was 1.846 7 MPa for M1, 0.419 0 MPa for M2, and 1.257 9 MPa for M3, M1 > M3 > M2. (3) L4/5 bilateral small cartilage produced different degrees of contact stress changes: It was 0.485 5 MPa for M1, 0.026 7 MPa for M2, and 0.441 4 MPa for M3, M1 > M3 > M2. Right cartilage contact force was 0.000 5 MPa for M1, 0.025 9 MPa for M2, and 0.001 3 MPa for M3, M2 > M3 > M1; the left greater than the right, M1 had the highest value; cartilage strain was consistent with contact stress changes. (4) Different operation modes will have some biomechanical influences on the diseased intervertebral disc and accessory structure. The M1 operation mode can maximize the displacement of protrusion, disc stress and left joint cartilage contact, which can better promote disc displacement, balance stress distribution and reduce facet joint disorder, so the operation is better. Figures and Tables | References | Related Articles | Metrics

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Mechanical analysis and finite element modeling of rabbit patellar tendon and tendon insertion under different mechanical conditions Wang Li, Wang Bo 2024, 28 (12):  1829-1836.  doi: 10.12307/2024.017 Abstract ( 191 )   PDF (2825KB) ( 26 )   Save BACKGROUND: The patella-patellar tendon junction is a high-incidence area of injury in patellar tendinopathy. The rabbit patella-patellar tendon injury model is a commonly used animal experimental research object. At present, the stress analysis of the injury mechanism and modeling method is not comprehensive.  OBJECTIVE: Based on the previous histological and mechanical measurements, this study used micro CT to scan and model the whole patella, the patella-patellar tendon junction and the tendon quadriceps junction, to analyze the characteristics of changes in stress, and explore the potential impact of different forms of exercise on patellar tendon degeneration so as to provide a theoretical basis for injury prevention and animal model establishment. METHODS: Female healthy adult New Zealand rabbits were selected to study the patella and tendons at both ends of the left knee joint. After the material was taken, the samples were scanned and saved with micro CT. Mimics, Geomagic Studio and SolidWorks were used to establish a three-dimensional model. Finite element analysis was carried out with Ansys Workbench. The equivalent displacement, stress and strain of the target region were analyzed under different loading conditions (load size and direction changes, different action modes).  RESULTS AND CONCLUSION: (1) Load direction change affected trend and value change; load size change affected value change. (2)  Compared with other areas, the stress concentration was more obvious at the insertion point of the patellar tendon, and the strain value was the lowest. (3)  At the insertion point of the patellar tendon, the stress concentration was greater in valgus than in varus and pronation than in extorsion. (4) The stress concentration effect and stress shielding during knee flexion and extension are the main causes of patellar tendon insertion injury. The stress in pronation and valgus states is also a potential factor leading to damage, which needs further study. The animal model established by jumping and running is more in line with the characteristics of sports injury. Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis of new horizontal screw-screw crosslink in C1-C2 pedicle screw-rod fixation Ouyang Beiping, Ma Xiangyang, Luo Chunshan, Zou Xiaobao, Lu Tingsheng, Chen Qiling 2024, 28 (12):  1837-1841.  doi: 10.12307/2024.021 Abstract ( 158 )   PDF (1514KB) ( 27 )   Save BACKGROUND: Posterior atlantoaxial pedicle screw rod internal fixation is the main method for treating atlantoaxial dislocation, and the horizontal crosslink plays an important role in the antirotation ability of the internal fixation system. The new horizontal screw-screw crosslink can effectively overcome the disadvantages of traditional horizontal crosslink, such as inconvenient installation, impact on bone grafting bed, and potential spinal cord injury. However, the biomechanical properties of the new horizontal screw-screw crosslink with different installation modes are still unclear.  OBJECTIVE: To investigate the biomechanical characteristics of new different installation modes of horizontal screw-screw crosslink in the C1-C2 pedicle screw-rod fixation and to provide a theoretical basis for optimal installation mode. METHODS: Six fresh human occipitocervical specimens were divided into the intact state group (group A), and the atlantoaxial instability model of type II odontoid fracture was established based on the intact state group as the instability group (group B). The C1-C2 pedicle screw-rod fixation was performed on each specimen based on the instability group (group C). In group C, different installation modes of horizontal screw-screw crosslink were successively installed in each specimen, including upper transverse connection (two atlas screw tails) as group D, lower transverse connection (two axis screw tails) as group E, diagonal transverse connection (upper left and lower right for group F, lower left and upper right for group G), and cross transverse connection as group H. The specimen models were tested in order of flexion, extension, lateral flexion and lateral rotation on a three-dimensional motion machine, and the atlantoaxial range of motion of each group of specimens was obtained. Repeated measure analysis of variance was used to evaluate the biomechanical properties of each group.  RESULTS AND CONCLUSION: (1) Under six states, the range of motion of groups A, C, D, E, F, G and H was smaller than that of group B, and there were statistically significant differences (P < 0.05). (2) In the flexion and extension states, there was no significant difference among the five types of horizontal screw-screw crosslink groups (P > 0.05). (3) In the left and right rotation directions, there were significant differences in D and E groups compared with F, G and H groups (P < 0.05); there were no significant differences between D and E groups, and F and G groups (P > 0.05), and there were no significant differences in F and G groups compared with H group (P > 0.05). (4) In conclusion, under flexion-extension states, the biomechanical stability of five types of horizontal screw-screw crosslink groups was similar, but under the rotation state, the stability of diagonal horizontal screw-screw crosslink group and cross horizontal screw-screw crosslink group was obviously better than that of transverse horizontal screw-screw crosslink group; however, the stability of diagonal horizontal screw-screw crosslink group is similar to the cross horizontal screw-screw crosslink group, so the former is more worthy of clinical recommendation. Figures and Tables | References | Related Articles | Metrics

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Biomechanical features of posterior “Y” osteotomy and fixation in treatment of ankylosing spondylitis based on finite element simulation analysis Zhang Le, Cao Zhenhua, Zhang Yunfeng, Xu Yangyang, Jin Feng, Su Baoke, Wang Lidong, Wang Xing, Tong Ling, Liu Qinghua, Fang Yuan, Sha Lirong, Wang Haiyan, Li Xiaohe, Li Zhijun 2024, 28 (12):  1842-1848.  doi: 10.12307/2024.012 Abstract ( 183 )   PDF (2399KB) ( 67 )   Save BACKGROUND: Ankylosing spondylitis is a progressive inflammation of spinal stiffness deformity caused by tissue ossification and fibrosis. The posture of ankylosing spondylitis patients is abnormal and their activities are limited that minor injuries can lead to thoracolumbar fractures. Traditional medical image observation limits doctors’ preoperative decision planning and postoperative disease prevention for ankylosing spondylitis treatment. OBJECTIVE: Based on the spinal model of ankylosing spondylitis patients before and after posterior spinal cancellous ossification osteotomy (“Y” osteotomy for short), to explore the biomechanical changes of “Y” osteotomy and fixation in the treatment of ankylosing spondylitis. METHODS: Based on the preoperative and postoperative CT images of an ankylosing spondylitis patient who went to the Second Affiliated Hospital of Inner Mongolia Medical University, a three-dimensional spine model (T11-S1) before and after “Y” osteotomy (L3 osteotomy) was reconstructed in Mimics 19.0 software. A 7.5 Nm torque was applied to the top of T11 vertebral body to simulate the movement of the spine under six conditions: flexion, extension, left bending, right bending, left rotation and right rotation. Finally, the range of motion of each vertebral body, the stress of each intervertebral disc, and the stress of the screw rod system were simulated.  RESULTS AND CONCLUSION: (1) After “Y” type osteotomy and posterior fixation, the range of motion of all vertebrae in the spine decreased, and the loss rate of upper vertebrae was large (L1: 77.95%). (2) The maximum stress of the spinal intervertebral disc before operation occurred at the L1-L2 segment (0.55 MPa), and the maximum stress of the spinal intervertebral disc after operation occurred at the T11-T12 segment (0.50 MPa), and the stress of intervertebral disc below T12 was far less than that before operation. (3) The maximum stress of the screw rod system (166.67 MPa) occurred in the upper and middle segments of the rod body and the root of the pedicle screw. (4) In conclusion, the “Y” type posterior fixation operation enhances the stability of the spine and reduces the range of motion of the spine. The vertebral body decompression of the fixed segment is great and the stress-shielding phenomenon of the lower vertebral body is significant. The stiffness of the rod body and the stress concentration area of the pedicle screw should be strengthened to avoid the fracture of the rod caused by stress fatigue.  Figures and Tables | References | Related Articles | Metrics

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Effect of finite element simulation of bilateral lumbar spinal canal decompression under single-channel splintered endoscope on lumbar biomechanics Zhang Jinghe, Dou Yongfeng, Xu Shidong, Xing Jianqiang, Liu Dong, Tian Lin, Dai Guohua 2024, 28 (12):  1849-1854.  doi: 10.12307/2024.071 Abstract ( 182 )   PDF (1410KB) ( 23 )   Save BACKGROUND: As a leading technique in the treatment of primary stenosis by posterior spinal endoscopy through unilateral approach and bilateral decompression using single channel endoscopy, the long-term efficacy needs to be further observed. There are few reports on the scope of intraoperative resection and few relevant studies on biomechanics and finite element analysis. OBJECTIVE: A three-dimensional finite element model was established to evaluate the effects of bilateral lumbar canal decompression under a one-hole split endoscope on lumbar range of motion and intradiscal pressure, to provide suggestions for clinical operation and theoretical basis for further clinical research. METHODS: A complete L3-L5 vertebral body model was reconstructed by CT images of nine healthy volunteers, which was used as the preoperative model M1. The simulated surgical resection range of L4-L5 was performed, and 1/4, 1/3 and 1/2 of bilateral facet joints were removed respectively to obtain models M2, M3 and M4. The range of motion and the maximum Von Mises stress of the four models were compared in the six directions of forward bending, backward extension, left and right bending, and left and right rotation. RESULTS AND CONCLUSION: (1) The L3-L5 finite element model established in this study was effective, and the range of motion was within the range of previous solid studies under six motion states. (2) Compared with the M1 model, the L4-L5 lumbar spine range of motion increased with the increase of resection range in M2 with M3 and M4 models under forward bending, left and right bending and left and right rotation loading, and the difference was significant (P < 0.05). Under posterior extension loading, there was no significant difference in lumbar range of motion between M1 and M2 (P > 0.05), but there was a significant difference of M1, M3 and M4 (P < 0.05). (3) The range of motion of the L3-L4 lumbar spine had no significant change with the increase of bilateral facet arthrotomy (P > 0.05). (4) There was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M2 (P < 0.05), and there was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M3, M4 (P < 0.01), and the maximum value of L4-L5 lumbar von Mises increased with the increasing range of bilateral facet joint resection. Resection of more than 1/3 was particularly obvious. (5) The maximum value of Von Mises in the L3-L4 lumbar spine was increased with the increase of the resection range under forward bending, left and right bending and left and right rotation loading and the difference was significant (P < 0.05). (6) The results exhibited that the L4-L5 lumbar motion and intervertebral disc pressure increased with the increase of the excision range. Intervertebral disc pressure at L3-L4 increased with the increased extent of excision, but the lumbar range of motion was not significantly affected. In conclusion, the stability of the operative segment may be affected by the increase in the scope of facet joint resection. Although the immediate stability of adjacent segments is not affected, it may accelerate disc degeneration. Figures and Tables | References | Related Articles | Metrics

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Robot-assisted minimally invasive transforaminal lumbar interbody fusion in treatment of lumbar degenerative diseases Li Ting, Liao Wenao, Zhong Wenjie, Liu Xilin, Wang Fei, Hu Jiang 2024, 28 (12):  1855-1862.  doi: 10.12307/2024.025 Abstract ( 216 )   PDF (1789KB) ( 24 )   Save BACKGROUND: Minimally invasive surgery is developing rapidly. Robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are important posterior minimally invasive surgical approaches to treat lumbar degenerative diseases. However, it is worth discussing which operation method is more advantageous.  OBJECTIVE: To compare the clinical efficacy and imaging examination between different operation groups, and discuss the clinical application value of robot-assisted minimally invasive lumbar posterior fusion technology to treat lumbar degenerative diseases.  METHODS: Clinical data of 83 patients with lumbar degenerative diseases from January 2018 to June 2022 at the Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital were retrospectively analyzed. Of them, 27 patients received robot-assisted minimally invasive transforaminal lumbar interbody fusion treatment (group A); 30 patients received robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion treatment (group B), and 26 traditional minimally invasive transforaminal lumbar interbody fusion patients were selected as the control group (group C). There were no significant differences in gender, age, body mass index, surgical segment, preoperative visual analog scale score and Oswestry Disability Index among the three groups (P > 0.05). The operation time, intraoperative blood loss, complications, fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency were compared among the three groups. Gertzbein-Robbins’ classification was used to evaluate the accuracy of percutaneous pedicle screw. Visual analog scale and Oswestry Disability Index scores were evaluated after surgery. The excellent and good rate of the three surgical options was evaluated using Macnab’s criteria.  RESULTS AND CONCLUSION: (1) The operation time of group A was significantly shorter than that of groups B and C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). The intraoperative blood loss in group B was significantly less than that in group A, and that in group A was significantly less than that in group C (P < 0.05). (2) The fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency of group C were significantly higher than those of groups A and B (P < 0.05). (3) Visual analog scale score and Oswestry Disability Index in the three groups significantly improved after operation when compared with that before operation (P < 0.05), but there was no significant difference among the three groups 1 day and 6 months after surgery (P > 0.05). (4) Postoperative imaging showed that the accuracy of percutaneous pedicle screw placement in groups A and B was better than that in group C (P < 0.05). (5) There was no significant difference in the excellent and good rate of MacNab criteria among the three groups (P > 0.05). (6) There was no significant difference in complications among the three groups (P > 0.05). (7) The results indicated that robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are effective surgery methods for lumbar degenerative diseases. Compared with traditional minimally invasive transforaminal lumbar interbody fusion, robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery has higher efficiency, less intraoperative radiation and higher internal fixation accuracy, which has a good clinical application value. Figures and Tables | References | Related Articles | Metrics

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Accuracy and influencing factor of artificial intelligence planning system in patients undergoing total hip arthroplasty Zhang Kai, Guo Zhuotao, Ma Qiaoqiao, Zha Guochun, Guo Kaijin 2024, 28 (12):  1863-1868.  doi: 10.12307/2024.026 Abstract ( 212 )   PDF (848KB) ( 29 )   Save BACKGROUND: Artificial intelligence planning system can automatically establish a three-dimensional model and generate planning schemes, but its accuracy in predicting the prosthesis size has not been fully verified.  OBJECTIVE: To investigate the accuracy of artificial intelligence planning system in predicting prosthesis size before total hip arthroplasty and its influence on clinical prognosis, and further analyze the risk factors affecting the accuracy of planning.  METHODS: Clinical data of patients with unilateral initial total hip arthroplasty who were admitted to the Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University from January 2021 to June 2022 were prospectively collected. The patients were randomly divided into the artificial intelligence planning system group (n=80) and the conventional template group (n=79). Intraoperative use of prostheses and preoperative planning of prosthesis matching were compared between the two groups. Postoperative follow-up Harris scores and the occurrence of complications such as leg length discrepancy, dislocation and prosthesis loosening were recorded in both groups. The effects of demographic indicators, preoperative diagnosis, and Dorr typing on the accuracy of femoral stem planning were explored using univariate and multivariate Logistic regression analyses. RESULTS AND CONCLUSION: (1) The prediction of the prosthesis size on the acetabular side and femoral side was 50%(40/80) and 55%(44/80) in the artificial intelligence planning system group, compared to 34%(27/79) and 37%(29/79) in the conventional template group, with statistically significant differences (P < 0.05). (2) The artificial intelligence planning system group had an accuracy rate within one size difference for the acetabular and femoral side prostheses of 91%(73/80) and 86%(69/80), compared to 82%(65/79) and 72%(58/79) in the conventional template group, with differences statistically different only on the femoral side (P < 0.05). (3) No dislocation or prosthesis loosening occurred in the two groups during postoperative follow-up. The difference in lower limb length between the artificial intelligence planning system and conventional template groups was (3.56±2.32) mm and (3.52±2.41) mm. At the last follow-up, the Harris scores of the artificial intelligence planning system and conventional template groups were (92.74±3.08) and (91.81±3.52), respectively; there was no significant difference in the above differences (P > 0.05). (4) Univariate analysis results showed that preoperative diagnosis as developmental dysplasia of the hip and osteonecrosis of the femoral head, and Dorr type B and C femurs had a significant effect on the accuracy of predicted prosthesis size using an artificial intelligence planning system (P < 0.05). (5) Multivariate logistic regression analysis showed that preoperative diagnosis of developmental dysplasia of the hip (OR=18.233, 95%CI: 2.662-124.888) was an independent risk factor for the prediction of femoral stem size by artificial intelligence planning system. (6) The artificial intelligence planning system has a higher accuracy in predicting prosthetic size than traditional two-dimensional templates, and there is not a significant difference in the risk of postoperative complications or joint function. The accuracy of the artificial intelligence planning system in patients with developmental dysplasia of the hip was low due to anatomical deformities and acetabular anatomical position reconstruction. Figures and Tables | References | Related Articles | Metrics

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Efficacy of joint replacement versus closed reduction and internal fixation in treatment of unstable intertrochanteric fractures combined with osteoporosis Zhu Ruizhi, Qu Qiang, Cui Pengfei, Liu Dong, Zhang Yongtao, Wang Changyao 2024, 28 (12):  1869-1874.  doi: 10.12307/2024.023 Abstract ( 172 )   PDF (908KB) ( 31 )   Save BACKGROUND: Stable intertrochanteric fractures can be treated by closed reduction and internal fixation, but there is no absolute advantage for unstable intertrochanteric fractures with osteoporosis.  OBJECTIVE: To investigate the efficacy of arthroplasty in the treatment of unstable intertrochanteric fractures in the elderly with osteoporosis by comparing the indexes related to closed reduction internal fixation and arthroplasty. METHODS: Clinical data of 102 elderly patients with unstable intertrochanteric fractures of the femur treated in Affiliated Hospital of Qingdao University from January 2017 to January 2020 were retrospectively analyzed. Patients were divided into two groups according to the surgical method. In the Gamma3 group, 62 cases received Gamma3 internal fixation system. In the joint replacement group, 40 cases received an artificial femoral head replacement or total hip replacement. Surgical information, hospitalization, hip function, and postoperative complications were compared between the two groups. RESULTS AND CONCLUSION: (1) There were statistical differences between the Gamma3 group and the joint replacement group in weight-bearing time (P < 0.001), hospital stay (P < 0.05), intraoperative bleeding (P < 0.001), and length of surgery (P < 0.001). The mean weight-bearing time and hospital stay were shorter in the joint replacement group than in the Gamma3 group. Intraoperative bleeding and duration of surgery were better in the Gamma3 group than in the joint replacement group. (2) There was no significant difference in Harris hip score, subitem centesimal hip score, and postoperative complications 12 months after surgery in both groups (P=0.526, 0.788, 0.228). (3) It is indicated that arthroplasty has achieved better outcomes in the treatment of elderly unstable intertrochanteric fractures combined with osteoporosis, enabling early weight bearing and functional exercise. Careful selection of the appropriate patient and prosthesis type for arthroplasty will result in greater patient benefit. Figures and Tables | References | Related Articles | Metrics

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Stability of early gait after unicompartmental knee arthroplasty Gu Xu, Zheng Xin, Shi Sifeng, Lu Renxiang, Cao Jie, Li Hongwei 2024, 28 (12):  1875-1879.  doi: 10.12307/2024.024 Abstract ( 207 )   PDF (876KB) ( 15 )   Save BACKGROUND: For the patients who have undergone unicompartmental knee arthroplasty, although the surgical effect is clear, there is still a lack of effective quantitative evaluation tools, and it is necessary to further explore the early postoperative gait and stability changes.  OBJECTIVE: To investigate the changes in gait and stability before and after unicompartmental knee arthroplasty.  METHODS: From May 2021 to May 2022, 30 patients aged (63.80±9.31) years who planned to perform unilateral unicompartmental knee arthroplasty in the Department of Joint Surgery, Affiliated Hospital of Xuzhou Medical University were selected as the unicompartmental knee arthroplasty group. 15 healthy elderly patients aged (61.28±8.60) years without a history of hip and knee pain and hip and knee joint dysfunction were recruited as the control group. Hospital for special surgery scores, stability parameters (center of pressure path length, 95% confidence ellipse area) and gait parameters (pace, stride length, stride frequency, gait cycle, and the proportion of single support period) were recorded and compared in the control group and unicompartmental knee arthroplasty group before operation, 1 and 3 months after operation.  RESULTS AND CONCLUSION: (1) There was no significant difference in the step frequency between the patients 1 month after operation and those before operation in the unicompartmental knee arthroplasty group (P > 0.05). The stability of 1 month after operation was worse than that before operation, and other parameters of 1 month after operation were better than those before operation, and the difference was statistically significant (P < 0.05). (2) Hospital for special surgery score, gait and stability parameters at 3 months after operation were better than those before operation (P < 0.05). (3) Compared with the control group, the pace, stride length, stride frequency, and the proportion of single support period of the unicompartmental knee arthroplasty group were significantly lower before and 3 months after operation. Center of pressure path length, 95% confidence ellipse area and gait cycle were greater in the unicompartmental knee arthroplasty group than those in the control group, with statistically significant differences (P < 0.05). (4) It is indicated that gait analysis is an effective means to quantitatively evaluate the rehabilitation status after unicompartmental knee arthroplasty. The early gait recovery after unicompartmental knee arthroplasty is good, but the gait frequency improvement is not obvious and the stability is poor 1 month after the operation.   Figures and Tables | References | Related Articles | Metrics

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Lesser trochanter reconstruction in artificial femoral head replacement for elderly patients with Evans-III femoral intertrochanteric fracture Ma Rui, Ge Ying, Wang Kunzheng, Yang Pei 2024, 28 (12):  1880-1884.  doi: 10.12307/2024.039 Abstract ( 187 )   PDF (1010KB) ( 14 )   Save BACKGROUND: Artificial femoral head replacement is an effective method for the treatment of elderly unstable intertrochanteric fractures. However, the effect of lesser trochanter reconstruction in femoral head replacement for Evans-III femoral intertrochanteric fractures has not been reported. OBJECTIVE: To analyze the effect of lesser trochanter reconstruction on the outcome of artificial femoral head replacement with long stem in elderly patients with Evans-III femoral intertrochanteric fracture.   METHODS: A retrospective analysis was performed on medical records of 45 elderly patients who underwent bipolar long-stem artificial femoral head replacement due to Evans-III femoral intertrochanteric fractures in the Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi’an Jiaotong University from June 2017 to May 2021. According to whether the small trochanter was reconstructed during surgery (reduction and fixation), they were divided into the reconstruction group (n=25) and the non-reconstruction group (n=20). The operation time, bleeding volume, time of getting out of bed, hospital stay time, Harris scores at 3 and 6 months postoperatively, and the incidence of complications during follow-up were compared between the two groups.  RESULTS AND CONCLUSION: (1) The operation time of the reconstruction group was longer (99.72±13.41 minutes) than that of the non-reconstruction group (88.90±16.53 minutes) (t=2.369, P=0.023), and there were no significant differences in bleeding volume, time of getting out of bed or hospital stay time between the two groups (P > 0.05). (2) The Harris score of the reconstruction group (69.06±5.64 points) was higher than that of the non-reconstruction group (63.35±5.93 points) at 3 months postoperatively (t=2.982, P=0.005). At 6 months postoperatively, the Harris score of the reconstruction group (86.67±4.49 points) was higher than that of the non-reconstruction group (82.34±5.68 points) (t=2.782, P=0.009). (3) In addition, no significant difference existed in the incidence of complications between the reconstruction and non-reconstruction groups (χ2=0.008, P=0.927). (4) It is concluded that in elderly patients with Evans-III femoral intertrochanteric fractures, lesser trochanter reconstruction in the artificial femoral head replacement significantly improved postoperative hip function despite increased operative time, demonstrating the importance of the lesser trochanter reconstruction in the artificial femoral head replacement for Evans-III intertrochanteric fractures in the elderly people. Figures and Tables | References | Related Articles | Metrics

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Percutaneous screw fixation with a novel guide for the treatment of scaphoid fractures Bai Jiangbo, Gao Ruijiao, Zhang Aru, Yu Kunlun, Zhang Chunhuan, Tian Dehu 2024, 28 (12):  1885-1889.  doi: 10.12307/2024.007 Abstract ( 211 )   PDF (1135KB) ( 45 )   Save BACKGROUND: Scaphoid fractures are common wrist fractures. The percutaneous screw is used to treat scaphoid fractures. The closed reduction of the fracture site, the precise placement of the hollow compression screw in the scaphoid axis and the compression fixation of the fracture site can promote fracture healing and achieve the better function of the wrist.   OBJECTIVE: To evaluate the efficacy of percutaneous hollow compression screw fixation of scaphoid fractures using a novel Kirschner wire guide. METHODS: Between January 2015 and December 2020, clinical data from 15 patients with scaphoid fractures selected at the Department of Hand Surgery, Third Hospital of Hebei Medical University were retrospectively analyzed. All patients underwent percutaneous hollow compression screw fixation by a novel Kirschner wire guide. Fracture healing time, operation time, number of intraoperative fluoroscopies, time to return to work and complications were collected. According to the modified Mayo wrist scoring system, the functional outcomes of wrists were assessed 12 months after surgery. Wrist flexion, extension, ulnar deviation, radial deviation and grip strength were measured. RESULTS AND CONCLUSION: All patients were followed up for 12 months. The compression screw was located in the axial position of the scaphoid by routine immediate postoperative radiographs. All scaphoid fractures united at an average of 10.0 weeks. The average operation time was 55.7 minutes. The number of intraoperative fluoroscopies was 10.9. The average time to return to work was 10.3 weeks. The results of wrist joint function were excellent in 9 cases, good in 5 cases, and average in 1 case, with an excellent and good rate of 93.3%. No significant differences in wrist flexion, extension, ulnar deviation, radial deviation and grip strength were found between the affected and healthy sides (P > 0.05). None of the patients had wound infection, malunion, screw displacement, or screw breakage. These findings indicate that the application of a novel guide can shorten the operation time, reduce the number of intraoperative fluoroscopies, improve the accuracy of screw insertion, and shorten the time to return to work. The function of the wrist was satisfactory after the operation. The novel Kirschner wire guide made percutaneous hollow compression screw fixation easier for scaphoid fractures. Figures and Tables | References | Related Articles | Metrics

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Micromorphological characteristics of the pedicle of the lower cervical vertebra Li Kun, Zhang Shaojie, Shi Jun , Wang Jian , Liu Yanan , Duo Lan , Yang Yang , Hao Yunteng , Li Zhijun, Wang Xing 2024, 28 (12):  1890-1894.  doi: 10.12307/2024.032 Abstract ( 174 )   PDF (1109KB) ( 21 )   Save BACKGROUND: The lower cervical vertebral pedicle is the main stress site of the posterior column of the spine, which is of great significance for the maintenance of the stability of the human center of gravity and the reduction of shock. At present, there are few reports on the characteristics of the internal bone trabeculae, and the characteristics of the joint site of the vertebral pedicle with the articular process and the vertebral body. It is urgent to understand the fine anatomical structure of the vertebral pedicle and the relationship and function of each part. OBJECTIVE: To observe the microanatomical morphology of the vertebral pedicle by Micro-CT scanning of cervical vertebra specimens, and to measure and analyze the microstructure and morphometric parameters of the bone trabecula in the cervical pedicle under normal conditions to evaluate the safety performance of the cervical spine. METHODS: Micro-CT scanning was performed on 31 sets of cervical vertebrae C3-C7. By checking and reconstructing the areas of interest in the bone trabecular within the vertebral pedicle, the morphological characteristics and distribution direction of the bone trabecular within the cervical pedicle were observed, and the bone microstructure parameters were detected, and the differences in the bone microstructure of the C3-C7 vertebral pedicle were analyzed and compared. RESULTS AND CONCLUSION: (1) The Micro-CT images showed that the honeycomb bone trabeculae of the pedicle of the lower cervical spine presented a complex network of microstructures. The trabeculae near the cortical bone were lamellar and relatively compact, extending forward toward the vertebral body and backward toward the articular process lamina. Abatoid bone trabeculae extended into the medullary cavity and transformed into a network structure, and then into rod-shaped bone trabeculae. The rod-shaped bone trabeculae were sparsely distributed in the medullary cavity. (2) Statistical results of morphological parameters of bone trabeculae showed that bone volume fraction values in C4 and C5 were higher than that in C7 (P < 0.05). The bone surface/bone volume value in C7 was higher than that in C3, C4 and C6 (P < 0.05). The bone surface density of bone trabeculae in C7 was higher than that in C3, C4, C5 and C6 (P < 0.05). Trabecular thickness in C7 was higher than that in C3, C4 and C5 (P < 0.05). Bone surface/bone volume and bone surface density of the left pedicle bone trabecular were greater than those on the right side (P < 0.05). (3) The microstructural changes of C3-C7 were summarized, in which the load capacity and stress of the C7 pedicle were poor, and the risk of injury was high in this area. Figures and Tables | References | Related Articles | Metrics

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Fracture accuracy on cortical bone structure under bending load using different numerical methods Fan Ruoxun, Liu Jie, Jia Zhengbin 2024, 28 (12):  1895-1900.  doi: 10.12307/2024.035 Abstract ( 181 )   PDF (1741KB) ( 19 )   Save BACKGROUND: Current fracture simulation for cortical bone structure is mainly based on three numerical methods: the element instantaneous failure, continuum damage mechanics, and extended finite element methods. Although many studies focus on cortical bone fracture simulation, few have compared the differences in prediction accuracy using the three numerical methods. OBJECTIVE: To probe the accuracy and applicability of the three numerical methods in simulating cortical bone fracture under bending load. METHODS: The rat femur samples were primarily used to perform the three-point bending experiment. The rat femoral finite element models were established based on the micro-CT images of the femur samples and the three numerical methods were used to conduct the fracture simulations under three-point bending loads. The predicted fracture loads and fracture patterns were compared with the experimental data to determine the accuracy of various numerical methods in simulating cortical bone fracture. RESULTS AND CONCLUSION: (1) The discernible differences in the failure processes could be observed in the same finite element model under the three numerical simulations due to different element failure strategies. (2) The simulation results showed that the fracture simulation using the continuum damage mechanics method was in better agreement with the experimental results. (3) The numerical method that was suitable for simulating cortical bone fracture under bending load could be determined by comparing it with experimental results. The variations in the fracture parameters were observed, and the reason for the differences in the predicted results using different numerical methods was also discussed, which aided in determining the range of applicability of structural fracture simulation for each numerical method and then improving the simulation accuracy. Figures and Tables | References | Related Articles | Metrics

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Proximal femoral nail antirotation Asian version for treating femoral intertrochanteric fractures: comparison of the protruding degree of intramedullary nails in Asian population Wang Anquan, Chen Hao, Hua Xingyi, Lu Xiaolin, Zhou Jian, Cui Yiliang, Li Guangyu, Yin Zongsheng 2024, 28 (12):  1901-1906.  doi: 10.12307/2024.016 Abstract ( 205 )   PDF (863KB) ( 126 )   Save BACKGROUND: Due to the mismatch between the design of the proximal femoral nail antirotation Asian version (PFNA-II) and Asian population, extrusion of the proximal femoral intertrochanteric nail may occur in the treatment of femoral intertrochanteric fractures. The influence of the protruding length on the curative effect of the operation needs to be further discussed.  OBJECTIVE: To quantitatively measure the protruding length of the proximal trochanter of the femur with intramedullary nail after PFNA-II, and to analyze the effect of protruding length on the efficacy of PFNA-II in the treatment of femoral intertrochanteric fractures.   METHODS: Totally 68 patients with femoral intertrochanteric fractures treated with PFNA-II internal fixation in the First Affiliated Hospital of Anhui Medical University were selected. The extramedullary process of the proximal trochanter of the femur was quantitatively measured on the anterior and posterior X-ray films of the hip joint within 6 months after operation. According to the existence of extrusion of the proximal trochanter intramedullary nail, the patients were divided into protruding group and non-protruding group. The data of sex, height, fracture type, length and diameter of the intramedullary nail, the position of screw blade in the femoral neck and protruding length of proximal greater trochanter were collected. The postoperative curative effect was judged by visual analog scale pain score and hip joint Harris score at 6 months after operation. The influence of protruding proximal trochanter of the PFNA-II intramedullary nail on the operative effect was observed.  RESULTS AND CONCLUSION: (1) There were significant differences in sexual characteristics between the protruding group and the non-protruding group (P=0.001). (2) According to AO/OTA classification, there were no significant differences in fracture type between the protruding group and the non-protruding group (P=0.289). (3) There was no significant difference in the length and diameter of the intramedullary nail between the two groups (P=0.067, P=1.000). (4) There was no significant correlation between the height of all patients and the length of the intramedullary nail (P=0.510), but there was a significant correlation between height and protruding length (P=0.034). There was no significant correlation between screw blade position and protruding length (P=0.968). (5) Six months after operation, there was no significant difference in the hip Harris score (P=0.373), but the visual analog scale pain score was significantly higher in the protruding group than that in the non-protruding group (P=0.000). (6) The results suggest that nail extrusion often occurs in the proximal greater trochanter when PFNA-II is used in the treatment of intertrochanteric fractures in Asians. When the nail extended into the proximal soft tissue of the greater trochanter, patients complained of proximal greater trochanteric pain and the visual analog scale score of proximal greater trochanter pain in the patient was significantly higher than that in the non-protruding group. To be more suitable for the Asian population, we suggest that the PFNA-II should be improved to further shorten the proximal nail end to obtain better clinical results of femoral intertrochanteric fracture fixation. Figures and Tables | References | Related Articles | Metrics

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Stepwise treatment strategy for spontaneous osteonecrosis of the medial femoral condyle of the knee joint Pan Jianke, Yang Meiping, Han Yanhong, Zhao Di, Huang Hetao, Cao Houran, Liu Jun, Luo Minghui, Li Xiang, Chen Hongyun, Yang Weiyi 2024, 28 (12):  1907-1913.  doi: 10.12307/2024.029 Abstract ( 204 )   PDF (2122KB) ( 12 )   Save BACKGROUND: Currently, there have been a variety of conservative and surgical treatment plans for spontaneous osteonecrosis of the knee, achieving excellent results. However, a broad consensus on indication and guide of surgical treatment has not been announced. In clinical practice, there is still a misunderstanding that unicondylar replacement or total knee arthroplasty should be performed upon the discovery of spontaneous osteonecrosis of the knee, while an urgent need for universal access to the concept of stepwise therapy.  OBJECTIVE: To summarize and find the factors leading to the poor effect of conservative treatment in spontaneous osteonecrosis of the knee, which occurred on the medial femoral condyle, from the literature and clinical cases, at the same time, combined with the Koshino stage, to propose the strategy of stepwise spontaneous osteonecrosis of the knee treatment on the medial femoral condyle.  METHODS: A systematic search of the literature database was conducted to summarize the factors leading to poor outcomes of conservative treatment in spontaneous osteonecrosis of the medial femoral condyle. Meanwhile, according to the Clinical & Health Records for analytics & Sharing system, the cases receiving conservative and surgical treatment in spontaneous osteonecrosis of the medial femoral condyle in the Department of Orthopedics of Guangdong Provincial Hospital of Chinese Medicine from January 2017 to January 2023 were analyzed retrospectively, then the causes of success and failure in typical cases were summarized and analyzed. RESULTS AND CONCLUSION: (1) Early diagnosis and treatment of spontaneous osteonecrosis of the knee were very important for prognosis. For sudden knee pain in some patients, if no obvious abnormality was found in the X-ray examination, and the symptoms persisted and could not be relieved for more than 1 week, an MRI examination was recommended to detect early spontaneous osteonecrosis of the knee. (2) The X-ray images of Koshino stage 1 and stage 2 of spontaneous osteonecrosis of the medial femoral condyle were difficult to be distinguished, which needed to be probed by MRI. MRI images of Koshino stage 1 were mainly characterized by bone marrow edema, and an osteonecrosis area with a clear boundary was not formed, while MR images of Koshino stage 2 showed a necrotic area with a clear boundary. (3) Five factors leading to the poor effect of conservative treatment on spontaneous osteonecrosis of the medial femoral condyle were summarized: a. The necrotic area was > 5 cm2; b. The necrotic area accounted for more than 40% of the condyle; c. relative compression percentage of medial meniscus ≥33% (with or without medial meniscus injury and subchondral bone marrow edema); d. MRI depth of necrotic area (anterior-posterior diameter of sagittal necrotic area) > 20 mm; e. varus deformity of lower limb >6°. (4) Conservative treatment of spontaneous osteonecrosis of the knee in Koshino stage 1 was good. For spontaneous osteonecrosis of the knee in Koshino stage 2, conservative treatment was preferred or combined with drilling decompression. If there was no relief or improvement of symptoms or in MRI after 3 months, while the patient had any of the previous five factors, then knee preservation surgery should be considered. For spontaneous osteonecrosis of the knee in Koshino stage 3 and stage 4, knee preservation surgery should be selected based on the previous five factors, including age, gender and activity level of the patient. Total knee arthroplasty was used for spontaneous osteonecrosis in Koshino stage 4, which was associated with symptomatic patellofemoral arthritis, valgus alignment, or necrotic area, which greatly affected the stability of unicondyle prosthesis. Figures and Tables | References | Related Articles | Metrics

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Two lumbar fusion regimens in treatment of single-level lumbar degenerative diseases based on propensity score matching Wan Jian, Wang Ning, Bei Chaoyong, Chen Yuanming, Wang Honggang 2024, 28 (12):  1914-1919.  doi: 10.12307/2024.061 Abstract ( 221 )   PDF (948KB) ( 18 )   Save BACKGROUND: Unilateral biportal endoscopic technique has been widely used in lumbar interbody fusion in recent years, but there is little comparison between its clinical efficacy and that of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative disease, whether the unilateral biportal endoscopic technique is a safe and effective lumbar fusion remains to be further demonstrated. OBJECTIVE: To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) and MIS-TLIF in the treatment of lumbar degenerative diseases and explore a more efficient lumbar fusion procedure. METHODS: Patients with single-level lumbar degenerative disease were enrolled in Affiliated Hospital of Guilin Medical College from October 2020 to February 2022, including 35 patients who underwent UBE-LIF and 286 patients who underwent MIS-TLIF. Propensity score matching was used to eliminate confounders. Four covariates including sex, age, disease type and surgical segment were matched 1:1 (caliper value 0.01). After matching, 29 patients from each group were included in the study. The perioperative operative time, hemoglobin loss and hospital stay were compared between the two groups. Visual analog scale score and Oswestry disability index were used to evaluate the functional recovery of the two groups before, 1, 6 months and 1 year after operation. The excellent and good rate of the two groups was evaluated by the modified MacNab standard at the last follow-up. The fusion of the two groups was evaluated by Lenke Dynamic X-ray film. RESULTS AND CONCLUSION: (1) The operative time in the MIS-TLIF group was shorter than that in the UBE-LIF group (P < 0.05). The amount of intraoperative hemoglobin loss in the MIS-TLIF group was higher than that in the UBE-LIF group. The hospital stay in the MIS-TLIF group was longer than that in the UBE-LIF group, and the differences were statistically significant (P < 0.05). (2) The visual analog scale scores for lumbago and leg pain, and Oswestry disability index were significantly reduced in both groups 1, 6 months, and 1 year after surgery compared to before surgery (P < 0.05). Except for the visual analog scale score for lumbago at 1 month after surgery, there was no significant difference in the visual analog scale score for lumbago and leg pain, and Oswestry disability index between the two groups at the above time points (P > 0.05). (3) At the last follow-up, the modified MacNab standard efficacy evaluation showed that the excellent and good rates were 93% (27/29) in the UBE-LIF group and 90% (26/29) in the MIS-TLIF group; there was no significant difference between the two groups (P > 0.05). (4) Lenke dynamic radiographic evaluation system evaluation for lumbar fusion exhibited that the fusion rate was 90% (grade A, 21 cases; grade B, 5 cases; grade C, 3 cases) in the UBE-LIF group; the fusion rate was 86% (grade A, 20 cases; grade B, 5 cases; grade C, 4 cases) in the MIS-TLIF group; there was no significant difference between the two groups (P > 0.05). (5) It is indicated that UBE-LIF and MIS-TLIF have similar clinical effects in the treatment of single-level lumbar degenerative disease with the advantages of less trauma, less bleeding and shorter hospital stay. In addition, the early postoperative lumbago was relatively mild and the learning curve was relatively smooth. Although the operative time in the UBE-LIF group was longer than that in the MIS-TLIF group, it was still a safe and effective operation. Figures and Tables | References | Related Articles | Metrics

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Quantitative CT measurement of bone mass density in different regions of the distal clavicle in reconstruction of acromioclavicular joint dislocation Xu Jian, Bi Wenzhi, Ji Yuncong, Kang Yunkang, Ma Peiqi, Wang Jialiang, Zhang Zongxi, Gan Fusheng, Yu Haiyang, Guo Biao 2024, 28 (12):  1920-1924.  doi: 10.12307/2024.009 Abstract ( 173 )   PDF (910KB) ( 48 )   Save BACKGROUND: There is no consensus on the optimal bone tunnel position in the lateral clavicle, which guides coracoclavicular ligament reconstruction. Postoperative complications such as enlargement of the lateral clavicle bone tunnel, bone osteolysis, clavicle fracture, and failure of internal fixation are likely to occur. Bone mass density plays an important role in the strength and stability of endophytic fixation. Regional differences in the bone mass density of the distal clavicle should not be overlooked in the repair and reconstruction of acromioclavicular dislocation. Currently, there are no quantitative clinical studies in humans regarding the bone mass density of the distal clavicle. OBJECTIVE: To measure the magnitude of bone mass density in different regions of the distal clavicle by quantitative CT to provide a reference for surgeons to repair and reconstruct the coracoclavicular ligament. METHODS: 101 patients undergoing quantitative CT checking in Fuyang People’s Hospital Affiliated to Anhui Medical University from October to December 2022 were enrolled, from which 1 616 samples of subdivisional bone mass density of the distal clavicle were measured. For each of the quantitative CT samples, firstly, the distal clavicle was divided medially to laterally into the following four regions: conical nodal region (region A), inter-nodal region (region B), oblique crest region (region C) and distal clavicular region (region D). Secondly, each region was divided into the first half and the second half to determine eight subdivisions, then setting semiautomatic region of interest (ROI) in each subdivision: (ROI A1, A2, B1, B2, C1, C2, D1, and D2). Thirdly, each quantitative CT scan was transferred to the quantitative CT pro analysis workstation, and cancellous bone mass density was measured in the distal clavicle ROI. Finally, the clavicular cortex was avoided when measuring.  RESULTS AND CONCLUSION: (1) There was no statistically significant difference in bone mineral density on the different sides of the shoulder (P > 0.05). (2) The analysis of bone mineral density in eight sub-areas of the distal clavicle A1, A2, B1, B2, C1, C2, D1, and D2 showed statistically significant differences (P < 0.05). It could be considered that there were differences in bone mineral density in different areas of the distal clavicle. After pairwise comparison, there was no statistically significant difference in bone mineral density between A1 and A2, D1 and D2, A2 and B1 (P > 0.05), and there was a statistically significant difference in bone mineral density between the other sub-areas (P < 0.05). (3) The bone mineral density in the region A2 of the anatomical insertion of the conical ligament was significantly higher than that in the inter-nodular area (region B) (P < 0.05). The bone mineral density in the region A1 was higher than that in the region A2, but the difference was not statistically significant (P > 0.05). The bone mineral density in the region C1 of the anatomical insertion of the trapezium ligament was higher than that in regions C2, D1 and D2, and the bone mineral density in the inter-nodular area (region B) was significantly higher than that in regions C and D (P < 0.05). (4) These results have suggested that there are differences in bone mass density in different regions of the distal clavicle; regional differences in bone mass density in the distal clavicle during repair and reconstruction of acromioclavicular dislocation cannot be ignored. Consideration should be given not only to biomechanical factors but also to the placement of implants or bone tunnels in regions of higher bone mass density, which could improve the strength and stability of implant fixation and reduce the risk of complications such as bone tunnel enlargement, osteolysis, fracture and implant failure. Figures and Tables | References | Related Articles | Metrics

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Effect of tibial nerve injury on treatment of tibial single-plane osteotomy and bone transport Xu Ao, Wang Bin, Fang Jun, Bai Cuiwei, Lyu Zichen, Cheng Kang, Zheng Yongxin, Wang Hongtao 2024, 28 (12):  1925-1930.  doi: 10.12307/2024.031 Abstract ( 178 )   PDF (1089KB) ( 29 )   Save BACKGROUND: Peripheral nerves play an important role in bone metabolism. In clinical practice, the specific impact of nerve injury on bone transport technology needs further study. OBJECTIVE: To investigate the effect of tibial nerve injury on the treatment of tibial slip by single-plane osteotomy. METHODS: Thirty-two patients with tibial bone defects admitted to Tangshan Second Hospital from May 2011 to June 2022 were selected. According to the presence or absence of tibial nerve injury, patients were divided into the tibial nerve injury group (n=16) and the non-tibial nerve injury group (n=16). Both groups were treated with single-plane osteotomy and bone slip. After treatment, the patients were followed up to collect the mineralization zone healing index, external fixation index, docking point healing and needle infection. After the removal of external fixation, the bone healing and functional evaluation were evaluated by a classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI). RESULTS AND CONCLUSION: (1) All 32 patients were followed up for (25.28±4.79) months. There were no significant differences in bone healing time, external fixation time, healing index and external fixation index between the two groups (P > 0.05). Needle infection occurred in two cases of the tibial nerve injury group and one case of the non-tibial nerve injury group, all of which were PALEY I, and there was no significant difference between the two groups (P > 0.05). The non-union rate of the occlusal end of the tibial nerve injury group was 31%, and that of the non-tibial nerve injury group was 13%; there was no statistical difference between the two groups (P > 0.05). The excellent and good rate of ASAMI bone healing score in the two groups was 100%; the excellent and good rate of limb score was 81% in the tibial nerve injury group and 94% in the non-tibial nerve injury group; there was no statistical difference between the two groups (P > 0.05). (2) Our research shows that tibial nerve injury has no significant effect on the mineralization speed, external fixation time, union of the occlusal end, infection of the needle tract, and the quality of bone formation in the mineralized area of the single-plane osteotomy. Figures and Tables | References | Related Articles | Metrics

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Regulation of Toll-like receptors on function of osteoblasts and osteoclasts Wang Xin, Huang Jinyong, Wubulikasimu · Mijiti, Xie Zengru 2024, 28 (12):  1931-1936.  doi: 10.12307/2024.052 Abstract ( 226 )   PDF (893KB) ( 22 )   Save BACKGROUND: Toll-like receptors are an important class of pattern recognition receptors that have important functions in pathogen immunity and cytokine synthesis by recognizing specific molecular patterns. Previous studies have found that different types of bone tissue cells also express Toll-like receptors. Activation or inhibition of Toll-like receptors can have significant effects on osteoblast and osteoclast function through multiple pathways.   OBJECTIVE: To summarize the expression and action pathways of Toll-like receptors in osteoblasts and osteoclasts, in order to further elucidate the biological mechanisms involved in the regulation of Toll-like receptors under physiological and pathological conditions. METHODS: Relevant literature was retrieved from databases such as PubMed and CNKI as of December 2022. The Chinese and English search terms included “Toll-like receptor, osteoblast, osteoclast, mesenchymal stem cells, macrophage, cytokine, signaling pathway”. According to the research needs, the corresponding criteria were established to screen the final literature. RESULTS AND CONCLUSION: (1) Toll-like receptors could directly regulate osteoblast and osteoclast differentiation through the activation of related signaling pathways. (2) Toll-like receptor activation induces cytokine production and exerts regulatory effects. (3) Toll-like receptor activation can affect the survival and migration ability of osteoblasts and osteoclasts. (4) Toll-like receptors in osteoblasts and osteoclasts are activated in certain diseases and pathological settings and are involved in intercellular interactions. Figures and Tables | References | Related Articles | Metrics

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Treatment of periprosthetic joint infection after hip and knee arthroplasty Zeng Zijun, He Wei, Wei Qiushi, He Mincong 2024, 28 (12):  1937-1943.  doi: 10.12307/2024.018 Abstract ( 252 )   PDF (973KB) ( 61 )   Save BACKGROUND: Periprosthetic joint infection is one of the most unwanted complications for surgeons and patients after arthroplasty, and its recalcitrance and intractability have always been a headache for arthroplasty surgeons. OBJECTIVE: To review the latest domestic and international clinical treatments used in the treatment of periprosthetic joint infection after hip and knee arthroplasty in recent years, including antibiotic treatment, surgical treatment, biological treatment and Chinese medicine treatment, to promote the research progress in the treatment of periprosthetic joint infection in China.   METHODS: The literature from January 2000 to October 2022 on CNKI, WanFang, VIP, and PubMed was retrieved by the first author. 762 articles were obtained by reading the titles for initial screening, then 194 articles were obtained by reading the abstracts and excluding studies with duplicate contents, low data reliability, and outdated views. Finally, 88 articles were included through intensive reading of the original text. RESULTS AND CONCLUSION: (1) Combined antibiotic regimens may help eradicate the infection in the treatment of periprosthetic infections. (2) Two-stage revision remained the golden indicator for the treatment of periprosthetic infection. (3) One-stage revision lacked large-sample clinical studies and required more clinical observation. (4) Phage therapy and newer drug delivery systems in biological therapy had been applied in small amounts in the clinic, showing their advantages in the prevention and eradication of periprosthetic infections. (5) Chinese medicine with antibiotics and surgical treatment methods can improve the prevention and treatment of periprosthetic joint infection, but high-level evidence-based medical evidence was lacking. Figures and Tables | References | Related Articles | Metrics

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Application of pulsed electromagnetic fields in the treatment of orthopedic diseases Liang Hairui, Cai Zhencun, Zhang He, Duan Siyu, Chen Beibei 2024, 28 (12):  1944-1949.  doi: 10.12307/2023.927 Abstract ( 218 )   PDF (871KB) ( 22 )   Save BACKGROUND: Pulsed electromagnetic field is a non-invasive and non-radiative treatment method. Clinical use of pulsed electromagnetic fields in the treatment of orthopedic diseases has achieved certain results.  OBJECTIVE: To review the current clinical application of the pulsed electromagnetic field in the treatment of orthopedic diseases, providing a scientific theoretical basis for the clinical treatment of orthopedic diseases. METHODS: The first author used a computer to search PubMed, CBM, Cochrane Library, CNKI, and WanFang Data for related studies on the pulsed electromagnetic field in the treatment of orthopedic diseases, using the keywords of “pulsed electromagnetic field, orthopedics, osteoarthritis, osteoporosis, bone healing, electromagnetic navigation” in English and Chinese. For the literature related to the same content, recent publications were selected. A total of 69 articles were selected from the search results for review. RESULTS AND CONCLUSION: Pulsed electromagnetic field has a definite curative effect on fracture healing. It can be used in the treatment of osteomyelitis by antibacterial, bactericidal, anti-inflammatory and promoting bone healing, and can inhibit osteoporosis and its progress. In addition, the treatment of early osteoarthritis, femoral head necrosis and postoperative rehabilitation of late joint replacement through various ways can become a treatment for orthopedic diseases. However, the therapeutic mechanism of the pulsed electromagnetic field for a variety of orthopedic diseases is still unclear, and most of the research is still in the primary stage. In the future, it is still necessary to obtain more reliable evidence from high-quality research and clinical trials to provide a more perfect basis for the clinical treatment of orthopedic diseases. Figures and Tables | References | Related Articles | Metrics

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Wnt signaling pathway in intervertebral disc degeneration Fan Zhihong, Zhang Xian, Li Chao 2024, 28 (12):  1950-1955.  doi: 10.12307/2024.005 Abstract ( 196 )   PDF (884KB) ( 90 )   Save BACKGROUND: Wnt signaling pathway is overexpressed in degenerative intervertebral discs, and inhibition of its expression can delay the process of intervertebral disc degeneration. Therefore, Wnt signaling pathway is closely related to intervertebral disc degeneration.   OBJECTIVE: To summarize the relationship between Wnt signaling pathway and intervertebral disc, especially the specific role and influence of Wnt signaling pathway in intervertebral disc degeneration. METHODS: The first author took “intervertebral disc, Wnt, cell proliferation, cell senescence, cell apoptosis, extracellular matrix” as the English search terms. PubMed, Web of science and OVID LWWSpringerlink were searched for articles published from 2000 to January 2023, and articles related to Wnt signaling pathway and disc degeneration were consulted. Totally 54 articles were reviewed by reading, collating and preserving.   RESULTS AND CONCLUSION: (1) During intervertebral disc formation in embryos, Wnt signaling pathway is overexpressed, which is involved in intervertebral disc formation and promotes posterior extension of notochord. (2) During intervertebral disc degeneration, Wnt signaling pathway can inhibit cell proliferation by stagnating cell cycle, increase the expression of age-related proteins and promote cell aging by participating in oxidative stress, and participate in cell apoptosis by regulation of long non-coding RNA. (3) Wnt signaling pathway can also decrease extracellular matrix related protein synthesis, promote extracellular matrix degradation and accelerate intervertebral disc degeneration. (4) Wnt signaling pathway can promote cell regeneration by activating as early intervertebral disc formation signal and participate in inducing stem cells to differentiate into intervertebral disc cells to repair damaged intervertebral disc. For example, Wnt signaling pathway can induce stem cells from cartilage endplate cells to migrate and transform to intervertebral disc. Figures and Tables | References | Related Articles | Metrics

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Decompression and fusion for degenerative lumbar spondylolisthesis affect sagittal disequilibrium of the spine Shi Haoran, Guan Haishan, Wang Yueyong, Liu Tao 2024, 28 (12):  1956-1961.  doi: 10.12307/2024.015 Abstract ( 201 )   PDF (945KB) ( 74 )   Save BACKGROUND: Lumbar decompression and fusion is the most effective surgical method to treat lumbar degenerative spondylolisthesis. In recent years, the sagittal balance of the spine has been widely considered the key factor to adjust the outcome of spinal surgery, and factors that can affect the sagittal balance of the spine indirectly affect the surgical effect and prognosis.  OBJECTIVE: To summarize the risk factors that can affect the sagittal balance of the spine during decompression and fusion due to lumbar spondylolisthesis, and play a certain reference role in the surgical treatment of lumbar spondylolisthesis. METHODS: With “lumbar spondylolisthesis, the sagittal plane balance of the spine, surgical treatment, risk factors” as the Chinese search terms, and “lumbar spondylolisthesis, sagittal balance, risk factor” as the English search terms, PubMed, Springer, ScienceDirect, Wanfang, VIP and CNKI were searched respectively. The focus of the search was from January 2010 to January 2023, and a few classic long-term articles were included. Preliminary screening was conducted by reading the title and abstract. After excluding repetitive research in Chinese and English literature, low-quality journals and irrelevant literature, 67 articles were finally included for review. RESULTS AND CONCLUSION: (1) Degenerative lumbar spondylolisthesis is an important factor causing spinal canal stenosis and lumbar instability, and is the main cause of low back pain and intermittent claudication. Lumbar decompression, fusion and internal fixation is an effective way to treat degenerative lumbar spondylolisthesis. (2) In the past, the treatment of degenerative lumbar spondylolisthesis with decompression, fusion and fixation focused on thorough exploration and release of nerve roots, reduction of spondylolisthesis and solid internal fixation, but less attention was paid to the balance of sagittal plane of the spine. (3) With the popularization of lumbar decompression, fusion and internal fixation, complications caused by the sagittal imbalance of the spine gradually increased, resulting in poor prognosis of patients and even increased risk of secondary surgery. (4) Previous studies have only discussed the correlation between lumbar sagittal plane parameters and spinal sagittal plane balance, but have not in-depth studied the relevant factors causing spinal sagittal plane imbalance. (5) Our results show that open lumbar fixation and fusion, complete reduction of spondylolisthesis, selection of thicker pedicle screws, selection of larger fusion cages, and autologous bone transplantation are beneficial factors for maintaining sagittal balance. The higher the number of fusion segments, the higher the level of fusion segments is, which is a risk factor for sagittal plane imbalance. Figures and Tables | References | Related Articles | Metrics

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Knee function recovery in patients with anterior cruciate ligament reconstruction after blood flow restriction training: a meta-analysis Zuo Huiwu, Geng Zhizhong, Chen Peng, Lin Xikai, Chen Jian 2024, 28 (12):  1962-1968.  doi: 10.12307/2024.008 Abstract ( 243 )   PDF (1708KB) ( 70 )   Save OBJECTIVE: To systematically review the clinical effect of blood flow restriction training on rehabilitation after anterior cruciate ligament reconstruction to provide a reference for clinical practice. METHODS: Databases including CNKI, WanFang, PubMed, Web of Science and EBSCO were searched to collect randomized controlled trials of blood flow restriction training in the intervention of anterior cruciate ligament reconstruction from inception to August 10, 2022. Outcomes included knee muscle strength, knee muscle mass, and knee function evaluation, all of which were continuous variables. Two reviewers independently screened the literature and extracted data. Cochrane bias risk assessment tool and Physiotherapy Evidence Database Scale were used to evaluate the bias risk of the included articles. Meta-analysis was then performed using RevMan 5.4 software. RESULTS: A total of 9 publications were included, including 226 subjects, 114 in the trial group and 112 in the control group. Meta-analysis results showed that compared with conventional resistance training, the blood flow restriction training group could significantly improve knee muscle strength [SMD=0.54, 95%CI(0.29,0.79), P < 0.01], muscle mass [SMD=0.26, 95%CI(0.06,0.46), P=0.01] and knee joint function [SMD=1.17, 95%CI(0.53,1.80), P < 0.01]. Subgroup analysis showed that only when the intervention time was more than 4 weeks, there were significant improvements in knee joint muscle strength [SMD=0.68, 95%CI(0.38,0.97), P < 0.01] and muscle mass [SMD=0.38, 95%CI(0.09,0.68), P=0.01].   CONCLUSION: Current evidence shows that blood flow restriction training can improve muscle strength and knee function in patients with anterior cruciate ligament reconstruction and reduce muscle atrophy. It is recommended that the postoperative intervention time should be more than 4 weeks to achieve better muscle strength and muscle mass improvement.  Figures and Tables | References | Related Articles | Metrics