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28 June 2024, Volume 28 Issue 18 Previous Issue   

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Effect of three-dimensional spatial distribution of necrotic and support areas on outcomes of fibular support for hip preservation Yuan Xinwei, Huang Yixuan, Xi Hongzhong, Guo Mingbin, Mai Jianbin, Sun Guangquan, Liu Xin, Du Bin 2024, 28 (18):  2789-2794.  doi: 10.12307/2024.074 Abstract ( 232 )   PDF (1262KB) ( 50 )   Save BACKGROUND: The distribution of the necrotic area plays an important role in hip preservation treatment. At present, there are few studies on whether the difference in the three-dimensional spatial distribution of osteonecrosis of the femoral head affects the clinical outcome of fibular support. OBJECTIVE: To explore the relationship between the spatial distribution and clinical outcome at the sites of osteonecrosis of the femoral head and fibular support using CT three-dimensional reconstruction so as to provide a basis for optimizing the applicable conditions of fibular support and improving the hip preservation effect of fibular support. METHODS: Eighty patients with osteonecrosis of the femoral head who were treated with fibular support for hip preservation from January 2010 to January 2021 were selected as the study subjects according to the inclusion criteria. They were followed up for at least 2 years. According to the clinical outcome, the patients were divided into the successful hip preservation group (n=55) and the failure hip preservation group (n=25). 3D reconstruction was performed according to the preoperative and postoperative CT images of the patients. According to the three-column theory, the femoral head was divided into outer nine areas, middle nine areas and inner nine areas (L1-9, C1-9, and M1-9) to explore the spatial distribution of necrotic area of the femoral head and fibular support area and its relationship with clinical outcome. RESULTS AND CONCLUSION: (1) Before operation, the necrotic area of the femoral head was mainly distributed in L1, L2, L4, L5, C1, C2, C4, and C5 (the upper and middle part of the anterior part of the outer ninth area and the middle part of the middle ninth area). After operation, the fibular support area was mainly distributed in L5, L6, C5, and C6 (the middle and lower part of the outer ninth area and the middle and lower part of the middle ninth area). (2) There were significant differences in the distribution of osteonecrosis of the femoral head between the successful hip preservation group and the failure hip preservation group in L8 (the posterior middle part of the outer ninth area), C3 (the anterior lower part of the middle ninth area), C6 (the lower middle part of the middle part of the inner ninth area) and M2 (the anterior middle part of the inner ninth area) (P < 0.05). There was a significant difference in the distribution of fibular support in L5 and L6 (middle and lower part of outer nine) (P < 0.05). Among them, the L8 region could be used as an independent predictor of hip preservation failure in fibular support surgery. The area under the curve of the L8 single factor prediction model was 0.698 [95%CI (0.575, 0.822)]; the sensitivity was 76%, and the specificity was 63.6%. (3) It turns out, when the necrotic area involves L8, C3, C6, and M2, especially L8, the failure of fibular support may increase, and when the fibular support involves L5 and L6, the effect of hip preservation is often not ideal. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of talus cartilage before and after anterior talofibular ligament injury Tu Hudi, Jurat·Matrozi, Zheng Hui, Li Chaojie 2024, 28 (18):  2795-2799.  doi: 10.12307/2024.050 Abstract ( 248 )   PDF (1103KB) ( 63 )   Save BACKGROUND: The injury of the anterior talofibular ligament is most common in joint ligament injuries. The use of the finite element method to simulate ankle joint motion has the advantages of short experimental time, complex boundary conditions that can be simulated, and mechanical properties.   OBJECTIVE: To analyze the effect of the anterior talofibular ligament on the stress distribution of the talus trochlea and the stability of the ankle joint. METHODS: A finite element model of the ankle was established based on CT and MRI images of patients with anterior talofibular ligament injury who were followed up for two months after Broström surgery to simulate ankle joint stress in patients with anterior talofibular ligament injury before and after surgery during normal gait cycles (ground phase, neutral phase, and off-ground phase). The stress distribution and maximum stress value of the talus bone cartilage were measured before and after surgery, and their differences were analyzed.   RESULTS AND CONCLUSION: Under normal gait, the anterior talofibular ligament has a certain protective effect on the talus trochlea in any position, reducing the wear of the ankle joint on the talus trochlea during movement. In all three phases, stress concentration was observed on the surface of the talus trochlea near the inner side of the ankle joint. The influence of the anterior talofibular ligament on the stability of the talus trochlear is much greater in the off-ground phase than in the ground phase and neutral phase. Under certain circumstances, the greater the torque on the ankle joint, the more significant the effect of the anterior talofibular ligament on the stability of the talus trochlea. Figures and Tables | References | Related Articles | Metrics

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Changes in plantar pressure of subjects with different foot positions during walking and jogging after Kinesio taping Ke Jingyue, Ma Shengnan, Dong Hongming, Li Jianping, Zhang Honghao, Liu Chao, Liu Ruihao, Li Guqiang 2024, 28 (18):  2800-2807.  doi: 10.12307/2024.051 Abstract ( 277 )   PDF (1802KB) ( 76 )   Save BACKGROUND: Kinesio taping is often used for the treatment of various sports injuries. The methods of foot and ankle sports taping are complex and diverse. Among them, Fascia taping is applicable to a wider range of people and can be used for different foot posture types, but it still lacks of practical verification, and its specific biomechanical role is not clear. OBJECTIVE: To observe the changes in plantar pressure characteristics of subjects with different foot positions during walking and jogging after Fascia taping. METHODS: Thirty-seven young healthy subjects were recruited from the Yantai campus of Binzhou Medical University to conduct the test. They were scored according to the foot posture index-six items version, and were divided into the supination foot group, the neutral foot group, and the pronation foot group. The static foot morphological indexes (including navicular drop, arch height index, arch height flexibility-longitudinal arch, and arch height flexibility-transverse arch) and the pressure-time integral of each foot zone during walking and jogging were collected and calculated respectively before and after Kinesio taping. The specific biomechanical mechanism of Fascia taping was analyzed.    RESULTS AND CONCLUSION: (1) General data: There was no statistical difference among the three groups of subjects in general data, such as gender, height, and body mass index (P > 0.05). Before taping, there was a significant difference in the foot morphological indexes and the areas of the outer front foot, midfoot, and hindfoot between different foot posture groups (P < 0.01). (2) Static foot morphological indexes: After taping, there was no statistically significant difference between the groups in navicular drop, arch height flexibility-longitudinal arch, and arch height flexibility-transverse arch (P > 0.05), while there was still a significant difference between the groups in the arch height index (P < 0.05). In the supination foot group, the arch height index increased slightly, but there was no significant difference before and after taping (P > 0.05). In the pronation foot group, the navicular drop and arch height flexibility-longitudinal arch was significantly reduced, and the arch height index was increased. There was a significant difference before and after taping (P < 0.05). (3) The index of plantar pressure during walking: After taping, there was no significant difference between the three groups in the area of lateral forefoot and medial midfoot (P > 0.05). In the pronation foot group, the lateral load of the forefoot increased after taping (P < 0.05). In the supination position group, the load of the lateral forefoot and midfoot regions increased significantly (P < 0.05), while the difference in the rear foot region was not significant (P > 0.05). (4) The index of plantar pressure during jogging: After taping, there was no statistically significant difference between groups in the lateral forefoot (P > 0.05). In the pronation foot group, the load of the medial forefoot increased significantly (P < 0.05). In the supination position group, the load of the lateral forefoot, the middle foot and the rear foot region increased significantly (P < 0.05). (5) The results showed that the Fascia taping was suitable for different foot postures. It could not only correct the static foot structure of subjects with different foot postures, but also regulate the abnormal plantar pressure distribution during the dynamic activities of walking and jogging, and the load of the midfoot, forefoot, and hindfoot in the supination and pronation posture tended to normal foot posture load level. Figures and Tables | References | Related Articles | Metrics

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Effects of body mass index on plantar pressure Zhu Chenchen, Yin Yuan, Zhou Yingji, Ma Tingting, Su Liyao, Zhang Ming 2024, 28 (18):  2808-2813.  doi: 10.12307/2024.059 Abstract ( 290 )   PDF (902KB) ( 81 )   Save BACKGROUND: Human plantar pressure can reflect the health status of the lower limbs and even the whole body, which is an important basis for gait analysis, and body mass index is an important influencing factor. OBJECTIVE: To investigate the effect of body mass index on plantar pressure. METHODS: Twenty young college students from Xuzhou Medical University, including 10 males and 10 females aged 19-21 years, were selected as test subjects and divided into three groups according to the body mass index value: overweight group (body mass index > 25 kg/m2, n=3), lean group (body mass index < 18 kg/m2, n=4), and normal group (body mass index 18-25 kg/m2, n=13). A natural walking gait test was carried out on the three groups of subjects with a Zebris pressure distribution measurement plate to obtain the complete gait cycle parameters. The time proportion of support time phase, peak pressure, time to peak force, peak force and impulse volume were analyzed and the correlation between each parameter and the body mass index was analyzed by Person analysis. RESULTS AND CONCLUSION: (1) Compared with the other two groups, the time proportion of support time phase of subjects in the overweight group was relatively small, while the time proportion in the foot heel contact period and forefoot extension period was relatively large. There was a positive correlation of the time proportion of the foot heel contact period and forefoot extension period with body mass index, while there was a negative correlation between the time proportion of the arch support period and body mass index. (2) The peak pressure of the left arch and palm of the foot of the subjects of the overweight group was higher than that of the normal group, and the peak pressure of the left and right palm of the foot of the lean group was lower than that of the normal group. The peak pressure was positively correlated with the body mass index during the foot heel contact period. There was a significant positive correlation between the peak pressure of the left foot and body mass index during the arch support period as well as the peak pressure of both feet and body mass index during the forefoot extension period. (3) Plantar peak force time in the order of the gait cycle in increasing order: heel < arch < metatarsal < toe. In the foot heel contact period, the time of peak force was negatively correlated with body mass index, but they were positively correlated with each other in the forefoot extension period. In the arch support period, the time of peak force of the left arch was significantly positively correlated with body mass index. (4) Plantar peak force was mainly expressed as medial heel > toe/middle 2-4 metatarsal > lateral heel > medial and lateral metatarsal > arch; medial heel peak force was the largest, and the arch peak force was the smallest. Except for the toe of the left foot, there was a significant positive correlation between peak force and body mass index. (5) The maximum ground impulse of the lean group and the overweight group was in the foot heel contact stage, the minimum ground impulse was in the forefoot extension period, and the minimum ground impulse of the arch was in the normal group. There was a significant positive correlation between ground impulse and body mass index at different periods. (6) The results show that young people should control their body mass index, wear appropriate shoes, protect their feet and ankles, and prevent the occurrence of flat feet. Figures and Tables | References | Related Articles | Metrics

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Application and economic effects of digital three-dimensional reconstruction in hip hemiarthroplasty for intertrochanteric femoral fractures in the elderly Li Peng, Han Xiaosong, Xiang Bingyan, He Yingyi, Huang Kun, Liu Li, Luo Hongjian, Ruan Shiqiang 2024, 28 (18):  2814-2818.  doi: 10.12307/2024.054 Abstract ( 200 )   PDF (976KB) ( 90 )   Save BACKGROUND: Digital three-dimensional reconstruction technology is gradually applied to orthopedic diseases with the advantages of visualization, accuracy and non-invasiveness, but there is less evidence-based support for its use in artificial hip hemiarthroplasty for intertrochanteric fractures of the femur in the elderly.   OBJECTIVE: To investigate the application value and economic effects of digital three-dimensional reconstruction techniques in artificial hip hemiarthroplasty of intertrochanteric fractures of the femur in the elderly. METHODS: One hundred and thirty elderly patients with intertrochanteric femur fractures admitted to Zunyi First People’s Hospital from January 2019 to December 2022 were selected and randomly divided into a control group (n=65) and an observation group (n=65). Artificial hip hemiarthroplasty was performed in both groups. The control group adopted the film template measurement method for manual preoperative planning while the observation group adopted a digital three-dimensional reconstruction technique. Preoperative planning and intraoperative actual application of prosthesis compliance rate, fibrinogen, D-dimer, bilateral femoral eccentric distance difference, bilateral lower limb length difference, Harris hip function score, visual analog scale score, excellent and good rate of hip function, complications, and hospitalization cost were observed in both groups.   RESULTS AND CONCLUSION: (1) The proportion of acetabular side and femoral side prosthesis in grade 0 (fully compliant) was higher in the observation group than that in the control group (P < 0.05). (2) Fibrinogen and D-dimer levels in the observation group were lower than those in the control group 3 days after surgery (P < 0.05). (3) The difference in bilateral femoral eccentric distance and the difference in bilateral lower limb length in the observation group were smaller than those in the control group immediately after surgery (P < 0.05). The differences in Harris and visual analog scale scores were not significantly different between the two groups preoperatively, 6 and 12 months postoperatively (P > 0.05). There was no significant difference in excellent and good rate of hip function between the two groups 12 months postoperatively (P > 0.05). (4) There was no significant difference in the complication rate between the two groups (P > 0.05). The hospitalization cost of the observation group was higher than that of the control group (P < 0.05). (5) It is indicated that digital three-dimensional reconstruction technology applied in artificial hip hemiarthroplasty of intertrochanteric femoral fracture in the elderly can not only accurately determine the prosthesis type before surgery, but also accurately reconstruct the bilateral lower limbs offline, but its hospitalization cost is high.  Figures and Tables | References | Related Articles | Metrics

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Three-dimensional digital model-assisted minimally invasive needle penetration and steel plate internal fixation in treatment of Sanders types II and III calcaneal fractures Liu Wendong, Xia Hongle, Liu Lin, Shen Runbin, Guo Wei, Wang Xuyang, Li Guoliang 2024, 28 (18):  2819-2824.  doi: 10.12307/2024.043 Abstract ( 197 )   PDF (1061KB) ( 32 )   Save BACKGROUND: At present, open reduction and internal fixation and minimally invasive needle aspiration are commonly used in patients with Sanders types II and III calcaneal fractures. However, there is little comparison between the clinical efficacy of the two methods and high-level clinical evidence is still available. OBJECTIVE: To compare the curative effect of Sanders types II and III calcaneal fractures treated by three-dimensional digital model-assisted minimally invasive needle penetration and tarsal sinus incision and manual reduction and internal fixation with steel plate. METHODS: From January 2021 to October 2022, 80 patients with Sanders types II and III calcaneal fractures who were treated in the Department of Orthopedics, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were randomly divided into control group (40 cases) and observation group (40 cases). The control group was treated with manual reduction and internal fixation with steel plate through the traditional tarsal sinus incision, while the observation group was treated with a three-dimensional digital model assisted with minimally invasive needle penetration fixation. The operation time, blood loss, hospitalization time and fracture healing time of the two groups were recorded. The changes in Maryland score, AO-FAS score, pain visual analog scale score, quality of life score (SF-36 score), and imaging parameters (Böhler angle, Gissane angle, calcaneal length, width and height) were observed before and 12 months after operation in the two groups. The complications during the follow-up were recorded.  RESULTS AND CONCLUSION: (1) Operation time, blood loss, hospitalization time and fracture healing time in the observation group were lower than those in the control group (all P < 0.05). (2) The Maryland score, AO-FAS score, SF-36 score, Böhler angle, Gissane angle, calcaneal length and height of the two groups after treatment were significantly higher than those before treatment (all P < 0.05). Visual analog scale score and calcaneal width were significantly lower than those before treatment (all P < 0.05). (3) After 12 months of follow-up, the incidence of complications in the observation group was lower than that in the control group (all P < 0.05). (4) In conclusion, the treatment of Sanders types II and III calcaneal fractures with three-dimensional digital model-assisted minimally invasive needle penetration fixation can significantly improve the operation time, bleeding volume and other perioperative indicators, and can reduce the occurrence of multiple complications. The recovery of ankle function, relief of pain symptoms, and improvement of quality of life are equivalent to traditional therapy. Figures and Tables | References | Related Articles | Metrics

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3D printing precise positioning guided ulnar groove plasty for treatment of cubital tunnel syndrome Dong Hanqing, Wu Xing, Xu Pengcheng, Wang Qingwen, Zhang Zhisheng, Zhao Jianyong 2024, 28 (18):  2825-2829.  doi: 10.12307/2024.062 Abstract ( 228 )   PDF (885KB) ( 16 )   Save BACKGROUND: With the increase of patients with cubital tunnel syndrome, ulnar groove plasty does not affect the normal anatomical structure and distribution of the ulnar nerve, which is one of the main surgical procedures for the treatment of cubital tunnel syndrome. 3D printing combined with ulnar groove plasty can more accurately position the expansion depth and width of the ulnar groove to avoid some surgical complications.  OBJECTIVE: To investigate the effect of 3D printing technology combined with ulnar groove plasty on nerve electrophysiology and prognosis in patients with cubital tunnel syndrome.  METHODS: A total of 70 patients with moderate and severe cubital tunnel syndrome who were treated in Cangzhou Integrated Traditional Chinese and Western Medicine Hospital from March 2020 to March 2022 were selected as the study subjects. They were divided into two groups, with 35 cases in each group. The control group underwent traditional ulnar groove plasty. The observation group underwent 3D printing technology combined with ulnar groove plasty. The patients were followed up for 3 months. The clinical efficacy, latency, amplitude of compound muscle action potential of abductor pollicis brevis of the affected limb and ulnar nerve motor conduction velocity, grip strength on the affected side, pinch strength of the middle and thumb fingers, S-W monofilament of the little finger, two-point discrimination of the little finger, and Disabilities of the Arm, Shoulder and Hand Questionnaire score were compared between the two groups.  RESULTS AND CONCLUSION: (1) Compared with the control group (74%), the excellent and good rate was significantly higher in the observation group (91%) (P < 0.05). (2) Compared with pre-treatment, the latency of compound muscle action potential of abductor pollicis brevis of affected limb was significantly shorter and the wave amplitude and ulnar nerve motor conduction velocity were significantly higher in the two groups after treatment. The latency was significantly shorter and the wave amplitude and ulnar nerve motor conduction velocity were significantly higher in the observation group than those in the control group (P < 0.05). (3) Compared with pre-treatment, the grip strength, middle finger and thumb pinch strength of the affected side, S-W monofilament of the little finger and two-point discrimination of the little finger were significantly decreased in the two groups after treatment. The grip strength, middle finger and thumb pinch strength on the affected side were greater, S-W monofilament of the little finger and two-point discrimination of the little finger were significantly smaller in the observation group than those in the control group (P < 0.05). (4) Compared with pre-treatment, the Disabilities of the Arm, Shoulder and Hand Questionnaire scores of the two groups were significantly reduced after treatment, and the Disabilities of the Arm, Shoulder and Hand Questionnaire scores of the observation group were significantly lower than those of the control group (P < 0.05). (5) It is concluded that 3D printing technology combined with ulnar groove plasty in the treatment of cubital tunnel syndrome can effectively improve its clinical efficacy, promote the neurophysiological recovery of patients, and enhance the function of fingers and upper limbs, which has high clinical application value. Figures and Tables | References | Related Articles | Metrics

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Clinical significance of digital measurement of occipital condyle and foramen magnum in children Li Kun, Zhou Zheyuan, Wang Jian, Zhang Yan, Zhao Yan, He Xuetong, Li Ke, Chen Simin, Wu Xingyu, Wang Xing, Zhang Shaojie 2024, 28 (18):  2830-2834.  doi: 10.12307/2024.028 Abstract ( 224 )   PDF (1171KB) ( 62 )   Save BACKGROUND: Due to the young age of children, the occipital condyle and foramen magnum are not fully developed, and they are prone to various diseases and injuries in the occipitocervical junction, which requires surgical treatment in severe cases. However, anatomical parameters for the development of the occipital condyle and foramen magnum in children are lacking. OBJECTIVE: To measure the morphological structure of the occipital condyle and foramen magnum by three-dimensional reconstruction technique, and to provide important anatomical parameters for occipitocervical junction lesions, related surgical procedures and forensic identification. METHODS: Imaging data of 389 cases of primitive children and adolescents involved in skull base undergoing spiral CT scanning (247 males and 142 females) aged 1-18 years were collected and divided into 1-3-year-old group, 4-6-year-old group, 7-9-year-old group, 10-12-year-old group, 13-15-year-old group, and 16-18-year-old group according to their age. Mimics 16.0 software was used to reconstruct the skull base and measure the length and width of the foramen magnum. A formula was used to calculate the area and index of the foramen magnum. We measured the length, width and height of the occipital condyle, the angle between the long axis and the sagittal axis of the occipital condyle (O-S angle), the included angle between the midpoint of the front and back edges of the foramen magnum and the connection between the back edge of occipital condyle and the intersection point of the foramen magnum (F-O angle), and the included angle between the midpoint of the front and back edges of the foramen magnum and the midpoint of the back wall of the sublingual neural tube (F-H angle). Gender, side and age differences were analyzed among the indicators. RESULTS AND CONCLUSION: (1) In foramen magnum measurement, there was no significant difference between sexes in the index of the foramen magnum (P > 0.05), but there were significant differences in length, width and area of the foramen magnum (P < 0.05). (2) The O-S angle, F-O angle and F-H angle of the occipitral condyle were not significantly different between genders (P > 0.05), but length, width and height of the occipital condyle were significantly different between genders (P < 0.05). (3) There were no significant differences in the length of the occipital condyle among different groups (P > 0.05), but there were significant differences in the width and height of the occipital condyle, O-S angle, F-O angle and F-H angle among different groups (P < 0.05). (4) Length, width and area of the foramen magnum, length, width and height of the occipital condyle showed a wavy increasing trend with the increase of age, while O-S, F-O and F-H angles showed a wavy decreasing trend with the increase of age, while the index of the foramen magnum showed no significant change. (5) In conclusion, there are gender and lateral differences in the morphological indexes of the foramen magnum and the occipital condyle in children. These differences can provide an important reference for clinical surgical approach selection and forensic examination. Figures and Tables | References | Related Articles | Metrics

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Effect of Rothman index on unplanned readmission and complications in elderly patients undergoing total hip and knee arthroplasty Zhou Sirui, Huang Kun, Bai Fan, Liu Li, Zhou Yangyang 2024, 28 (18):  2835-2839.  doi: 10.12307/2024.067 Abstract ( 261 )   PDF (810KB) ( 65 )   Save BACKGROUND: Total hip and knee arthroplasty is widely used in the elderly population, but there is a lack of accurate prediction methods for unplanned readmission and postoperative complications. OBJECTIVE: To investigate the effect of the Rothman index on unplanned readmission and complications in elderly patients undergoing total hip and knee arthroplasty. METHODS: A total of 153 patients who underwent elective total hip and knee arthroplasty from December 2020 to December 2022 in Ward Area One, Department of Orthopedics, The First People’s Hospital of Zunyi were selected as the study subjects. According to whether they were unplanned readmission within 90 days after discharge, they were divided into a readmission group (n=21) and a non-readmission group (n=132). The general data of all patients were collected through the electronic medical record system, including gender, age, body mass index, diabetes mellitus, hypertension, and surgical joint type. The Rothman index was evaluated according to the literature. Postoperative complications were counted. RESULTS AND CONCLUSION: (1) There was no significant difference in gender, body mass index, surgical joint type, and length of hospital stay between the readmission group and the non-readmission group (P > 0.05). There were significant differences in the number of comorbidities, age, and Rothman score between the two groups (P < 0.05). (2) The results of multivariate Logistics regression analysis showed that the number of comorbidities, age, and Rothman score were independent influencing factors for readmission 90 days after total hip and knee arthroplasty in elderly patients with hip and knee diseases (P < 0.05). (3) The results of receiver operating characteristic curve analysis exhibited that the area under the curve of the Rothman index for predicting readmission 90 days after total hip and knee arthroplasty was 0.824; the sensitivity was 80.85%; the specificity was 78.85%; the maximum Youden index was 0.597, and the optimal cutoff value was 46 points. (4) The incidence of total complications in elderly patients with Rothman < 46 was higher than that in elderly patients with Rothman ≥46 (P < 0.05). (5) It is concluded that the Rothman index can accurately predict unplanned readmission after total hip and knee arthroplasty in elderly patients with hip and knee joint diseases. Simultaneously, patients with Rothman index of less than 46 points have a higher overall risk of complications and poor joint recovery, which can be used to improve postoperative management of patients in clinical practice. Figures and Tables | References | Related Articles | Metrics

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Body weight support Tai Chi footwork improves balance function after total hip arthroplasty Zhang Liying, Ding Yuwu, Yu Xiaoming, Liao Wangsheng, Wang Jiening 2024, 28 (18):  2840-2845.  doi: 10.12307/2024.055 Abstract ( 128 )   PDF (969KB) ( 68 )   Save BACKGROUND: Most balance disorders after total hip arthroplasty require a variety of rehabilitation methods to improve. Body weight support Tai Chi footwork can be used as a safe and effective balance training method.  OBJECTIVE: To observe the effect of body weight support Tai Chi footwork on the balance function of patients after total hip arthroplasty.  METHODS: Totally 74 subjects undergoing total hip arthroplasty were recruited and randomly divided into a control group (n=37) and a trial group (n=37). The control group received 30 minutes of body weight support walking training and 60 minutes of routine rehabilitation training; the trial group received 30 minutes of body weight support Tai Chi footwork training and 60 minutes of routine rehabilitation training, once a day, 5 times a week, for 12 consecutive weeks. Before the intervention, 4, 8, and 12 weeks after intervention, the Berg balance scale and the dynamic balance ability test were used to evaluate the balance function. Harris score was used to evaluate the hip joint function, and the fall risk index was used to evaluate the fall risk. RESULTS AND CONCLUSION: (1) The four observation indicators all showed significant time effects (P < 0.001). (2) Berg balance scale, Harris score and fall risk index all had an interaction effect (P < 0.001), and there was a significant inter-group difference after 12 weeks of intervention (P < 0.001), and the effect of the trial group was better than that of the control group. (3) After 12 weeks of intervention, there was an interaction and group effect in the scores of the front and left directions of the dynamic balance test (P < 0.001), and there were significant group differences in the scores of the overall, front, left and right directions (P < 0.001). (4) The results showed that after 12 weeks of intervention, the balance functions of the trial group and the control group were improved, and the improvement effect of body weight support Tai Chi footwork training was better than body weight support walking training on patients after total hip arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Comparison of gait and hip ambulation ability after total hip arthroplasty through different approaches Pan Yunchun, Wei Hongjun, Ren Guoqing, Zhang Qiliang 2024, 28 (18):  2846-2851.  doi: 10.12307/2024.034 Abstract ( 240 )   PDF (1120KB) ( 38 )   Save BACKGROUND: In the selection of minimally invasive total hip arthroplasty approaches, there is considerable debate about whether direct anterior and posterior approaches differ in postoperative gait, limb balance, and hip motor capacity, and therefore further investigation is warranted.   OBJECTIVE: To assess the gait and hip ambulation ability of direct anterior and posterior approaches for primary unilateral total hip arthroplasty with a prospective randomized controlled study.  METHODS: A total of 61 patients with unilateral avascular necrosis of the femoral head in Qingdao Municipal Hospital from January 2019 to June 2020 were included in the study. There were 40 males and 21 females, at a mean age of (64.83±5.52) years. All the patients were randomly divided into a direct anterior approach group (n=28) and a posterior approach group (n=33), and received initial total hip arthroplasty by direct anterior approach and posterior approach, respectively. Gait analysis (gait time-space parameters such as stride length, stride frequency, single-leg support time, and plantar pressure difference) and hip ambulation ability (standing-walking timing test and 2-minute walking test) were performed before and 1, 3 and 6 months after operation.  RESULTS AND CONCLUSION: (1) With the extension of postoperative time, gait time-space parameters in both groups were gradually improved. The stride length, stride frequency, single-leg support time, and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 1 month after surgery (P < 0.01). The stride frequency, single-leg support time, and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 3 months after surgery (P < 0.05). The plantar pressure difference in the direct anterior approach group was significantly better than that in the posterior approach group 6 months after surgery (P < 0.01). (2) With the extension of postoperative time, the results of the standing-walking timing test and 2-minute walking test were gradually improved in both groups. The results of the standing-walking timing test and 2-minute walking test 1 and 3 months after operation in the direct anterior approach group were better than those in the posterior approach group (P < 0.05). (3) The results have indicated that the recovery of postoperative gait and hip ambulation ability of the two groups is inconsistent. The direct anterior approach group has some advantages in the improvement of postoperative gait and hip ambulation ability compared with the posterior approach group in the early postoperative period.  Figures and Tables | References | Related Articles | Metrics

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Effect analysis of a modified topical application of tranexamic acid in primary total knee arthroplasty Li Bowei, Pan Wenjie, Xu Chao, Huang Yuanchi, Ma Jianbing 2024, 28 (18):  2852-2858.  doi: 10.12307/2024.044 Abstract ( 227 )   PDF (1012KB) ( 17 )   Save BACKGROUND: In recent years, tranexamic acid has been extensively used to mitigate the substantial blood loss associated with total knee arthroplasty. However, the optimal method of topical application has not yet been established. OBJECTIVE: To evaluate the effectiveness and safety of intraoperative topical application of tranexamic acid combined with physical compression dressing in reducing perioperative blood loss in total knee arthroplasty. METHODS: A retrospective analysis was conducted on 90 patients who underwent total knee arthroplasty at the Honghui Hospital in Xi’an from January 2021 to December 2022. Based on the different topical use methods of tranexamic acid during surgery, patients were divided into three groups, with 30 cases in each group. In the compression dressing group, 2 g of tranexamic acid was placed in the articular cavity, and after packing the wound with gauze and cotton pads, a bandage was used to compress the wound. In the periarticular injection group, 2 g of tranexamic acid was injected into the surrounding tissue of the articular cavity. In the intra-articular injection group, 2 g of tranexamic acid was injected into the articular cavity. The blood loss, operation time, coagulation indicators, inflammatory indicators, and postoperative complications of the three groups were statistically analyzed.  RESULTS AND CONCLUSION: (1) In terms of total blood loss, hidden blood loss, and maximum hemoglobin drop, the periarticular injection group had the least amount, and there was no statistically significant difference between the compression dressing group and periarticular injection group (P > 0.05). In terms of intraoperative blood loss, the compression dressing group had the least amount, and there were statistically significant differences compared with the periarticular injection group and intra-articular injection group (P < 0.05). There was no statistically significant difference in operation time among the three groups (P > 0.05). (2) There were no statistically significant differences in coagulation indicators (D-dimer and fibrinogen degradation products) and inflammation indicators (C-reactive protein and erythrocyte sedimentation rate) among the three groups preoperatively and on the first and third days after operation (P > 0.05). (3) There was no statistically significant difference observed among the three groups in terms of slow blood flow in the affected limb, intramuscular venous thrombosis, soft tissue swelling, and incidence of wound complications (P > 0.05). Additionally, no cases of deep vein thrombosis or pulmonary embolism were detected in any of the groups. (4) The topical application of tranexamic acid combined with compression dressing achieves the same effect as a periarticular injection in terms of simplicity of operation and reduced perioperative blood loss. This method also avoids the trauma caused by repeated punctures and does not increase the incidence of postoperative complications, making it a worthwhile option for clinical promotion. Figures and Tables | References | Related Articles | Metrics

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Application of 5-point positioning point-contact pedicle navigation template in the case of scoliosis and complex pedicle Wang Lihang, Lu Tingsheng, Chen Qiling, Yao Shudan, Pu Xingwei, Ji Linsong, Zhao Guoquan, Ouyang Beiping, Zhang Bin, Yang Zaisong, Luo Chunshan 2024, 28 (18):  2859-2864.  doi: 10.12307/2024.037 Abstract ( 174 )   PDF (1221KB) ( 43 )   Save BACKGROUND: The pedicle navigation template has many advantages, but there are still some problems. For example, poor soft tissue dissection leads to poor adhesion of the pedicle navigation template, resulting in screw path deviation; careful dissection of soft tissue to fit the pedicle navigation template leads to prolonged surgery time and increased bleeding; the design of the pedicle navigation template cannot predict the vertebral rotation and the impact of body position changes, resulting in the poor fitting.  OBJECTIVE: To explore the utility of a new 5-point positioning point-contact pedicle navigation template in the case of scoliosis and complex pedicle.  METHODS: A total of 20 patients with scoliosis and complicated pedicle admitted to the Department of Spinal Surgery, Guizhou Hospital, Beijing Jishuitan Hospital from February 2020 to February 2023 were selected for scoliosis orthopedics. During the operation, the 5-point positioning point-contact pedicle navigation template was used to guide the screws. According to the inclusion and exclusion criteria, 34 cases were matched as the empirical nail placement group, and conventional barehanded nail placement was performed. The time of placement, the amount of bleeding, the number of fluoroscopies, the number of manual diversions, the level and accuracy of pedicle screws, the complications of placement, and the rate of correction of main curvature were compared between the two groups.  RESULTS AND CONCLUSION: (1) There were no significant differences in sex, age, coronal Cobb’s angle of the main curvature, bending Cobb’s angle of the main curvature, pedicle variation, apex rotation, fusion segment, number of screws, level of screws, accuracy of screws, and rate of correction of main curvature between the navigation template group and the empirical nail placement group (P > 0.05). (2) Compared with the empirical nail placement group, the navigation template group had more advantages in time of placement (P=0.034), amount of bleeding (P=0.036), number of fluoroscopies (P=0.000) and number of manual diversions (P=0.021). (3) There were 0 cases of screw-related complications in both groups. (4) In conclusion, the 5-point positioning point-contact 3D printing pedicle navigation template has a claw-like structure. It can firmly adapt to various deformities of the lamina articular process, avoid drift, and accurately place the screws. It has a point-like contact lamina structure to avoid extensive and complete dissection of the posterior structure, and reduce bleeding, operation time, and trauma. Pre-designed screw entry points and directions can reduce the number of fluoroscopy and operation time. Segmental design can avoid discomfort due to changes in anesthesia position. The operation is simple and the accuracy of screw placement is high. Figures and Tables | References | Related Articles | Metrics

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Stage III Kümmell’s disease treated with injured-vertebra screw placement combined with transpedicular impaction bone grafting: quick restoration of spinal stability Zheng Xuejing, Mei Wei, Zhu Yanyu, Bao Xiaoxiao, Zhang Zhenhui, Wang Qingde 2024, 28 (18):  2865-2870.  doi: 10.12307/2024.042 Abstract ( 209 )   PDF (1143KB) ( 84 )   Save BACKGROUND: Stage III Kümmell’s disease is characterized by a high degree of vertebral compression and posterior wall defects. Most of the patients are elderly people with severe osteoporosis and various medical diseases. Clinically, some surgical methods are often at high risk and are controversial.   OBJECTIVE: To investigate the clinical efficacy of screw placement combined with transpedicular impaction bone grafting in the treatment of stage III Kümmell’s disease.  METHODS: The clinical data of injured vertebral screw placement combined with transpedicular impaction bone grafting in treatment of stage III Kummell’s disease from May 2016 to August 2021 were retrospectively analyzed. Visual analog scale score, Oswestry disability index, anterior vertebral heights, kyphotic Cobb angle and American Spinal Injury Association (ASIA) impairment scale were used to evaluate the effects of surgery. The operation time, intraoperative blood loss and complications were recorded. CT scans were used to evaluate the healing of injured vertebrae at the final follow-up visit.  RESULTS AND CONCLUSION: (1) A total of 26 patients were included, with 7 males and 19 females, at the age range of 62-81 years [mean (69.7±4.8) years]. The follow-up time was 18-60 months [mean (35.1±8.9) months]. The average operative duration was 133.5 minutes (100-165 minutes), and the average intraoperative blood loss was 285.3 mL (210-350 mL). (2) Visual analog scale and Oswestry disability index scores 1 week after surgery were significantly lower than those before surgery. (3) At 1 week after surgery, the anterior vertebral height corrections and the Cobb angle were (9.0±0.7) mm and (16.2±1.0)°, respectively. During the follow-up period, the loss of vertebral height and kyphosis correction were (5.1±0.3) mm and (8.0±0.4)°, respectively. (4) 14 patients (54%) had ASIA grade D before operation, which recovered to grade E at the last follow-up. CT scan showed that all patients achieved good osseous union. (5) Complications occurred in seven patients (27%), including hypostatic pneumonia in two cases, postoperative superficial wound tissue liquefaction in two cases, and adjacent vertebral compression fractures in three cases. (6) It is concluded that screw placement of the injured vertebra combined with transpedicular impaction bone grafting can rapidly rebuild spinal stability, effectively relieve pain and improve neurological function in the treatment of stage III Kümmell’s disease. This technique is an effective and relatively minimally invasive surgical option. Figures and Tables | References | Related Articles | Metrics

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Prediction of osteoporotic vertebral compression fracture based on comprehensive index of lumbar vertebral bone strength Zhang Wensheng, Song Zhenjie, Wu Chunfei, Li Wenchao, Liu Hongjiang, Yang Xiaoguang, Yuan Chao 2024, 28 (18):  2871-2875.  doi: 10.12307/2024.046 Abstract ( 229 )   PDF (955KB) ( 22 )   Save BACKGROUND: Osteoporotic vertebral compression fracture is a common fracture secondary to osteoporosis. At present, there is no effective prediction index and method for osteoporotic vertebral compression fracture. OBJECTIVE: To investigate the predictive effect of the comprehensive index of lumbar vertebral body bone strength on osteoporotic vertebral compression fracture. METHODS: 233 patients with osteoporosis were divided into a fracture group and a non-fracture group according to whether a vertebral fracture occurred. The demography, body mass index, vertebral bone mineral density and other details were collected. Lateral X-ray films of the lumbar spine were photographed. The vertebral body width, vertebral body length, sacral slope, pelvic tilt, pelvic incidence, lumbar compressive strength index and the lumbar impact strength index were measured, calculated, and analyzed by univariate and multivariate, and the receiver operating characteristic curve was analyzed. The survival analysis was conducted according to the cut-off value. RESULTS AND CONCLUSION: (1) All patients were followed up for 2-4 years, with an average of 3.1 years. During the follow-up period, 99 cases (38 cases of L1 vertebral body, 61 cases of L2 vertebral body) had fractures (fracture group), and 134 cases (52 cases of L1 vertebral body, 82 cases of L2 vertebral body) had no fractures (non-fracture group). Univariate analysis showed that there was no significant difference in age, sex, height, body mass, body mass index and fracture segment between the two groups (P > 0.05). (2) Lumbar compressive strength index and lumbar impact strength index in the fracture group were lower than those in the non-fracture group (P < 0.05). Pelvic incidence and pelvic tilt in the fracture group were higher than those in the non-fracture group (P < 0.05). (3) Multivariate analysis showed that lumbar compressive strength index, lumbar impact strength index and pelvic tilt were risk factors for osteoporotic vertebral compression fractures (P < 0.05). (4) Receiver operating characteristic curve analysis showed that the cutoff values of vertebral bone mineral density, lumbar compressive strength index, lumbar impact strength index, pelvic tilt and pelvic incidence were 0.913 5 g/cm2, 1.932, 0.903, 21.5° and 55°, respectively; areas under the curve were 0.630, 0.800, 0.911, 0.633 and 0.568, respectively. (5) According to the survival analysis (with osteoporotic vertebral compression fracture as the end point), the average survival time of the patients with lumbar impact strength index ≥ 0.903 was significantly longer than that of the patients with lumbar impact strength index < 0.903 (P < 0.05). (6) These findings conclude that the comprehensive index of lumbar vertebral body bone strength is more accurate than the bone mineral density of the vertebral body and spine-pelvis sagittal parameters in predicting osteoporotic vertebral compression fractures, which is helpful for early prevention and treatment of osteoporotic vertebral compression fractures. Figures and Tables | References | Related Articles | Metrics

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Morphological classification of CT reconstruction of the narrowest part of pediculoisthmic component Hao Shuai, Ma Xun, Zhang Yannan, Zhao Haoliang, Liu Qingqing 2024, 28 (18):  2876-2880.  doi: 10.12307/2024.053 Abstract ( 205 )   PDF (956KB) ( 45 )   Save BACKGROUND: It has been suggested that CT multiplanar reconstruction should be performed prior to the placement of axial pedicle screws to determine the anatomy of the C2 pedicle in each patient, to design the appropriate screw locus and diameter, and to evaluate the feasibility of screw placement to reduce the incidence of surgery-related complications. OBJECTIVE: To evaluate the feasibility of axis pedicle screw placement by morphologic classification of pediculoisthmic component with CT multiplanar reconstruction. METHODS: The CT data of 200 patients (400 axial pedicle screws) with cervical spine were retrospectively studied by using Siemens Syngo.Via software. According to the direction of the axis of the pedicle, the CT multiplanar reconstruction positioning line was adjusted to reconstruct the sectional image of the narrowest part of the pediculoisthmic component. According to its morphological characteristics, the narrowest part of the pediculoisthmic component was divided into three types: type 1, “hook” type: Type 1a outer diameter width (a1)> 0.4 cm, type 1b outer diameter width (a1)≤0.4 cm; type 2, “like circle/ellipse” type; type 3, “horizontal ellipse” type. The outer diameter width of the narrowest part of pediculoisthmic component (d1), medullary cavity width (d2), outer diameter height (a1), and medullary cavity height (a2) were compared among the three types, and the feasibility of pedicle screw placement of the three types was evaluated. RESULTS AND CONCLUSION: (1) A total of 400 axial pedicles included 269 cases of type 1, 130 cases of type 2, and 1 case of type 3. (2) The mean external diameter height between types 1 and 2 was not significantly different (P > 0.05). The mean medullary cavity height, mean outer diameter widths, and mean medullary cavity width were significantly different (P < 0.001). There were 42 cases (15.6%) of type 1 and 0 cases (0.00%) of type 2 with mean external diameter width ≤ 0.4 cm, and the difference was significant (P < 0.001). There was only one case of type 3, whose external diameter height, medullary cavity height, outer diameter width and medullary cavity width were 1.20 cm, 0.84 cm, 0.64 cm and 0.31 cm, respectively. (3) These results confirm that axial pedicle screws can be safely inserted in patients with types 1a, 2 and 3, which requires no further measurement and assessment. Pedicle screw insertion should be performed with caution in type 1b patients. Therefore, in type 1 patients, the width of the narrowest outer diameter of the pediculoisthmic component should be further measured to evaluate the feasibility of axial pedicle screw placement.  Figures and Tables | References | Related Articles | Metrics

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Consistency between two types of cone-beam CT transformed two-dimensional images and traditional lateral cephalometric radiographs for quantitative analysis of cervical vertebral bone age Peng Yuanhao, Lyu Dongmei, Zhuang Xinyi, Yu Ting, Cheng Qian 2024, 28 (18):  2881-2886.  doi: 10.12307/2024.056 Abstract ( 229 )   PDF (1347KB) ( 24 )   Save BACKGROUND: Traditional lateral cephalometric radiographs always suffer from some problems, such as magnification distortion, left and right overlap inconsistency and so on, while the cone-beam CT can truly display the three-dimensional structure of the craniofacial region. Performing three-dimensional reconstruction of cone-beam CT and then transforming the cone-beam CT in the selected area into the two-dimensional image can make the overlap between the left and right sides consistent and reduce the influence of surrounding tissue structures.  OBJECTIVE: To explore the consistency of quantitative analysis of cervical vertebral bone age between two kinds of cone-beam CT transformed two-dimensional images with different integrated thicknesses and traditional lateral cephalometric radiographs.   METHODS: The cone-beam CT and lateral cephalometric radiograph data of 118 adolescent orthodontic patients were collected. Firstly, the cone-beam CT image was reconstructed in 3D imaging software. After reconstruction, two types of cone-beam CT images with different integrated thicknesses were selected in the sagittal interface and transformed into two-dimensional images, which were named ICB-1 and ICB-2, respectively. The Zhibeiyun system was used to measure and calculate the angle between the concave base of the second cervical vertebra and the lower edge of the vertebral body (@2), the ratio of the third cervical spine to the posterior height (AH3/PH3), the ratio of height to width of the fourth cervical spine (H4/W4) in lateral cephalometric radiograph, ICB-1, ICB-2 and the cervical vertebral bone age. After an interval of two weeks, 20 adolescents were randomly selected to repeat the above measurements. The intraclass correlation coefficient (ICC) method was used to evaluate the repeatability of the three images in measuring cervical bone age. Paired t-test was used to analyze the consistency of cervical bone age measurements between the three images. The Kappa test was used to analyze the consistency of cervical vertebral bone age staging assessment between the three images.  RESULTS AND CONCLUSION: (1) ICC of AH3/PH3 in the lateral cephalometric radiograph group was < 0.9, and the ICC of other measurement items in each group was > 0.9. (2) Paired t-test results showed that there were statistical differences in AH3/PH3 and H4/W4 between the ICB-1 group and lateral cephalometric radiograph group and between the ICB-1 group and ICB-2 group (P < 0.05), and there were no statistically significant differences in the other items between the three groups (P > 0.05). (3) The Kappa test results showed that the Kappa coefficients of the two groups were all more than 0.8 according to the staging of cervical vertebral bone age in three groups (P < 0.001). (4) It is indicated that the repeatability of ICB-1 and ICB-2 in the measurement of cervical vertebral bone age is better than that of lateral cephalometric radiographs. Lateral cephalometric radiographs, ICB-1 and ICB-2 have good consistency in the measurement of cervical vertebral bone age, but considering the integrity of cervical vertebra structure, ICB-2 is more suitable for quantitative analysis of cervical vertebral bone age than ICB-1. Figures and Tables | References | Related Articles | Metrics

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Imaging analysis of anatomical morphological risk factors for posterior cruciate ligament injury of the knee Wang Dening, Zhang Kefan, Shi Hui, Du Changling, Wang Xin 2024, 28 (18):  2887-2894.  doi: 10.12307/2024.057 Abstract ( 239 )   PDF (1359KB) ( 20 )   Save BACKGROUND: Studies have shown that posterior cruciate ligament injuries are associated with the anatomical morphology of the knee joint. OBJECTIVE: To explore anatomical morphological risk factors for posterior cruciate ligament injury. METHODS: The imaging data of 142 patients who visited Affiliated Hospital of Binzhou Medical University for knee joint problems from January 2015 to August 2022 were retrospectively analyzed. They were divided into posterior cruciate ligament injury group (n=71, including 49 males and 22 females) and posterior cruciate ligament intact group (n=71, including 49 males and 22 females). Intercondylar notch width, intercondylar notch height, bicondyle width, notch width index, angle of intercondylar notch, Blumensaat’s line inlication angle, medial tibial spine height, lateral tibial spine height, tibial spine width, tibiofemoral consistency index, tibial plateau anterior-posterior diameter, medial tibial depth and patellar tendon-tibial shaft angle were measured on MRI images. Posterior tibial slope was measured on X-ray images. The above indicators were included in the logistic regression analysis for investigation.  RESULTS AND CONCLUSION:  (1) Univariate logistic regression analysis in men showed that tibial spine width, tibiofemoral consistency index, medial tibial depth, and posterior tibial slope were associated with posterior cruciate ligament injury (P < 0.05). Multivariate binary logistic regression analysis showed that tibiofemoral consistency index and medial tibial depth were associated with posterior cruciate ligament damage (P < 0.05). (2) Univariate logistic regression analysis in women showed that medial tibial spine height, lateral tibial spine height, tibial spine width, and posterior tibial slope were associated with posterior cruciate ligament injury (P < 0.05). Multivariate binary logistic regression analysis showed that posterior tibial slope was associated with posterior cruciate ligament damage (P < 0.05). (3) The receiver operating characteristic curve showed that tibiofemoral consistency index, medial tibial depth and posterior tibial slope had a certain predictive value on posterior cruciate ligament damage. (4) These findings suggest that anatomical morphological risk factors for posterior cruciate ligament injury differ between men and women, and tibial spine width and posterior tibial slope are common risk factors. In the male population, abnormal tibial spine width, tibiofemoral consistency index, medial tibial depth, and posterior tibial slope are easy to induce posterior cruciate ligament injury. In the female population, abnormal medial tibial spine height, lateral tibial spine height, tibial spine width, and posterior tibial slope are easy to induce posterior cruciate ligament injury. Clinicians can use the above risk factors to identify abnormal knee morphology, assess people at risk of posterior cruciate ligament injury, and provide preventive advice and guidance for treatment. Figures and Tables | References | Related Articles | Metrics

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Effect of dementia on postoperative complications in older patients with hip fractures Jiang Yu, Luo Yan, Lin Xisheng, Wang Yilin, Gao Zefu, Lyu Houchen, Zhang Licheng, Tang Peifu, Liu Yujie 2024, 28 (18):  2895-2900.  doi: 10.12307/2024.027 Abstract ( 292 )   PDF (904KB) ( 58 )   Save BACKGROUND: The number of hip fracture patients with dementia is increasing with an aging population, posing challenges for surgical treatment.  OBJECTIVE: To determine the effect of dementia on postoperative complications in older patients with hip fractures.  METHODS: Patients aged over 60 years old with hip fractures from 2000 to 2019 at Chinese PLA General Hospital were included. Dementia patients with a preexisting diagnosis of dementia at admission were identified. Each dementia patient was matched, for age ± 5 years, gender, and fracture type with 10 non-dementia patients. The differences in postoperative complications were compared between the two groups, including pneumonia, respiratory failure, gastrointestinal bleeding, urinary tract infection, surgical site infection, deep venous thrombosis, pulmonary embolism, angina pectoris, arrhythmia, heart failure, myocardial infarction, stroke, and death. The impact of dementia on major complications was evaluated using multivariate conditional logistic regression.  RESULTS AND CONCLUSION: A total of 2 887 patients were included, of whom 125 (4.3%) were dementia patients and matched with 1 243 non-dementia patients. The average age of dementia patients was (80.6±7.4) years; 64.8% were female; 53.6% were intertrochanteric fractures, and 46.4% were femoral neck fractures. Major complications occurred in 25 (20.0%) patients with dementia and 123 (9.9%) patients without dementia (P < 0.01). The risk of major complications was 200.0 per 1 000 persons (95%CI, 139.3-278.6) in dementia patients and 99.0 per 1 000 persons (95%CI, 83.6-116.9) in non-dementia patients. Multivariate conditional logistic regression showed that a 2-fold risk of major postoperative complications after hip fracture surgery was found in dementia patients than in those without dementia (adjusted OR, 2.11; 95%CI, 1.08-4.10). The results show that dementia is an independent risk factor for postoperative complications in elderly patients with hip fractures. Appropriate preoperative risk assessment and corresponding preventive and therapeutic measures should be given to this vulnerable population to mitigate postoperative complications. Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis of optimal Halo gravity traction in treatment of Lenke 3 scoliosis Fu Rongchang, Yang Xiaozheng, Li Xianzheng 2024, 28 (18):  2901-2905.  doi: 10.12307/2024.072 Abstract ( 210 )   PDF (1322KB) ( 97 )   Save BACKGROUND: Halo gravity traction is a pre-operative traction method recognized by many scholars, but most of them rely on clinical observation and lack finite element analysis. OBJECTIVE: To explore the best traction force of Halo gravity traction on Lenke 3 scoliosis by finite element method and to provide a theoretical basis for clinics from a biomechanical point of view. METHODS: The CT images scanned by patients with scoliosis were processed by reverse modeling, and a finite element model was established. The validity of the model was verified by taking normal segments (T1-T4 vertebral bodies). Five groups of different stress conditions were set on the lumbar-thoracic scoliosis model to simulate the correction of patients under different traction forces. In all five groups, the lower surface of L5 was completely restrained, and different traction forces were applied to the upper surface of T1 along the positive direction of the Z axis (the opposite direction of gravity), which were 50, 100, 150, 200, and 250 N, respectively. The displacement of the scoliosis spine, Cobb angle change of the main bending, elongation of the spine, and Von Mises stress were compared under different traction forces. RESULTS AND CONCLUSION: (1) When the Halo gravity traction force was 150 N to 200 N, the reduction of the Cobb angle of the main bending was 69.4% to 88.9% of the maximum reduction; the elongation of the Z axis was 69.4% to 85.9%, and the stress was 63.6% to 82.9% of the maximum stress. (2) When the traction force was greater than 200 N, the reduction of the Cobb angle and the elongation of the Z axis did not change obviously, but the stress value increased sharply. At this time, the distance from the centroids of T6, T7, and T8 to the vertical line of L5 was the most obvious. (3) When the Halo gravity traction force was 150 N to 200 N, the correction effect on this type of patient was the best—the reduction of Cobb angle and the elongation of the Z axis were better without the sharp increase in stress. (4) It has certain theoretical support for clinical correction and can ensure the safety of patients when scoliosis is corrected to a large extent. Figures and Tables | References | Related Articles | Metrics

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Construction of shoulder joint complex model and finite element research and progress in this field Zeng Yuyuan, Yang Zhen, You Yihang, Zhang Enshui, Zhang Tao 2024, 28 (18):  2906-2911.  doi: 10.12307/2024.038 Abstract ( 257 )   PDF (863KB) ( 105 )   Save BACKGROUND: The shoulder joint, as a non-weight-bearing joint of the human upper limb, is considered a perfect compromise between flexibility and stability. The traditional experimental mechanics research of shoulder joints has some limitations due to the complexity of internal structure, measurement techniques and ethical issues. The finite element analysis method is applied to the research of shoulder joints, which provides valuable reference conclusions for the discussion of shoulder joint diseases and the decision of surgical methods.   OBJECTIVE: To review the status of finite element research in the field of the shoulder joint, and to put forward the prospect of future research. METHODS: The finite element analysis method was used to search the literature on shoulder joint complex-related diseases in PubMed, Web of Science, WanFang and CNKI databases by computer. Chinese search terms were “shoulder joint, finite element analysis, rotator cuff injury, glenoid labrum, shoulder joint replacement”. English search terms were “FE, should joint, glenohumeral joint, rotator cuff tears, glenoid labrum, shoulder arthroplasty”. The search period was mainly from January 2010 to January 2023. Some important documents were also tracked, retrieved and read. RESULTS AND CONCLUSION: (1) With the open network of model data and the establishment of relevant model databases, finite element research has become more and more standardized and reproducible. (2) The widely validated finite element model of the shoulder joint deepens our understanding of the shoulder field to enable more efficient clinical decision-making. (3) With the continuous development of computer technology and software development, future finite element research is bound to become an indispensable practical tool for clinical scientific research. Figures and Tables | References | Related Articles | Metrics

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Molecular mechanisms of autophagy-apoptosis interactions in osteoarthritis Zhao Kui, Pan Runsang, Lan Fengjun, Deng Jin, Chen Houping 2024, 28 (18):  2912-2917.  doi: 10.12307/2024.058 Abstract ( 254 )   PDF (855KB) ( 76 )   Save BACKGROUND: With the deepening of the aging of the world population, the prevalence rate of osteoarthritis is increasing. In recent years, more and more attention has been paid to the study of osteoarthritis. Studies have shown that autophagy and apoptosis are strongly associated with the occurrence and development of osteoarthritis, and play an important role in it. OBJECTIVE: To review the molecular mechanisms of the interaction between autophagy and apoptosis in osteoarthritis, aiming to explore the relationship between autophagy and apoptosis in osteoarthritis and the coupling mechanism of the two to mediate the occurrence and development of osteoarthritis, so as to provide new ideas for the treatment of osteoarthritis. METHODS: The Chinese and English key words “osteoarthritis, autophagy, apoptosis” were searched in the CNKI and PubMed. After screening by reading the title, abstract and key words, the relevant literature was carefully read. After excluding studies unrelated to the content of the paper and repetitive studies, 68 articles were finally included for the summary. RESULTS AND CONCLUSION: (1) The occurrence and development of osteoarthritis are related to autophagy and apoptosis of chondrocytes. Autophagy protects chondrocytes from stress damage, but excessive autophagy also induces or promotes chondrocyte apoptosis and reduces the survival rate of chondrocytes. The two perturb each other to regulate the degeneration of articular cartilage. (2) miRNA, Beclin-1 and oxidative stress are all involved in the regulation of autophagy and apoptosis on osteoarthritis, and affect the development of osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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Research status of traditional Chinese medicine monomer mediating related signaling pathways in treatment of intervertebral disc degeneration Yang Yunyun, Chen Qiqing, Zhao Jirong, Zhu Bao, Ma Dong, Huang Junkai, An Dehao, Zou Jipeng, Liu Weihang 2024, 28 (18):  2918-2924.  doi: 10.12307/2024.060 Abstract ( 216 )   PDF (905KB) ( 30 )   Save BACKGROUND: Intervertebral disk degeneration is a pathological change caused by a series of complex molecular mechanisms that result in the aging and damage of intervertebral discs, ultimately leading to severe clinical symptoms. Traditional Chinese medicine has unique advantages in the treatment of intervertebral disk degeneration due to its low cost, non-addictive nature, multi-target effects, minimally toxic and side effects, and high patient acceptance. OBJECTIVE: To review the latest research results of traditional Chinese medicine monomer intervention-related signaling pathways in the treatment of intervertebral disk degeneration, describe and analyze the action mechanism of traditional Chinese medicine monomer on intervertebral disk degeneration, and provide a new approach and theoretical basis for future basic research and clinical treatment.  METHODS: The first author searched for relevant literature from January 2018 to February 2023 in CNKI, PubMed, VIP, and WanFang using the search terms “intervertebral disc, signal pathway”. The articles that did not meet the criteria were excluded after preliminary screening of the titles and abstracts. Finally, 72 articles were selected for review and analysis. RESULTS AND CONCLUSION: Traditional Chinese medicine monomers can regulate multiple classical signaling pathways such as Wnt/β-catenin, PI3K/Akt, mTOR, NF-κB, and MAPK. They achieve this by regulating oxidative stress, adjusting the expression of pro/anti-apoptotic proteins in cells, stimulating cellular autophagy function, reducing stimulation of cell inflammatory factors, increasing the expression of extracellular matrix markers, reducing the production of matrix-degrading enzymes, maintaining the synthesis and stability of extracellular matrix, inducing differentiation of mesenchymal stem cells in the nucleus pulposus into nucleus pulposus cells, promoting endogenous repair and reconstruction, controlling apoptosis and aging of nucleus pulposus cells, and increasing the activity of nucleus pulposus cells. These actions improve the microenvironment within the intervertebral disc, maintain the normal physiological function of the intervertebral disc, and delay intervertebral disc degeneration. Figures and Tables | References | Related Articles | Metrics

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Application and prospect of reconstructing bladder micturition reflex in neurogenic bladder after spinal cord injury Zhan Lifen, Ai Kun, Zeng Xuejiu, Liang Rouyun, Ding Qiangsheng, Zhang Hong 2024, 28 (18):  2925-2931.  doi: 10.12307/2024.047 Abstract ( 228 )   PDF (1061KB) ( 42 )   Save BACKGROUND: The dysfunction of bladder function caused by spinal cord injury is a difficult point in clinical treatment and a hot spot in research. Repairing the injured spinal cord and remodeling the bladder micturition reflex pathway are the fundamental treatment methods.   OBJECTIVE: To summarize the reconstruction of the bladder innervation pathway after spinal cord transection injury and its related influencing factors. METHODS: The relevant literature concerning the reconstruction of bladder micturition reflex, neurogenic bladder and urinary reflex and spinal cord repair was retrieved on CNKI, WanFang Data, PubMed and Web of Science. Chinese and English search terms were “neurogenic bladder; spinal cord injury; micturition reflex; spinal cord repair”.   RESULTS AND CONCLUSION: In the process of reconstructing the bladder micturition reflex, there are many factors involved, including the repair and reconstruction of the injured spinal cord, the remodeling of micturition center, the changes of bladder tissue and substances and hormones in and out of the body. In this process, there are mainly the following problems: (1) As a complex process, there are many sites involved in the reconstruction of the micturition reflex, so the main sites of action can be selected for in-depth study, so as to break through the doubts existing in the reconstruction of the micturition reflex pathway. (2) The mechanism of the normal micturition reflex is complex. After spinal cord transection injury, whether the central nucleus mass controlling or participating in the micturition reflex is compensated and the corresponding compensatory mechanism needs to be further investigated. (3) Information communication between the center and the bladder is interrupted after spinal cord transection injury. Whether there is a direct information connection between the center and the bladder remains to be further investigated. (4) The relationship between reconstructing micturition reflex and body fluid after spinal cord transection injury needs further study. In the reconstruction of the bladder micturition reflex, the key treatment is to promote spinal cord repair, nerve reflex reconstruction, substance metabolism and bladder tissue structure adjustment through intervention. Chinese medicine and Western medicine have their methods. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of efficacy of orthopedic robot-assisted versus freehand percutaneous sacroiliac screw fixation for posterior pelvic ring fractures Zhang Guoxu, Zeng Jianbo, Li Jing, Xie Qijun, Zhou Guanbin, Guan Jianhao, Chen Wenchuang, Chen Haiyun 2024, 28 (18):  2932-2938.  doi: 10.12307/2024.033 Abstract ( 272 )   PDF (1025KB) ( 76 )   Save OBJECTIVE: Percutaneous sacroiliac screw internal fixation has become the main surgical procedure for the treatment of posterior pelvic ring fractures; however, the unassisted closure operation requires high operator experience and repeated fluoroscopy increases the radiation hazard for patients and medical personnel. This article compares the clinical efficacy of robot-assisted versus unassisted percutaneous sacroiliac screw placement for posterior pelvic ring fractures by meta-analysis. METHODS: Computer searches of CNKI, WanFang, VIP, CBM, PubMed, Embase, Cochrane Library and ClinicalTrials.gov were conducted from the time of database inception to December 2022. The literature on the clinical efficacy of robot-assisted versus freehand percutaneous sacroiliac screw placement in the treatment of posterior pelvic ring fractures was collected in and outside China. The data were independently screened and extracted by two investigators according to the inclusion and exclusion criteria, respectively. The quality of randomized controlled trials was evaluated using Cochrane risk assessment criteria. The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software for inclusion metrics. Outcome metrics included operative time, intraoperative bleeding, fluoroscopy time, fluoroscopy frequency, number of holes drilled, Majeed postoperative function score, the excellent and good rates of Matta fracture reduction, the excellent and good rates of Gras screw position, fracture healing time and complications.  RESULTS: (1) A total of 13 publications were included, 2 were randomized controlled trials both referring to randomized methods, 11 non-randomized controlled studies were evaluated for quality of literature according to the Newcastle-Ottawa Scale, 1 scored 8, 9 scored 7; and 1 scored 6; the quality of literature was good. A total of 748 patients were included, including 430 in the robot-assisted group and 318 in the freehand group. (2) The results of the meta-analysis showed that the operative time (MD=-28.30, 95%CI:-40.20 to -16.40), intraoperative bleeding (MD=-6.36, 95%CI:-10.06 to -2.66), intraoperative fluoroscopy time (MD=-12.13, 95%CI:-19.54 to -4.72), intraoperative fluoroscopy frequency (MD=-17.39, 95%CI:-29.00 to -5.78), number of intraoperative needle drillings (SMD=-9.50, 95%CI:-14.27 to -4.73) and the excellent and good rates of Gras screw position (OR=8.65, 95%Cl:3.26-22.92) in the robot-assisted group were significantly better than those in the freehand group (P < 0.05). (3) In the robot-assisted group, the overall postoperative complication rate was significantly reduced (OR=0.10, 95%Cl: 0.02-0.48, P < 0.05). (4) No significant difference was detected in fracture healing time (MD=-0.08, 95%CI:-0.21,0.06), the excellent and good rates of Matta fracture repositioning rate (OR=2.06, 95%Cl: 0.97-4.39), and Majeed functional score (MD=0.91, 95%CI: -0.31-2.13) between both groups (P > 0.05).  CONCLUSION: Compared with freehand sacroiliac joint nailing, robotic assistance shortens the operative time, reduces intraoperative bleeding, decreases radiation damage to patients and medical staff, improves the excellent and good rate of screw position, and reduces the overall incidence of postoperative complications in patients, but there was no significant improvement in fracture reduction quality, fracture healing time, and postoperative function. In the future, more large-sample, multicenter, and high-quality randomized controlled trials are still needed to verify. Figures and Tables | References | Related Articles | Metrics

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Biomechanics characteristics during sitting up in knee osteoarthritis patients of different ages: a systematic review and meta-analysis Wang Ke, Zhang Zeyi, Zhang Liwen, Zhang Meizhen 2024, 28 (18):  2939-2946.  doi: 10.12307/2024.049 Abstract ( 253 )   PDF (1724KB) ( 88 )   Save OBJECTIVE: There is no consensus on which sit-up strategy to adopt in knee osteoarthritis patients of different ages. Therefore, this study evaluated the biomechanical characteristics of sit-ups in knee osteoarthritis patients of different ages compared with healthy individuals by meta-analysis system and analyzed the sit-up movement patterns of patients of different ages to provide a reference for improving the sit-up function of patients. METHODS: By March 2023, observational studies of biomechanical characteristics of sitting up in patients with knee osteoarthritis and healthy population were retrieved on PubMed, Web of Science and CNKI. Subjects were required to be patients over 50 years of age with knee osteoarthritis who had Kellgren-Lawrence severity grading ≥I on knee imaging and who had regular knee pain. Subjects were analyzed by age (50-60 years vs. over 60 years) and severity (mild to moderate patients vs. severe patients) subgroups according to inclusion and exclusion criteria. Quality assessment was performed using the modified Down and black scale. Stata 16.0 software was used to perform subgroup analysis to determine the biomechanical characteristics of sitting up in patients with knee osteoarthritis of different ages and severities. RESULTS: A total of 14 randomized controlled trials (824 subjects) were included in the meta-analysis. The mean quality score of all included literature was 76.2, with a range of 66.7 to 86.7, all of which were of medium to high quality and representative. The included studies were of moderate to high quality and representative. Meta-analysis results found that (1) compared to healthy individuals, patients with knee osteoarthritis had longer total sitting up time (SMD=0.92, 95%CI:0.76-1.09), P < 0.001) and longer extension phase time (SMD=0.46, 95%CI:0.18-0.74, P=0.001). Compared to mild to moderate patients, the total duration increased more significantly in severe patients (P < 0.001) and the duration of the extension phase increased more significantly in patients over 60 years of age than in patients 50-60 years of age (P=0.001). (2) Compared to healthy individuals, patients with knee osteoarthritis had greater sitting-up trunk flexion motion range (SMD=0.64, 95%CI:0.37-0.91, P < 0.001); knee flexion motion range (SMD=-0.47, 95%CI: -0.70 to -0.24, P < 0.001) and ankle dorsiflexion motion range (SMD=-0.32, 95%CI:-0.56 to -0.08, P=0.01) were smaller. And knee flexion motion range decreased more significantly in patients over 60 years of age than in patients 50-60 years of age (P < 0.001). (3) The peak hip flexion moment (SMD=-0.57, 95%CI:-0.83 to -0.31, P < 0.001) and peak knee extension moment (SMD=-0.83, 95%CI:-1.08 to -0.59, P < 0.001) were smaller in patients with knee osteoarthritis. CONCLUSION: (1) Patients with knee osteoarthritis over the age of 60 years have a longer sit-up cushion and extension phase than patients aged 50 to 60 years. The increase in total sit-up duration was also more pronounced in patients with higher severity grades. The increased length of sitting up in patients with advanced age and knee osteoarthritis severity may increase the duration of cartilage loading, exacerbate knee pain symptoms, and increase the difficulty of sitting up in this population. (2) Patients with knee osteoarthritis exhibit limited knee and ankle flexion motion range. Knee mobility is more limited in patients over 60 years of age. (3) Patients with knee osteoarthritis have reduced peak hip flexion and knee extension moments, which may be a compensatory strategy for pain relief. Figures and Tables | References | Related Articles | Metrics

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International research trends and hotspots in posterior cruciate ligament reconstruction Ge Hao, Liu Xianwang, Huang Yiwei, Ye Pengcheng, Fan Yueguang, Zeng Jianchun 2024, 28 (18):  2947-2952.  doi: 10.12307/2024.048 Abstract ( 246 )   PDF (2055KB) ( 91 )   Save BACKGROUND: Nowadays, posterior cruciate ligament injury caused by a sports injury or vehicle injury is more common than people think. Posterior cruciate ligament reconstruction is one of the main treatment methods, but there are still a lot of controversies about the surgical method and ligament selection of posterior cruciate ligament reconstruction. OBJECTIVE: To comprehensively analyze the global application trend of posterior cruciate ligament reconstruction and identify promising research hotspots of posterior cruciate ligament reconstruction based on bibliometrics and visual analysis. METHODS: Publications (articles and reviews) related to posterior cruciate ligament reconstruction from 2000 to 2022 were retrieved from the Web of Science (WOS). The country, institution, publication year, author, journal, average citations per item, H index, title, keywords of publication, and the top 25 cited articles were extracted and analyzed in detail. The VOSviewer/citespace/Pajek software was used to analyze the co-occurrence result of keywords to predict the hotspots of posterior cruciate ligament reconstruction. RESULTS AND CONCLUSION: A total of 664 articles were included. (1) In the past 22 years, the number of posterior cruciate ligament reconstruction articles has shown an increasing trend in general. The top 3 countries (the USA, China, and South Korea) accounted for 65.51% of all articles published. The USA has the largest number of publications. The University of Pittsburgh is the largest contributor. Knee Surgery Sports Traumatol Arthrosc and American Journal of Sports Medicine are the most influential journals. Laprade, Robert F. is the professor who has published the most articles in the field of posterior cruciate ligament reconstruction, and Fanelli, GC is the professor who has the highest total chain strength in the field of posterior cruciate ligament reconstruction. (2) The research direction can be divided into the following five clusters: “posterior cruciate ligament anatomical and biomechanical studies”, “posterior cruciate ligament reconstruction prognosis, outcome, and complications”, “posterior cruciate ligament reconstruction surgical method and tendon selection”, “surgical technique”, and “posterior cruciate ligament tear combined with multiple ligament injury”. (3) It is concluded that in terms of the trend of previous years, an increasing number of articles related to posterior cruciate ligament reconstruction will be published in the future. The USA is a world leader in the field of posterior cruciate ligament reconstruction. China and South Korea presented great potential in this area. Anatomical and biomechanical research of posterior cruciate ligament and posterior cruciate ligament reconstruction methods and the selection of tendons may be the future hotspots in the field of posterior cruciate ligament reconstruction. Figures and Tables | References | Related Articles | Metrics