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    28 July 2024, Volume 28 Issue 21 Previous Issue    Next Issue
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    Effect of tibial prosthesis riser length on knee biomechanics after unicompartmental knee arthroplasty
    Zhang Kai, Zhao Mingxin, Yang Yuzhu, Guo Yuan, Ji Binping
    2024, 28 (21):  3281-3285.  doi: 10.12307/2024.086
    Abstract ( 159 )   PDF (1065KB) ( 13 )   Save
    BACKGROUND: Unicompartmental knee arthroplasty can effectively treat severe unilateral knee osteoarthritis. It has been found that posterior tibial cortical fracture is prone to occur after unicompartmental knee arthroplasty. The fracture begins at the keel groove of tibial osteotomy. The tibial prosthesis riser length affects the biomechanical results of the knee joint after unicompartmental knee arthroplasty.
    OBJECTIVE: To investigate the effect of tibial prosthesis riser length on knee biomechanics in unicompartmental knee arthroplasty, and to find out the relationship between prosthesis riser length and anterior and posterior tibial diameters of patients.
    METHODS: Computed tomography image data and commonly used unicompartmental prostheses were selected from a 37-year-old healthy female with no history of knee disease. A natural knee joint model was established and a unicompartmental prosthesis model was built. Eight different lengths of tibial prosthesis risers were established, with a minimum length of 31 mm and a maximum length of 34.5 mm in 0.5 mm increments, for comparison with the commonly used hospital prosthesis riser length of 33.2 mm. The material of the femoral component and tibial disc was cobalt-chromium-molybdenum alloy, and the tibial spacer was ultra-high molecular weight polyethylene. The biomechanical changes of the knee joint were observed using finite element analysis software loaded with 1 000 N over the femur. 
    RESULTS AND CONCLUSION: (1) The tibial stress was minimal at a tibial prosthesis riser length of 33 mm; the anterior cruciate ligament stress was minimal; the lateral meniscus stress was minimal, and the femoral prosthesis stress was minimal. The remaining components were less stressful. (2) The subject’s medial tibial plateau anterior-posterior diameter length was 53 mm, and by calculating the ratio, the optimal ratio of tibial prosthesis riser length to anterior-posterior tibial diameter should be about 62%. If it is lower than this value, aseptic loosening of the prosthesis may occur, and if it is higher than this value, fracture of the bone cortex at the anterior-posterior end of the tibia may occur.
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    Biomechanical characteristics of ligament injury affecting lumbar spine stability
    Li Yinqian, Lyu Jie, Ding Lijun, Wang Duoduo, Guo Panjing, Cao Jinfeng, Zhou Nan, Lyu Qiang
    2024, 28 (21):  3286-3292.  doi: 10.12307/2024.070
    Abstract ( 189 )   PDF (1346KB) ( 25 )   Save
    BACKGROUND: Ligaments are important structures in maintaining the stability of the lumbar spine, and these structures are prone to degradation due to the generated mechanical stress. However, there are few studies on ligament injuries.
    OBJECTIVE: To determine the range of motion and stress of each ligament in the state of motion based on a three-dimensional finite element model, and to systematically explore the influence of ligament injury on the stability of the lumbar spine and its biomechanical significance.
    METHODS: The L4-L5 lumbar finite element model was established. All free forces on the lower surface of L5 were constrained, and a torque of 5 N·m was applied to simulate the motion states of the lumbar spine. Progressive ligament damage was simulated by changing Young’s modulus of the ligament. 
    RESULTS AND CONCLUSION: (1) The extension range of motion of most ligament injuries increased significantly. In contrast, there was no significant change in the lateral bending range of motion. (2) The range of motion of capsular ligament injury increased significantly in flexion, extension and lateral bending. The extension range of motion increased significantly after the anterior longitudinal ligament injury. Intertransverse ligament injury resulted in a significant increase in the lateral bending range of motion. (3) After a single ligament injury, the most significant change in range of motion was observed during extension. After a single ligament injury, the stress of the remaining ligaments increased, especially the capsular ligament. The stress changes of the interspinous ligament and ligamentum flavum were the least obvious. Ligament stress changes least in lateral bending and most in torsion. (4) Ligament damage did not result in major changes in disc pressure, indicating that ligament injury leads to an increased range of motion of the lumbar spine and affects the stability of the lumbar spine. (5) Capsular ligament was stable in flexion, extension and lateral bending. The anterior longitudinal ligament showed a stable extension; the intertransverse ligament stabilizes the lateral curve. (6) Extension exercise is sensitive to a ligament injury, and the pathological changes of the ligament can be examined by extension exercise. (7) Stress compensation was given to the remaining ligaments to maintain the stability of the lumbar spine after a single ligament injury. (8) Interspinous ligament and ligamentum flavum injuries have the least impact on the peripheral ligaments, while capsular ligament injuries have the greatest impact on the peripheral ligaments. (9) The ligament injury has the least effect on the residual ligament stress during lateral bending exercise, while it has the greatest effect on the ligament stress during the twisting exercise. Patients with ligament injury should avoid twisting exercises. Ligament injuries do not affect disc pressure.
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    Finite element mechanical analysis of different screw-rod internal fixation methods in lateral lumbar fusion
    Tang Fubo, Zhong Yuanming, Li Zhifei
    2024, 28 (21):  3293-3298.  doi: 10.12307/2024.077
    Abstract ( 175 )   PDF (1138KB) ( 18 )   Save
    BACKGROUND: Taking into account the stability of spinal fixation, the preferred approach for lateral lumbar interbody fusion is commonly the utilization of posterior bilateral pedicle screws, typically performed in two stages. An alternative method involving the posterior approach of unilateral fixation using lateral vertebral nail rods in the lateral decubitus position has shown potential for enhanced mechanical stability. This technique also offers additional advantages such as reduced operation time, lowered risks, and decreased costs, making it a promising area for further investigation. 
    OBJECTIVE: To compare the biomechanical effect of lateral lumbar interbody fusion with four different types of posterior instruments. 
    METHODS: A validated L3-5 finite element model was modified to simulate four different types of lateral lumbar interbody fusion: Model A: posterior bilateral pedicle screw fixation; Model B: posterior unilateral pedicle screw fixation; Model C: lateral bilateral screw fixation; Model D: lateral unilateral screw fixation. The stability in the range of physiological motion, and the stress difference of screw fixation and interbody fusion apparatus were compared among the models. 
    RESULTS AND CONCLUSION: (1) When compared with the intact model, all reconstructive models displayed decreased motion range at L4-5. Model A had a more obvious range of motion decline. (2) In the flexion, lateral flexion and axial rotation, the differences between the peak stress of the lateral screw fixation and the peak stress of the posterior screw fixation were more than 67.74 MPa, 80.10 MPa and 43.95 MPa, respectively. (3) In terms of internal fixed stress distribution in different reconstructed models, the stress distribution of Model A and Model B screws was mainly concentrated in the body of the pedicle screw, while the peak stress of Model C and Model D screws was mainly concentrated in the tail of the screw. (4) It is suggested that Model A could obtain the best stability and reduce the risk of cage sinking and displacement. Model B could also provide better stability, and could be a choice for lateral fusion on the premise of ensuring stability and fixation. (5) Besides, Model C could achieve the same effect as Model D when the lateral road screw was selected. However, patients with lumbar instability should be cautious to choose unilateral lateral internal fixation, and excessive extension should be avoided to reduce the possibility of screw loosening and fixation fatigue. 
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    Constructing a risk prediction model for failure after locking plate fixation for proximal humeral fractures in the elderly by combining the deltoid tuberosity index with preoperative factors
    Xu Daxing, Ji Muqiang, Tu Zesong, Xu Weipeng, Xu Weilong, Niu Wei
    2024, 28 (21):  3299-3305.  doi: 10.12307/2024.614
    Abstract ( 225 )   PDF (1228KB) ( 17 )   Save
    BACKGROUND: Proximal humeral fracture in older adults is one of the three major osteoporotic fractures. Anatomic locking plate fixation is the first choice for most scholars to treat difficult-to-reduce and complex fracture types. However, the probability of reduction failure after the operation is high, which seriously affects patients’ quality of life. 
    OBJECTIVE: To investigate the correlation between deltoid tuberosity index and postoperative reduction failure of proximal humeral fractures in the elderly, analyze and filter preoperative independent risk factors for reduction failure of proximal humeral fractures in the elderly, and construct and verify the effectiveness of a clinical prediction model. 
    METHODS: The clinical data of 153 elderly patients with proximal humeral fractures who met the diagnosis and inclusion criteria and received open reduction and locking plate surgery in Foshan Hospital of TCM from June 2012 to June 2021 were collected. The patients were divided into the reduction failure subgroup and the reduction maintenance subgroup. The independent risk factors were selected by multivariate Logistic regression analysis, and the nomogram was constructed by R language. After 1000 times of resampling by Bootstrap method, the Hosmer-Lemeshow goodness of fit correlation test, receiver operating characteristic curve, calibration curve, clinical decision, and influence curve were plotted to evaluate its goodness of fit, discrimination, calibration ability, and clinical application value. Fifty-five elderly patients with proximal humeral fractures from June 2013 to August 2021 were selected as the model’s external validation group to evaluate the prediction model’s stability and accuracy.
    RESULTS AND CONCLUSION: (1) Of the 153 patients in the training group, 44 patients met reduction failure after internal plate fixation. The prevalence of postoperative reduction failure was 28.8%. Multivariate Logistic regression analysis identified that deltoid tuberosity index [OR=9.782, 95%CI (3.798, 25.194)], varus displacement [OR=4.209, 95%CI (1.472, 12.031)], and medial metaphyseal comminution [OR=4.278, 95%CI (1.670, 10.959)] were independent risk factors for postoperative reduction failure of proximal humeral fractures in older adults (P < 0.05). (2) A nomogram based on independent risk factors was then constructed. The Hosmer-Lemeshow test results for the model of the training group showed that χ2=0.812 (P=0.976) and area under curve=0.830[95%CI (0.762, 0.898)]. The calibration plot results showed that the model’s predicted risk was in good agreement with the actual risk. The decision and clinical influence curves showed good clinical applicability. (3) In the validation group, the accuracy rate in practical applications was 86%, area under curve=0.902[95%CI (0.819, 0.985)]. (4) It is concluded that deltoid tuberosity index < 1.44, medial metaphyseal comminution, and varus displacement were independent risk factors for reduction failure. (5) The internal and external validation of the risk prediction model demonstrated high discrimination, accuracy, and clinical applicability could be used to individually predict and screen the high-risk population of postoperative reduction failure of proximal humeral fractures in the elderly. The predicted number of patients at high risk is highly matched to the actual number of patients who occur when the model’s threshold risk probability is above 65%, and clinicians should use targeted treatment.
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    Mechanism by which Bushen Yiqi Huayu granule improves callus angiogenesis in osteoporotic rats after fracture operation
    Wang Jun, Dong Zhiwei, Wang Xiaodong, Xiu Xiaoguang
    2024, 28 (21):  3306-3312.  doi: 10.12307/2024.075
    Abstract ( 167 )   PDF (2115KB) ( 16 )   Save
    BACKGROUND: Bushen Yiqi Huayu granule has the effect of replenishing qi and eliminating blood stasis, tonifying kidney and smoothing collages, and is often used in the treatment of osteoporosis. At present, there are few studies on the effect of Bushen Yiqi Huayu granule on the callus angiogenesis of osteoporotic fractures.
    OBJECTIVE: To explore the mechanism of Bushen Yiqi Huayu granule by up-regulating extracellular signal-regulated kinase/mitogen-activated protein kinases (ERK/MAPK) signaling pathway to improve callus angiogenesis after fracturing in osteoporotic rats. 
    METHODS: (1) Bone marrow mesenchymal stem cells from osteoporotic SD rats and bone marrow monocytes from C57BL/6 mice were collected. MTT assay was used to detect different doses of Bushen Yiqi Huayu granule on bone mesenchymal stem cell toxicity. Bone mesenchymal stem cells and bone marrow monocytes were cultured in the medium supplemented with 0 and 1.5 mg/mL Bushen Yiqi Huayu granules, respectively, and osteogenic differentiation and osteoclast differentiation were carried out in vitro. (2) 144 SD rats were randomly divided into sham operation group, model group, granule group and granule+PD98059 group with 36 rats in each group. The osteoporotic model was established in the model group, granule group and granule+PD98059 group, and only part of the adipose tissue near the ovary was removed in the sham operation group. 8 weeks later, all rats received left tibial osteotomy. In the granule+PD98059 group, 5 g/kg Bushen Yiqi Huayu granule was given intragastrically, and 0.3 mg/kg PD98059 was injected into the tail vein. The granule group was given 5 g/kg Bushen Yiqi Huayu granule, and the same volume of normal saline was injected into the tail vein. The sham operation group and model group were given an equal volume of normal saline, and the caudal vein was injected with an equal volume of normal saline. Drug administration was conducted once a day for 8 weeks. Fracture healing and callus angiogenesis were observed by X-ray, micro-computed tomography and microvascular perfusion angiography. Bone mineral density and mechanical strength of the callus were measured. The tibia was observed by hematoxylin-eosin staining and Masson staining. Western blot assay and immunohistochemistry were used to examine the expression of ERK/MAPK signaling pathway-related molecules. 
    RESULTS AND CONCLUSION: (1) Compared with the 0 mg/mL group, the alkaline phosphatase activity, mineralization level, p-ERK1/2 and p-p38 MAPK expression levels of osteocytes increased (P < 0.05), while the density and volume of osteoclasts decreased in the 1.5 mg/mL group (P < 0.05). (2) Compared with the sham operation group, the fracture healing degree of the granule group was similar at 4 and 8 weeks, but there was no significant difference in Lane-Sandhu score, total callus volume, mineralized callus volume, mineralized callus volume/total callus volume, trabecular thickness, vascular number, spacing, thickness, vascular volume/total volume, bone mineral density, ultimate load of callus, stiffness, p-ERK1/2, p-p38 MAPK, p-IκB-α, and p-p65 expression levels (P > 0.05). In the model group and granule+PD98059 group, fracture healing was slow, Lane-Sandhu score, total callus volume, mineralized callus volume, mineralized callus volume/total callus volume, trabecular thickness, vascular number, thickness, vascular volume/total volume, bone mineral density, ultimate load of callus, stiffness, p-ERK1/2, p-p38 MAPK, p-IκB-α, and p-p65 expression levels decreased (P < 0.05), and vascular spacing increased (P < 0.05), compared with the sham operation group. (3) It is indicated that Bushen Yiqi Huayu granule can improve fracture healing, promote callus angiogenesis and alleviate the symptoms of osteoporosis by enhancing the expression of the ERK/MAPK signaling pathway-related molecules in osteoporotic rats.
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    Finite element analysis of intramedullary nail and locking plate fixation for proximal humeral fractures
    Yang Fangjun, Wang Fuyang, Su Yun, Wang Yongze, Yang Cunheng, Wang Tienan
    2024, 28 (21):  3313-3318.  doi: 10.12307/2024.085
    Abstract ( 163 )   PDF (1223KB) ( 12 )   Save
    BACKGROUND: Intramedullary nails and locking plates are widely used in the treatment of proximal humeral fractures, but there is no consensus on the choice of internal fixation. 
    OBJECTIVE: To compare the biomechanical stability of intramedullary nails and locking plates in the treatment of two-part and three-part proximal humeral fractures by finite element analysis.
    METHODS: CT data of the humerus of a volunteer were collected and imported into Minics 21.0, Geomagic Wrap, Soildwork 2017, and Abaqus 2021 to establish finite element models of two-part and three-part fractures treated with two internal fixation methods, respectively. Group A: two-part fracture fixed with intramedullary nail model; group B: two-part fracture fixed with locking plate model; group C: three-part fracture fixed with intramedullary nail model; group D: three-part fracture fixed with locking plate model. The stress distribution, displacement degree, and maximum value of the humerus and internal fixation were compared and analyzed. 
    RESULTS AND CONCLUSION: (1) The maximum stress and maximum displacement of the humerus were the smallest in the model of group A, and the maximum stress and maximum displacement of the humerus were the largest in the model of group D. The stress of the locking plate group was mainly concentrated in the medial inferior part of the humeral head and the screw hole area, while the stress of the intramedullary nail group was mainly concentrated around the fracture line and the lateral inferior part of the surgical neck of the humerus. There is no significant difference in displacement distribution between the two. It is mainly concentrated in the distal humerus. (2) The maximum stress value of the intramedullary nail was the lowest in the model of group A, and the maximum stress value of the locking plate was the highest in the model of group D. The maximum stress of the two internal fixations was mainly concentrated in the talar screw and the connection with the internal fixation. The stress cloud distribution of the locking steel plate was concentrated, while the stress cloud distribution of the intramedullary nail was more uniform. (3) The results showed that compared with the locking plate, the intramedullary nail had more biomechanical advantages, and this advantage was more obvious in three-part fractures.
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    Finite element analysis of femoral neck fracture treated by internal fixation of femoral neck system under nonanatomical reduction
    Jia Jizhai, Yin Guikun, Xie Hui, Fu Weimin, Han Shun, Ma Yingjie, Wen Zhun, Wang Benjie
    2024, 28 (21):  3319-3325.  doi: 10.12307/2024.081
    Abstract ( 183 )   PDF (1921KB) ( 12 )   Save
    BACKGROUND: Irreducible femoral neck fracture was difficult to obtain anatomic reduction. As a new type of internal fixation, the femoral neck system is still blank for the treatment of non-anatomical reduced femoral neck fractures.
    OBJECTIVE: To explore the biomechanical stability of femoral neck system internal fixation under nonanatomical reduction in the treatment of femoral neck fractures based on finite element analysis.
    METHODS: CT data of the hip joint of a healthy female adult were obtained. Anatomical reduction of femoral neck fracture models with Pauwels angles of 30°, 50°, and 70° were established using Mimics 21.0, Geomagic Wrap 2021, and SolidWorks 2020. The fracture proximal ends of the three anatomical reduction models were shifted upward by 2 mm along the fracture line, and three positive buttress models with different Pauwels angles were obtained. In the same way, three negative buttress models were acquired by shifting downward by 2 mm. SolidWorks 2020 was used to make the femoral neck system internal fixation, and the nine femoral neck fracture models were assembled with the femoral neck system. Then Ansys 19.0 was used for finite element analysis. The displacement distribution and maximum displacement, stress distribution and maximum stress of the femur and femoral neck system were recorded under 2 100 N stress. 
    RESULTS AND CONCLUSION: (1) When Pauwels angles were 30°, 50°, and 70°, the maximum stresses of the femoral neck system appeared to be concentrated at the junction of the sliding hip screw and anti-rotation screw. The maximum femur stresses appeared to be concentrated in the medial cortex of the femur. The maximum displacement was concentrated at the upper of the femoral head and femoral neck system. (2) When Pauwels angles were 30° and 50°, the maximum displacement and maximum stress of the femoral neck system and femur were: negative buttress > anatomical reduction > positive buttress. (3) When Pauwels angle was 70°, the maximum displacement and maximum stress of the femoral neck system were: negative buttress > anatomical reduction > positive buttress; the maximum displacement and maximum stress of the femur were: negative buttress > positive buttress > anatomical reduction. (4) With the increase of Pauwels angle, the biomechanical advantage of the positive buttress was weakening. However, it was better than a negative buttress. When Pauwels angle was 30°, positive buttress was more stable than anatomical reduction. When Pauwels angle was 50°, the biomechanical difference between positive buttress and anatomical reduction became smaller. When Pauwels angle was 70°, the stability of anatomical reduction was slightly better than positive buttress. (5) If it was difficult to achieve anatomical reduction of femoral neck fracture during operation, but the positive buttress had been displaced within 2 mm, the femoral neck system could be used to offer stable mechanical fixation. It is necessary to avoid negative buttress reduction. 
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    Structural design of tibial intramedullary stem of artificial knee joint
    Cao Xuekun, Dong Wanpeng, Dong Yuefu, Zhang Zhen, Zhang Jichao, Li Jiayi, Su Dejun, Ma Honghao
    2024, 28 (21):  3326-3333.  doi: 10.12307/2024.093
    Abstract ( 209 )   PDF (4478KB) ( 52 )   Save
    BACKGROUND: With social progress, the incidence rate of knee osteoarthritis is getting higher and higher in the face of the rapidly developing aging problem in the social population, and the number of total knee replacement operations is gradually increasing.
    OBJECTIVE: To study the relationship between prosthesis size and stress shielding by improving the tibial prosthesis base.
    METHODS: A female patient with severe knee osteoarthritis was selected. Based on Mimics, through extracting the bone structure of the knee joint and simulating the total knee replacement surgery, osteotomy, positioning, and implantation operations were carried out to establish the geometric modeling of the total knee replacement prosthesis (including the femoral prosthesis, tibial bracket, and tibial pad), and improve the design of the tibial prosthesis base, analyze the effect of different tibial prosthesis bases on stress shielding of surrounding bone tissue.
    RESULTS AND CONCLUSION: (1) Compared with single-stem tibial intramedullary stem prosthesis, the design of four-post tibial intramedullary stem prosthesis created a certain degree of stress shielding around the short stem. However, compared with a thicker single long stem, this stress shielding effect was significantly reduced, and the load was evenly distributed among the four short stems, so there was no stress concentration at the bottom of the pile. (2) The design with a rectangular hole in the middle not only provided relatively good stability, but also helped to reduce stress shielding of cancellous bone to a certain extent, with a reduction rate of 77.5%. (3) Compared with a single-stem tibial intramedullary stem prosthesis, both the four-post tibial intramedullary stem prosthesis and the four-post tibial intramedullary stem prosthesis with a hole in the middle have good stability, which can reduce stress shielding to a certain extent without causing stress concentration, providing theoretical guidance for the design of the tibial intramedullary stem. 
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    Value of mean platelet volume combined with thromboelastography in predicting thrombosis after total knee arthroplasty
    Chen Jiahao, Feng Shuo, Wang Hu, Zhang Qiang, Chen Xiangyang
    2024, 28 (21):  3334-3338.  doi: 10.12307/2024.076
    Abstract ( 166 )   PDF (815KB) ( 55 )   Save
    BACKGROUND: Thromboelastography plays an important role in identifying the hypercoagulable state of blood and thrombosis in humans. Recent studies have shown a correlation between an increase in mean platelet volume and thrombosis. We can therefore ask whether the combined diagnosis of thromboelastography and mean platelet volume is a more accurate predictor of thrombosis. 
    OBJECTIVE: To predict the status of blood and the occurrence of thrombosis after total knee arthroplasty by means of mean platelet volume combined with thromboelastography.
    METHODS: One hundred and twenty patients who underwent unilateral total knee arthroplasty between May 2015 and March 2022 were collected. Patients were divided into 60 patients in the thrombosis group and 60 patients in the control group based on ultrasound findings on postoperative day 7. Whole blood cell and thromboelastography were performed 1 day before, 1 and 7 days after surgery, respectively. Multifactorial analysis was used to investigate independent predictors of thrombosis after total knee arthroplasty. The receiver operating characteristic curve and area under the curve were measured in the subjects.
    RESULTS AND CONCLUSION: Mean platelet volume correlated most strongly with maximum amplitude, followed by coagulation angle. Mean platelet volume and coagulation angle on postoperative day 1 were independent predictors of thrombosis. Mean platelet volume tended to rise and then fall in patients with thrombosis. The best critical value for mean platelet volume to predict thrombosis was 10.73 fL. The area under the receiver operating characteristic curve of subjects was 0.665 (95%CI: 0.568-0.762, P < 0.05]; whereas the area under the receiver operating characteristic curve for subjects using mean platelet volume combined with coagulation angle was 0.815 (95%CI: 0.750-0.879, P < 0.05). In addition, the maximum amplitude, coagulation angle, coagulation index and mean platelet volume were significantly higher in the thrombosis group than in the control group postoperatively (P < 0.05). The results suggest that the mean platelet volume can reflect the hypercoagulable state of blood after surgery, and the combination of mean platelet volume and coagulation angle on day 1 after total knee arthroplasty can improve the prediction of thrombosis.
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    Measurement of three-dimensional parameters of lower cervical facet joints and design of transarticular facet screw guide
    Li Zhongwei, Chu Fuchao, Gao Chunjiu, Yuan Feng
    2024, 28 (21):  3339-3343.  doi: 10.12307/2024.066
    Abstract ( 170 )   PDF (907KB) ( 33 )   Save
    BACKGROUND: In recent years, cervical facet joints have been paid more and more attention to the pathogenesis and surgical treatment of cervical spondylosis, but there are few anatomical studies on adult lower cervical facet joints. 
    OBJECTIVE: To measure three-dimensional parameters of the lower cervical facet to provide a basis for the design of the lower cervical transarticular facet screw guide.
    METHODS: From June 2021 to June 2022, 100 cases receiving cervical spine CT examination in the Affiliated Hospital of Xuzhou Medical University were selected, with 50 males and 50 females, aged 20-50 years. After screening, each image showed no cervical spinal stenosis, cervical disc herniation, obvious bone hyperplasia, infection or tumor. The sagittal inclination angle of each segment of the cervical spine facet joint and the angle between the lower cervical spine facet joint surface and the transarticular facet joint screw at the C3-7 levels were measured after 3D reconstruction. According to the measurement results of statistical analysis, a lower cervical transarticular facet screw guide was designed using CAD software.  
    RESULTS AND CONCLUSION: The inclination angle of the cervical facet joint surface on the sagittal plane was distributed in a U-shaped shape centered on C5, and the magnitude relationship was C7 > C6 > C3 > C4 > C5. The relationship between transarticular facet screw angles on the sagittal plane was: C6/7 > C5/6 > C4/5 > C3/4, where the angle of C3/4, C4/5 and C5/6 was close to 90°, and the angle of C6/7 exceeded 100°. By measuring the sagittal inclination angle of the cervical facet joint and the angle of the transarticular facet screw, this study designed a guide that was perpendicular to the lower cervical facet joint surface in the sagittal plane.
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    One-year follow-up of visual trephine arthroplasty for single-level lumbar disc herniation
    Chen Feng, Li Dongya, Pan Bin, Yuan Haibo, Wu Jibin
    2024, 28 (21):  3344-3348.  doi: 10.12307/2024.083
    Abstract ( 175 )   PDF (921KB) ( 48 )   Save
    BACKGROUND: With the progress of minimally invasive procedures of the spine, endoscopic lumbar decompression has been widely used in the treatment of lumbar disc herniation. The indications of different endoscopic surgical approaches are different, and the decision of the specific operation plan needs to be combined with the actual situation and the choice of clinical surgeons.
    OBJECTIVE: To investigate the short-term effect in treatment of single-level lumbar disc herniation by percutaneous endoscopic visual trephine arthroplasty.
    METHODS: Ninety patients with single-level lumbar disc herniation admitted to Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021 who met the inclusion criteria were included in this study. According to different approaches of percutaneous endoscopic visual trephine arthroplasty, they were divided into transforaminal approach group (control group, n=48 cases) and translaminar approach group (trial group, n=42 cases). The general information of patients in the two groups was recorded, including sex, age, disease course, body mass index, incision length, operation time, intraoperative fluoroscopy times, length of hospital stay, and amount of blood loss. Visual analog scale score of pain and Japanese Orthopaedic Association score at different follow-up stages were assessed. The modified MacNab standard was used to evaluate the clinical outcome at the last follow-up, and the postoperative complications and recurrence rate were measured.
    RESULTS AND CONCLUSION: (1) The operation time and intraoperative fluoroscopy times of the trial group were less than those of the control group, and the difference was statistically significant (P < 0.05). However, there were no significant differences in intraoperative blood loss, incision length, and hospital stay between the two groups (P > 0.05). (2) There was no significant difference in visual analog scale score of pain and Japanese Orthopaedic Association score between the two groups before surgery (P > 0.05). However, visual analog scale of pain and Japanese Orthopaedic Association score were significantly improved 1 week, 3, 6, and 12 months after surgery (P < 0.05). (3) At the last follow-up, the good and good rate of modified MacNab standard was 94% in the control group and 95% in the trial group. (4) In the control group, one patient still felt back and leg pain after surgery, underwent open surgery, and recovered well after surgery without obvious sequelae. There were no postoperative complications or recurrent cases in the trial group. (5) It is concluded that both percutaneous transforaminal approach and interlaminar approach have good short-term clinical efficacy and high patient satisfaction in the treatment of single-level lumbar disc herniation, but the time of the interlaminar approach is shorter and has less intraoperative fluoroscopy times.
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    Effects of distal tibial tuberosity-high tibial osteotomy on ankle angle on coronal plane
    Yin Yuetong, Zhu Guangyu, Tian Xiangdong, Tan Yetong, Ma Sheng, Xue Zhipeng, Hu Yuanyi, Li Xiaomin
    2024, 28 (21):  3349-3354.  doi: 10.12307/2024.091
    Abstract ( 180 )   PDF (1506KB) ( 46 )   Save
    BACKGROUND: Distal tibial tuberosity-high tibial osteotomy is a surgical treatment for knee osteoarthritis, but there is still a lack of clinical studies on its effect on ankle joints. 
    OBJECTIVE: To observe the effects of distal tibial tuberosity-high tibial osteotomy on ankle angle on coronal plane of the radiography of the full length of lower limb in weight loading.  
    METHODS: Data of 40 patients (41 knees) with distal tibial tuberosity-high tibial osteotomy from March 2021 to March 2022 were retrospectively analyzed, including 31 females and 9 males, 20 left knees and 21 right knees, aged 49-75 years, mean (63.44±6.57) years. The radiographic data of the full length of the lower limb in weight loading were collected before, week 2 and week 48 postoperatively. Hip-knee-ankle angle, talar tilt angle, tilt angle of the ankle, tibiocrural angle, and tibial articular surface angle were measured before and after surgery.  
    RESULTS AND CONCLUSION: (1) Hip-knee-ankle angle improved from (-6.24±3.69)° before operation to (2.59±3.49)° week 2 postoperatively and (2.15±3.49)° week 48 postoperatively. The tilt angle of the ankle changed from (-7.90±3.11)° before operation to (-2.51±2.59)° week 2 postoperatively and (-2.46±2.42)° week 48 postoperatively, with statistically significant difference (P < 0.001). (2) There was no significant difference in talar tilt angle, tibiocrural angle, and tibial articular surface angle before and week 2 postoperatively. (3) No significant difference in the angle changes was detected between week 2 and week 48 postoperatively. (4) It is indicated that distal tibial tuberosity-high tibial osteotomy can not only correct genu varus but also improve ankle angle. This result remains stable after 48 weeks of weight-bearing activities.
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    Correlation of tibial and fibular fractures in Pilon fractures
    Xu Shizhuang, Chen Hongquan, Hou Jianwen, Sun Kefu
    2024, 28 (21):  3355-3360.  doi: 10.12307/2024.084
    Abstract ( 171 )   PDF (916KB) ( 11 )   Save
    BACKGROUND: The Pilon fracture has a complex fracture line and a comminuted fracture fragment. It is often associated with bone loss and soft tissue damage and is one of the most difficult fractures to treat clinically.
    OBJECTIVE: To analyze the correlation between tibial and fibular fractures in Pilon fractures.
    METHODS: A retrospective analysis was conducted on 188 patients with Pilon fracture in the Department of Trauma Orthopedics, The Second People’s Hospital of Lianyungang City from January 2014 to January 2022. Imaging data of these patients were collected. Fibular fracture level, fibular fracture type, number of fibular fracture blocks, tibial position status, main fracture blocks of the tibia, size of medial fracture blocks of the tibia, tibial fracture angle, Topliss classification (sagittal plane) and Topliss classification (coronal plane) were summarized into a database. SPSS 25.0 was used to analyze the data of tibia and fibula in Pilon fractures by Spearman correlation analysis. On the basis of the correlation, multiple disordered Logistic regression was used to further analyze the correlation.
    RESULTS AND CONCLUSION: (1) Spearman correlation analysis showed that tibial fracture angle was positively correlated with fibular fracture type, fibular fracture level and fibular fracture number. Tibial position status was positively correlated with tibial fracture angle and Topliss classification (coronal plane), but negatively correlated with major tibial fracture blocks and Topliss classification (sagittal plane). The level of fibular fracture was positively correlated with the type of fibular fracture and the number of fibular fractures. The main fracture blocks of the tibia were positively correlated with Topliss classification (coronal plane) and negatively correlated with Topliss classification (sagittal plane). (2) Multiple Logistic regression analysis showed that: the level of fibular fracture was correlated with the type of fibular fracture (P < 0.05); the number of fibular fractures was correlated with the main fracture block of tibia (P < 0.05). (3) It is indicated that the more inclined the ankle joint was to the valgus, the more likely it was to lead to fibular fracture, and the higher the fibular fracture level, the more serious the fibular fracture degree, the more complex the fibular fracture type, the larger the tibial fracture angle, the more the tibia presented Topliss classification (coronal plane) fracture. (4) When the ankle joint was more inclined to be in varus or varus + dorsiflexion, the fibula often did not fracture or simple fracture occurred, and the lower the fracture level, the smaller the tibial fracture angle, the more Topliss classification of the tibia (sagittal plane), the more main fracture blocks of the tibia, the larger the medial fracture block. When the ankle joint is in the dorsiflexion, it often results in a simple fibular fracture with a posterolateral tibial fracture.
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    Risk factors of postoperative mortality of femoral neck fractures in elderly patients and construction of a nomogram predictive model
    Li Zhipeng, Huan Dawei, Yuan Zhaofeng, Qiu Yue, Zhang Chao, Xia Tianwei, Shen Jirong
    2024, 28 (21):  3361-3366.  doi: 10.12307/2024.095
    Abstract ( 166 )   PDF (918KB) ( 18 )   Save
    BACKGROUND: With a gradually aging population, improving the ability to screen for the risk of death after arthroplasty and implementing timely personalized intervention programs for the increasing number of elderly patients with femoral neck fractures is key to improving the postoperative status of patients and prolonging survival expectations.
    OBJECTIVE: To investigate the risk factors for postoperative mortality in elderly patients with femoral neck fractures and to construct a nomogram predictive model to predict their mortality risk.
    METHODS: The study was conducted on 155 elderly patients (≥ 65 years old) who underwent arthroplasty for femoral neck fracture from January 2016 to January 2021, and 147 patients who met the inclusion criteria were analyzed to collect clinical data that may affect the patients’ postoperative mortality. Single-factor and multi-factor Cox regression analyses were successively used to screen independent risk factors associated with postoperative mortality. The column line graph model was constructed and validated using Rstudio software.
    RESULTS AND CONCLUSION: (1) Age, frailty (age-adjusted Charlson comorbidities score), preoperative activity status, osteoporosis, and postoperative serum albumin level were five independent risk factors for postoperative mortality in elderly patients with femoral neck fractures (P < 0.05). (2) The nomogram predictive model was constructed based on the results of multifactorial analysis, with a consistency index of 0.819 (95%CI: 0.771-0.868). Receiver operating characteristic curve analysis showed that the area under curve for 1-year and 3-year survival prediction was 0.854 3 and 0.726 3, respectively, indicating that the nomogram predictive model has good discriminatory and predictive power; calibration curve and decision curve analysis also showed good model discriminative power and clinical utility value. (3) The constructed nomogram predictive model has good diagnostic efficacy and accuracy, and can effectively assess the risk of postoperative death of patients.
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    Effects of intravenous and topical tranexamic acid on blood loss and inflammatory response after posterior cervical decompressive laminectomy
    Tan Yubo, Xia Yingpeng
    2024, 28 (21):  3367-3372.  doi: 10.12307/2024.092
    Abstract ( 178 )   PDF (835KB) ( 20 )   Save
    BACKGROUND: With the increase of the incidence of cervical spondylosis, it is particularly important to control the postoperative bleeding and related inflammatory reaction of cervical vertebra. 
    OBJECTIVE: A prospective study was conducted to investigate the combined effect of intravenous and topical tranexamic acid of different concentrations on postoperative blood loss and inflammatory response during posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion.  
    METHODS: From January 2020 to December 2022, 150 patients who were scheduled to undergo posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion for cervical spondylotic myelopathy in Tianjin People’s Hospital were enrolled in the study. Patients were divided into A, B, and C groups (n=50) by randomized double-blind lottery. The patients in the A, B, and C groups were treated with 1%, 3%, and 5% intravenous and topical tranexamic acid solution, respectively. Postoperative blood loss and inflammation-related indicators were compared among three groups. The occurrence of venous thromboembolism and hematoma was observed after operation. 
    RESULTS AND CONCLUSION: (1) There were significant differences in blood loss-related indexes, such as intraoperative blood loss, overall blood loss, and occult blood loss among the three groups (P < 0.01). The above indexes were significantly lower in groups B and C than that in group A. There was no significant difference between groups B and C (P > 0.05). (2) On days 1 and 3 after surgery, the levels of inflammatory indicators including serum C-reactive protein and interleukin-6 were increased to varying degrees in the three groups compared to before surgery (P < 0.05). As the drug concentration increased, its expression decreased, and there was a significant difference among the three groups (P < 0.001). (3) Two cases of intramuscular venous thrombosis appeared in each of the three groups after surgery. No hematoma or pulmonary embolism occurred in all three groups. (4) It is concluded that in posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion, intravenous combined with topical application of different concentrations of tranexamic acid is effective in reducing perioperative blood loss and inflammatory response. 3% tranexamic acid achieves the same effect without significantly increasing the risk of postoperative venous thromboembolism.
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    Free vascularized fibular grafting in treatment of femoral head osteonecrosis
    Huang Jie, Shi Yanghua, Tan Zhen, Bo Zhandong
    2024, 28 (21):  3373-3379.  doi: 10.12307/2024.080
    Abstract ( 180 )   PDF (1706KB) ( 8 )   Save
    BACKGROUND: Free vascularized fibular grafting is an effective hip preservation treatment for femoral head osteonecrosis, but its influencing factors are still controversial.
    OBJECTIVE: To explore the clinical efficacy of free vascularized fibular grafting for femoral head osteonecrosis, and the influence of the etiology and severity of femoral head osteonecrosis on its efficacy.
    METHODS: Clinical data and clinical efficacy scores of preoperative and postoperative hip joints in 63 patients with femoral head osteonecrosis (73 cases of hip) were enrolled. The subjects were divided into three groups by the etiological classification criteria of femoral head osteonecrosis, including glucocorticoid-associated, alcohol-associated, and idiopathic groups, and also were divided into three groups by the Ficat classification system, including Ficat II, Ficat III and Ficat IV groups. The effects of etiological classification and lesion degree on the clinical efficacy of free vascularized fibular grafting for femoral head osteonecrosis were analyzed.
    RESULTS AND CONCLUSION: (1) The visual analog scale scores in all periods after free vascularized fibular grafting for femoral head osteonecrosis were significantly decreased compared with preoperative data (P < 0.001), and Harris scores were significantly increased compared with preoperative data (P < 0.001). (2) In the glucocorticoid-associated, alcohol-associated, and idiopathic groups, except the glucocorticoid-associated group, postoperative Harris scores were significantly increased 2 and 3 years after surgery in other groups compared with preoperative data (P < 0.05). (3) In the three groups of Ficat II, Ficat III, and Ficat IV, the postoperative Harris scores of Ficat II and Ficat III groups were significantly increased compared with preoperative data (P < 0.05), while the difference was not significant in the Ficat IV group between the preoperative and postoperative data (P > 0.05). (4) These results indicate that the clinical effect of free vascularized fibular grafting for the femoral head osteonecrosis is significant, which can reduce hip pain and improve hip joint function. It may not be affected by the etiology, but by the severity of the femoral head osteonecrosis.
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    Establishment of a nutritional risk prediction model for femoral intertrochanteric fractures treated with intramedullary nails
    Zhang Qiang, Li Dawei, Liu Ninghao, Li Qianru, Zheng Yingjie, Zhang Zhifeng
    2024, 28 (21):  3380-3384.  doi: 10.12307/2024.069
    Abstract ( 155 )   PDF (899KB) ( 32 )   Save
    BACKGROUND: Patients with femoral intertrochanteric fracture may have nutritional risks during proximal femoral nail anti-rotation surgery, and a clinical predictive model is established based on nutritional assessment tools.
    OBJECTIVE: To establish the nomogram of the nutritional risk prediction model for patients with intertrochanteric fracture after proximal femoral nail anti-rotation fixation and evaluate the accuracy of the model.  
    METHODS: From December 2018 to July 2022, patients with femoral intertrochanteric fractures who underwent proximal femoral nail anti-rotation fixation in First Department of Orthopedics, Second Affiliated Hospital of Baotou Medical College were selected as the study subjects. The nutritional risk status of patients was assessed using nutritional risk screening 2002. Logistic regression was used to build the model. The receiver operating characteristic curve, Calibration plot calibration curve, and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the discrimination, calibration and clinical applicability of the prediction model. The model was visualized using Nomogram diagrams. 
    RESULTS AND CONCLUSION: (1) Seventy-six patients were included according to the inclusion criteria. The incidence of nutritional risk was 80% after being assessed using nutritional risk screening 2002. (2) The results of Logistic regression analysis demonstrated that age ≥ 77 years old, body mass index < 22.80 kg/m2, upper arm circumference < 25.01 cm, hemoglobin < 98.51 g/L, albumin < 31.61 g/L, and prealbumin < 138.56 g/L were all independent risk factors for nutritional risk (P < 0.05). (3) The area under the receiver operating characteristic curve was 0.919 (95%CI: 0.843-0.994). (4) The results of the Hosmer-Lemeshow goodness-of-fit test displayed that nutritional risk prediction value was high. (5) It is concluded that the nutritional risk assessment model constructed in this study has a good degree of discrimination and calibration, and has a certain predictive ability, which can be used as a reference tool for nutritional risk assessment of patients after proximal femoral nail anti-rotation fixation.
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    Applicable techniques for subchondral separation of femoral head necrosis treated by tissue engineering
    Huang Yixuan, Chen Hao, Xue Peng, Xi Hongzhong, He Shuai, Sun Guangquan, Du Bin, Liu Xin
    2024, 28 (21):  3385-3392.  doi: 10.12307/2024.601
    Abstract ( 189 )   PDF (990KB) ( 86 )   Save
    BACKGROUND: The appearance of the crescent sign in femoral head necrosis is a “turning point” in the progression of the disease, and repairing and stabilizing the bone-cartilage interface is particularly important in preventing further progression and collapse of the femoral head. Tissue engineering offers potential advantages in the simultaneous repair and integration of the bone-cartilage interface.  
    OBJECTIVE: To review potentially suitable techniques addressing the subchondral separation in femoral head necrosis. 
    METHODS: Relevant articles from January 1970 to April 2023 were searched in PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) using English search terms “femoral head necrosis, avascular necrosis of femoral head, osteonecrosis of femoral head” and Chinese search terms “femoral head necrosis, subchondral bone, cartilage, integration of cartilage and subchondral bone”. A total of 114 articles were included for review and analysis.
    RESULTS AND CONCLUSION: (1) Structural defects, ischemic and hypoxic environment, inflammatory factors, and stress concentration may cause subchondral separation in osteonecrosis of the femoral head. Subchondral bone collapse and failure of hip-preserving surgery may be associated. Integration of tissue engineering scaffolds with the bone-cartilage interface is one potential approach for treating subchondral separation in osteonecrosis of the femoral head. (2) Current literature suggests that multiphase scaffolds, gradient scaffolds, and composite materials have shown improvements in promoting cell adhesion, proliferation, and deposition of bone and cartilage matrix. These advancements aid in the integration of scaffolds with the bone-cartilage interface and have implications for the treatment of subchondral separation in osteonecrosis of the femoral head. (3) Surface modifications of scaffolds can enhance interface integration efficiency, but they have their advantages and disadvantages. Scaffolds providing different environments can induce differentiation of mesenchymal stem cells and facilitate integration between different interfaces. (4) Future scaffolds for subchondral separation in osteonecrosis of the femoral head are expected to be composite materials with gradient and differentiated biomimetic structures. Surface modifications and stem cell loading can promote integration between the bone-cartilage interface and scaffolds for therapeutic purposes, but further experimental verification is still needed. Challenges include synchronizing scaffold degradation rate with repair progress and ensuring stability between different interfaces.
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    Novel programmed cell death in periprosthetic osteolysis
    Liang Xiaolong, Zheng Kai, Geng Dechun, Xu Yaozeng
    2024, 28 (21):  3393-3399.  doi: 10.12307/2024.065
    Abstract ( 101 )   PDF (1031KB) ( 44 )   Save
    BACKGROUND: In addition to apoptosis, recent studies have discovered novel forms of programmed cell death in periprosthetic osteolysis, which is involved in regulating local chronic inflammation and the outcome of osteoblast and osteoclast under pathological conditions. This has an important value for the treatment and prognosis of periprosthetic osteolysis.
    OBJECTIVE: To provide new ideas and strategies for the prevention and treatment of periprosthetic osteolysis by summarizing studies on the novel forms of programmed cell death.
    METHODS: The first author used the computer to search the articles published from 2005 to 2022. Chinese search terms “wear particles, periprosthetic osteolysis, programmed cell death, apoptosis, autophagy, pyroptosis, necrotizing apoptosis, iron death” were used to search the databases of CNKI, WanFang and VIP. English search terms “osteolysis, wear debris, wear particles, peri*prosthetic osteolysis, PPOL, aseptic loosening, autophagy, regulated cell death, programmed cell death, apoptosis, pyroptosis, autophagic cell death, autophagy, necroptosis, ferroptosis” were used for search in PubMed and Web of Science databases. A total of 68 articles were finally included according to the inclusion criteria.
    RESULTS AND CONCLUSION: (1) Inadequate or excessive activation of autophagy can cause cell death, inhibit bone formation, and promote bone resorption, leading to bone metabolism disorders and osteolysis. (2) Recent studies have paid close attention to pyroptosis in periprosthetic osteolysis, where the Nod-like receptor, pyrin containing 3 inflammasome plays an important role in local inflammation. Inhibiting pyroptosis can effectively alleviate osteolysis. (3) In vitro studies have shown that necroptosis can inhibit the formation and function of osteoblasts and osteoclasts, affecting the process of osteolysis and destruction. (4) Ferroptosis is the newest form of programmed cell death, which is regulated by complex signaling pathways and mechanisms, but is not yet fully understood. (5) Autophagy, pyroptosis, necroptosis, and ferroptosis play important roles in the development of periprosthetic osteolysis, and their associated signaling pathways and genes require further investigation.
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    Regulation of bone tissue cells by tumor necrosis factor-alpha
    Wang Xin, Wubulikasimu·Mijiti, Huang Jinyong, Xie Zengru
    2024, 28 (21):  3400-3406.  doi: 10.12307/2024.082
    Abstract ( 205 )   PDF (1094KB) ( 29 )   Save
    BACKGROUND: Tumor necrosis factor-α is a broadly acting inflammatory cytokine that plays an important role in the immune inflammatory response of the body. The current study concluded that tumor necrosis factor-α has significant biological effects on a variety of bone tissue cells.
    OBJECTIVE: To summarize the expression and action pathways of tumor necrosis factor-α in osteoblastic and osteoclastic cells to further elucidate the regulatory role of tumor necrosis factor-α on bone tissue cells. 
    METHODS: PubMed and CNKI were searched until March 2023, and the Chinese search terms included “tumor necrosis factor α, osteoblast, osteoclast, osteoclast, osteoprogenitor”; the English search terms included “TNF-α, osteoblast, osteoclast, osteocyte, osteoprogenitor cell”. The corresponding criteria were established according to the research needs, and the final literature was screened. Finally, 77 articles were included for review. 
    RESULTS AND CONCLUSION: (1) Tumor necrosis factor-α is participating in regulating the recruitment, appreciation, and differentiation of osteoprogenitor cells, but leads to osteoprogenitor cell stripping and death under specific environments. It also participates in bone resorption directly or indirectly through secreted enzymes. (2) Tumor necrosis factor-α can increase the level of inflammatory factors in the environment by activating relevant signaling pathways in osteoclast lineage cells or directly induce the generation of osteoclasts in specific environments. (3) Tumor necrosis factor-α can inhibit osteogenic differentiation by activating nuclear factor-κB signaling pathway, inhibiting the expression of transcription factors such as RUNX2 and Osterix, and inducing apoptosis and necrotizing apoptosis in osteoblasts. (4) Tumor necrosis factor-α inhibits osteogenesis and promotes osteoclastogenesis by activating the nuclear factor-κB signaling pathway in osteocytes and inducing cytokines such as RANKL, SOST, and DKK1, while enhancing apoptosis of the osteocytes, as well as bone resorption around the apoptotic bone tissue. (5) Taken together, the effect of tumor necrosis factor-α in bone tissue is mainly to inhibit osteogenesis and promote osteoclastosis. The biological effect of tumor necrosis factor-α in bone tissue cells is usually dependent on the activation of tumor necrosis factor receptor and nuclear factor-κB signaling pathways. (6) The interaction of tumor necrosis factor-α with other tissue cell types surrounding bone tissue and its role in bone immune regulation still deserve attention in future studies.
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    Effects of biomechanics on biological characteristics of osteoblasts
    Xiong Wanqi, Li Zhenhao, Cui Yan, Liu Jiahe, Li Chenzhi, Wu Mingjian, Li Yancheng, Yang Fan, Liu Baoyi
    2024, 28 (21):  3407-3412.  doi: 10.12307/2024.088
    Abstract ( 210 )   PDF (805KB) ( 29 )   Save
    BACKGROUND: Bone formation is the process by which osteoblasts synthesize and secrete osteoid and promote its mineralization, which generally involves mechanical signal transduction. Osteoblasts are primarily regulated by mechanical factors such as gravity, compressive stress, tensile stress, fluid shear stress, and hydrostatic pressure in vivo, and different mechanical stimuli modulate the proliferation, differentiation, and apoptosis of osteoblasts through various mechanisms, including hormones, cytoskeletal proteins, and microRNAs. By clarifying the effects of biomechanical forces on osteoblasts, it provides ideas and a reference basis for the treatment of osteometabolic diseases involving osteoblasts.
    OBJECTIVE: To review the effects of different biomechanical forces on the biological characteristics of osteoblasts.
    METHODS: We conducted a literature search using PubMed, Web of Science, FMRS, CNKI, and WanFang databases for relevant publications published from 2000 to 2023, covering basic research and tissue engineering studies related to the effects of biomechanical forces on osteoblasts. Ultimately, a total of 70 articles were reviewed.
    RESULTS AND CONCLUSION: Different biomechanical forces have an impact on the biological characteristics of osteoblasts, including proliferation, differentiation, and apoptosis, and these effects are dependent on the intensity and duration of the applied force. Specifically, the effects are as follows: (1) Under microgravity conditions, osteoblast proliferation and differentiation are inhibited, resulting in a decrease in bone density and the development of osteoporosis. (2) Compared to microgravity, hypergravity has a promoting effect on osteoblast proliferation. (3) The effects of compressive stress on osteoblasts are dependent on the loading intensity and time. Appropriate compressive stress can promote osteoblast proliferation and differentiation, which is beneficial for bone tissue formation and repair, while excessive compressive stress can cause osteoblast apoptosis and bone tissue destruction. (4) The biological effects of different types of tensile stress on osteoblasts differ. Studies have shown that a strain rate within the range of 0-12% has a promoting effect on osteoblast proliferation. (5) Fluid shear stress can promote osteoblast proliferation and differentiation and enhance the bone-inducing effect of biomaterials. (6) Static hydrostatic pressure can affect the biological behavior of osteoblasts, including proliferation, differentiation, and apoptosis, and these effects are closely related to the time and intensity of the pressure. Understanding the effects of different biomechanical forces on osteoblasts is of great significance for a deeper understanding of bone growth and maintenance mechanisms.
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    Advantages and disadvantages of trauma effects during robot-assisted total knee arthroplasty
    Yang Yongze, Cheng Qinghao, Zhang Anren, Yang Xin, Zhang Zhuangzhuang, Fan Hua, Zhang Fukang, Guo Hongzhang
    2024, 28 (21):  3413-3417.  doi: 10.12307/2024.079
    Abstract ( 204 )   PDF (980KB) ( 25 )   Save
    BACKGROUND: The application of robot-assisted technology for total knee arthroplasty is one of the current research hotspots. Since the 1980s, robot-assisted technology has been introduced into total knee arthroplasty outside China to achieve accurate osteotomy and good recovery of lower limb alignment. After decades of use, the robot has continuously improved its performance with new iterations, but has been criticized for increasing perioperative time and surgical trauma.
    OBJECTIVE: To summarize the advantages and disadvantages of current orthopedic surgical robots in total knee arthroplasty.
    METHODS: PubMed database and CNKI were searched to analyze the advantages and disadvantages of robot-assisted total knee arthroplasty in surgical trauma. English search terms were “arthroplasty, replacement, knee, knee replacement arthroplasty, procedure, robotic surgical, total knee arthroplasty, arthroplasty, replacement, knee, robotic-assisted”. The Chinese search terms were “robot-assisted, robotic arm, knee osteoarthritis, arthritis”. After the initial screening of all articles according to the inclusion and exclusion criteria, 62 articles with high quality and relevance were reviewed.
    RESULTS AND CONCLUSION: (1) Robot-assisted total knee arthroplasty did not increase the degree of surgical trauma in patients, and showed a lower trauma effect than conventional manual total knee arthroplasty. (2) Robot-assisted total knee arthroplasty has the advantages of accurate auxiliary osteotomy, individualized prosthesis implantation, better protection of soft tissue around the knee joint, reduction of analgesic drug use, reduction of postoperative inflammatory index changes, and shortening of hospital stay. However, there are also shortcomings such as prolonged operation time, increased complications, and increased medical costs. (3) It is concluded that preliminary clinical application studies have shown that robot-assisted total knee arthroplasty can reduce surgical trauma, but it is necessary to be alert to potential risks. Simultaneously, its exact advantages compared with conventional manual total knee arthroplasty need to be verified by large-sample randomized controlled studies and long-term follow-up.
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    Classification and comparison of orthoses for adolescent idiopathic scoliosis and application progress of digital intelligent technology
    Zhu Peikun, Bai Jinzhu
    2024, 28 (21):  3418-3423.  doi: 10.12307/2024.063
    Abstract ( 254 )   PDF (875KB) ( 43 )   Save
    BACKGROUND: Orthosis is a common and effective treatment for mild to moderate scoliosis, which can delay and inhibit the progression of scoliosis and reduce the incidence of severe deformity. Different types of orthoses have different indications, application characteristics, and efficacies. In recent years, the application of new technology like digital and intelligent has promoted the improvement and development of new orthoses.
    OBJECTIVE: To classify and compare the commonly used scoliosis orthoses, and describe the application progress of new technologies such as digital and intelligent technology in recent years, so as to provide a reference for the clinical selection of orthoses and the improvement of new orthoses.
    METHODS: PubMed, Embase, IEEE, CNKI and WanFang databases were searched for relevant literature. Chinese and English search terms were “scoliosis, orthosis, brace, progress, artificial intelligence, digitization”. The search time limit was from 2012 to 2022. Finally, 56 articles were included for review and analysis. 
    RESULTS AND CONCLUSION: (1) Scoliosis orthosis has a good effect on mild to moderate adolescent idiopathic scoliosis. Through the Hueter-Volkmann law, it can accelerate the growth of the concave spine with a high success rate and has been widely used in this field. (2) The indications, application characteristics and efficacy of different types of orthoses are different, and the clinical selection is targeted. (3) Scoliosis orthosis has been developed in the direction of more humanity, paying attention to the comfort of patients, and the manufacturing process has been transformed from plaster casting to computer-aided manufacturing. It is simple and hygienic, with higher correction accuracy, and patients’ compliance has been significantly improved. (4) Scoliosis orthosis is developing in the direction of digitalization and intelligence and has been widely integrated with artificial intelligence, Internet of things and other technologies to monitor the patient’s orthopedic force, body temperature, and compliance in real time, so as to provide patients with more accurate treatment. (5) At present, there are still many defects in scoliosis orthosis that cannot be ignored, such as affecting development, decreased muscle strength, and body stiffness, which need further exploration and improvement.
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    Visualization analysis of research hotspots and trends in adolescent idiopathic scoliosis
    Hou Zhaomeng, Su Shaoting, Chen Longhao, Wei Guikang, Zhou Honghai
    2024, 28 (21):  3424-3430.  doi: 10.12307/2024.064
    Abstract ( 196 )   PDF (3618KB) ( 29 )   Save
    BACKGROUND: Adolescent idiopathic scoliosis is the most common scoliosis deformity, accounting for about 80% of all scoliosis. Its pathogenesis is unknown. In recent years, the incidence rate has shown an obvious upward trend, which seriously threatens the physical and mental health of adolescents. 
    OBJECTIVE: To perform the visualization analysis of the relevant literature on adolescent idiopathic scoliosis in recent 20 years through the Bibliometrics method, and explore the research hotspots and trends in this field to provide references for further research. 
    METHODS: The relevant articles included in the Web of Science core collection database from January 1, 2002 to December 31, 2021 were searched by computer. The scientific knowledge map was drawn by CiteSpace 5.8.R3 software. The cooperation network, co-citation network, keyword co-occurrence, burst, clustering and timeline map were visually analyzed. 
    RESULTS AND CONCLUSION: A total of 5 245 papers were included. In the past 20 years, the annual publication volume has shown a fluctuating upward trend. The analysis of the cooperation network shows that the author with the most publications is Qiu Yong; the institution is Nanjing University; the country is USA. The author with the highest intermediary centrality is Lowe TG; the institution is Childrens Hosp Philadelphia, and the country is Switzerland. The co-citation network analysis exhibits that the author with the highest frequency of citations is Lenke LG; the document is Weinstein SL, 2013, N Engl J Med; the journal is Spine, and the author with the highest intermediary centrality is Suk SI, and the cited document is Danielsson AJ, 2001, Eur Spine J; the cited journal is Spine. Keyword analysis displays that the research hotspots mainly focus on conservative treatment, imaging parameters, pathogenesis, and genome-wide associations. Through the visualization analysis of the literature in this research field, this study clarifies the context of the research in this field, reveals the research hotspots and trends in this field, and provides research ideas and methods for many scholars.
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    Experimental validation of machine learning identification of KDELR3 as a signature gene for osteoarthritis hypoxia
    Xu Wenfei, Ming Chunyu, Mei Qijie, Yuan Changshen, Guo Jinrong, Zeng Chao, Duan Kan
    2024, 28 (21):  3431-3437.  doi: 10.12307/2024.078
    Abstract ( 160 )   PDF (3433KB) ( 53 )   Save
    BACKGROUND: Hypoxia is strongly associated with the development and progression of osteoarthritic chondrocyte injury, but the specific targets and regulatory mechanisms are unclear.
    OBJECTIVE: A machine learning approach was used to identify KDEL(Lys-Asp-Glu-Leu) receptor 3 (KDELR3) as a characteristic gene for osteoarthritis hypoxia and immune infiltration analysis, to provide new ideas and methods for the treatment of osteoarthritis. 
    METHODS: The osteoarthritis-related datasets were downloaded from the GEO database and the GSEA website to obtain hypoxia-related genes. The osteoarthritis datasets were batch-corrected and immune infiltration analyzed using R language, and osteoarthritis hypoxia genes were extracted for differential analysis. Differentially expressed genes were analyzed for GO function and KEGG signaling pathway. Weighted correlation network analysis (WGCNA) and machine learning were also used to screen osteoarthritis hypoxia signature genes, and in vitro cellular experiments were performed to validate expression and correlate immune infiltration analysis using the datasets and qPCR. 
    RESULTS AND CONCLUSION: (1) 8 492 osteoarthritis genes were obtained by batch correction and principal component analysis, mainly strongly associated with immune cells such as Macrophages M2 and Mast cells resting; 200 hypoxia genes were also obtained, resulting in 41 osteoarthritis hypoxia differentially expressed genes. (2) GO analysis involved mainly biological processes such as response to nutrient levels and glucocorticoids; cellular components such as lysosomal lumen and Golgi lumen; and molecular functions such as 14-3-3 protein binding and DNA-binding transcriptional activator activity. (3) KEGG analysis of osteoarthritis hypoxia differentially expressed genes was associated with signaling pathways such as PI3K-Akt, FoxO, and microRNAs in cancer. (4) The characteristic gene KDELR3 was obtained after using WGCNA analysis and machine learning screening. (5) The gene expression of KDELR3 was found to be higher in the test group than in the control group in the synovium (P=0.014) but lower in the meniscus (P=0.024) after validation by gene microarray. (6) In vitro chondrocyte assay showed that the expression of KDELR3 was higher in cartilage than in the control group (P=0.005), while KDELR3 was closely associated with Macrophages M0 (P=0.014) and T cells follicular helper (P=0.014). Using a machine learning approach, we confirmed that KDELR3 can be used as a hypoxic signature gene for osteoarthritis and may intervene in osteoarthritis pathogenesis by improving hypoxia, expecting to provide a new direction for better treatment of osteoarthritis.
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    Integrative analyses of pyroptosis-related genes associated with intervertebral disc degeneration
    Xie Yue, Zhai Weifeng, Guo Ji, Jia Yongwei
    2024, 28 (21):  3438-3444.  doi: 10.12307/2024.068
    Abstract ( 162 )   PDF (1732KB) ( 12 )   Save
    BACKGROUND: Early diagnosis and treatment of intervertebral disc degeneration is particularly important. Pyroptosis of nucleus pulposus cells plays an important role in the early process of intervertebral disc degeneration, but the role of pyroptosis-related molecules of nucleus pulposus cells in early intervertebral disc degeneration and related molecular markers are still unclear.
    OBJECTIVE: To explore the diagnostic and therapeutic value of differentially expressed genes related to pyroptosis during intervertebral disc degeneration.
    METHODS: Public datasets of the GEO database were integrated for differential analysis, and intersected with 33 pyroptosis-related genes previously reported. Using Gene Ontology analysis and Kyoto Encyclopedia of Genes and Genomes, pathway enrichment analysis was performed in genes related to pyroptosis during intervertebral disc degeneration. Enrichment analysis of the intervertebral disc degeneration dataset was conducted using gene set enrichment analysis. To construct the immune cell spectrum in intervertebral disc degeneration samples, the correlation between the differentially expressed pyroptosis-related genes and immune cells was analyzed. Protein interaction networks were built. Screening of the Hub gene to identify key genes associated with intervertebral disc degeneration in protein interaction networks. The receiver operating characteristic curve of the differentially expressed pyroptosis-related genes was plotted, and the area under the curve was calculated. The clinical diagnostic value of target genes was explored. qRT-PCR was applied to verify the difference in the expression of pyroptosis-related genes between normal human nucleus pulposus cells and degenerated human nucleus pulposus cells with intervertebral discs.
    RESULTS AND CONCLUSION: (1) 4 426 differentially expressed genes associated with intervertebral disc degeneration were obtained, and 14 differentially expressed pyroptosis-related genes were obtained after the intersection. (2) Gene Ontology and Kyoto Encyclopedia of Genes and Genomes revealed important enrichment pathways, mainly related to inflammation, cell cycle, infection and NOD-like receptor pathway. Gene set enrichment analysis showed that pathways such as amino acid metabolism and P53 transcription regulation were significantly enriched in patients with intervertebral disc degeneration. Immune infiltration analysis suggested that the occurrence and development of intervertebral disc degeneration were closely related to immune cells. (3) A total of five Hub genes were screened, namely IL1-β, Caspase-1, AIM2, Caspase-5, and NLRC4. (4) Acquisition and identification of key biomarkers for intervertebral disc degeneration: After intersecting the two datasets of GEO with the pyroptosis-related gene, it was found that NLRP3 had significant expression differences, and the receiver operating characteristic curve showed that NLRP3 had clinical diagnostic significance. (5) qRT-PCR showed that the expression of Hub genes such as IL1-β, Caspase-5 and NLRC4 was significantly increased in the nucleus pulposus cells of intervertebral disc degeneration (P < 0.05), and there was no difference in Caspase-1, AIM2 and NLRP3 expression (P > 0.05). (6) It is suggested that cell pyroptosis plays an important mechanism in the occurrence and development of intervertebral disc degeneration, among which pyroptosis-related molecules NLRP3, IL1-β, Caspase-5 and NLRC4 have early diagnosis and treatment value.
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