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    28 August 2024, Volume 28 Issue 24 Previous Issue    Next Issue
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    Biomechanical response of postural kyphosis under the action of bending moments
    Wang Lei, Wang Chenyan, Guo Yuan, Li Xiaona, Chen Weiyi
    2024, 28 (24):  3773-3777.  doi: 10.12307/2024.605
    Abstract ( 163 )   PDF (2204KB) ( 56 )   Save
    BACKGROUND: Most of the biomechanical studies on kyphosis have focused on trunk muscle strength and sagittal plane balance, and little has been reported on the biomechanical response within the spine during kyphosis.
    OBJECTIVE: To investigate the biomechanical response of the spine during postural kyphosis by simulating the process of postural kyphosis.
    METHODS: A three-dimensional finite element model of the normal thoracolumbar segment (T1-S1 segment) was established by using the finite element method. 10 groups of pure bending loads from 1.15-11.52 N·m were applied using a three-point force system on T1, T6, and T12 vertebrae to simulate the process of postural kyphosis in normal humans. The relationship between the loads and Cobb angle and the biomechanical responses of vertebrae, ribs, and intervertebral discs were analyzed. 
    RESULTS AND CONCLUSION: (1) During postural kyphosis, the Cobb angle size of T1-T12 segments was linearly related to the load size. (2) The maximum stresses on the vertebrae, ribs, and intervertebral discs increased with increasing load. (3) Under the action of 11.52 N·m moment, the maximum stresses on the vertebral body, ribs, and intervertebral disc were found in the front of the T6 vertebral body, the rib head of the 10th pair of ribs, and the right posterior side of the intervertebral disc of the T5-T6 segments. (4) The results of this study suggest that postural kyphosis leads to increased stress on the vertebrae, ribs, and discs, with the most significant increase in stress on the anterior side of the T6 vertebrae, at the rib head of the 10th pair of ribs, and on the anterior side of the disc at the T5-T6 segment, as well as on the posterior side, which may increase the risk of injury to the vertebrae, ribs, and discs, which provides a biomechanical basis for the design of kyphosis orthoses.
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    Correlation between sagittal alignment and clinical symptom improvement after lumbar fusion
    Fang Zhao, Qiao Pan, Xu Tiantong
    2024, 28 (24):  3778-3782.  doi: 10.12307/2024.618
    Abstract ( 162 )   PDF (1451KB) ( 58 )   Save
    BACKGROUND: Up to date, there is seldom research about the correlation between the harmonious alignment degree of lumbar lordosis and pelvic incidence and the improvement of postoperative clinical symptoms in patients with lumbar stenosis fusion. 
    OBJECTIVE: To investigate the harmonious alignment degree of lumbar lordosis and pelvic incidence in patients with lumbar spinal stenosis and fusion, and compare the differences of spinal and pelvic sagittal parameters and clinical outcomes among different harmonious alignment degrees.
    METHODS: The medical records of 110 patients with lumbar spinal stenosis (48 males and 62 females, aged 57±11 years) who were treated with posterior lumbar laminar decompression and internal fixation in the Department of Spinal Surgery, Tianjin Union Medical Center from December 2019 to December 2021 were retrospectively analyzed. The postoperative follow-up was more than 1 year. According to the harmonious alignment degree of lumbar lordosis and pelvic incidence, they were divided into two groups: Group A (n=47) (pelvic incidence-lumbar lordosis >10°) and group B (n=63) (pelvic incidence-lumbar lordosis ≤10°). The changes of clinical scores (low back pain visual analog scale score and Oswestry disability index) and spinal and pelvic sagittal parameters before and after surgery were compared between the two groups. The correlation between clinical symptom improvement and spinal and pelvic imaging parameters was analyzed.
    RESULTS AND CONCLUSION: (1) There were no significant differences in preoperative pelvic sagittal parameters and clinical function between the two groups (P > 0.05). (2) There were no significant differences in operation time and blood loss between the two groups (P > 0.05). (3) At the last postoperative follow-up, the visual analog scale score and Oswestry disability index in group B were significantly improved compared with group A (P=0.000, P=0.005). Lumbar lordosis and sacral slope were also significantly improved (P=0.000, P < 0.05), and pelvic tilt was more significantly recovered (P=0.000). (4) Pearson correlation coefficient method results showed that the improvement of visual analog scale score of low back pain was significantly correlated with the improvement of pelvic tilt (r=0.209, P=0.008), lumbar lordosis (r=-0.133, P=0.021) and sacral slope (r=-0.156, P=0.031). Pelvic tilt was significantly correlated with Oswestry disability index (r=0.196, P=0.014). (5) It is concluded that reconstructed lumbar lordosis and reduced pelvic tilt for the harmonious alignment (pelvic incidence-lumbar lordosis ≤ 10°) can effectively improve the clinical symptoms of patients.
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    Mechanical analysis of cortical bone trajectory screw placement in lumbar revision
    Zhang Lianpeng, Julaiti•Maitirouzi, Zhang Zhihao, Zhang Rui, Abulikemu·Maimaiti, Paerhati·Rexiti
    2024, 28 (24):  3783-3788.  doi: 10.12307/2024.604
    Abstract ( 151 )   PDF (1189KB) ( 60 )   Save
    BACKGROUND: At present, there are shortcomings and risks in the surgical revision of vertebral bodies that failed to be fixed in clinical practice. To avoid the risks of conventional revision surgery, the cortical bone trajectory technique is used to perform revision surgery on vertebral bodies that failed to be fixed. However, the mechanical properties of cortical bone trajectory technique screws in revision surgery are not clear. 
    OBJECTIVE: The mechanical properties of cortical bone trajectory in lumbar revision surgery were analyzed by the finite element method to provide a theoretical basis for the clinical application of cortical bone trajectory in revision surgery. 
    METHODS: CT scan data of the osteoporotic vertebral body were obtained and the L4 vertebral body model was established. The initial cortical bone trajectory placement and traditional pedicle screw in the L4 vertebral body model were completed, respectively, and their mechanical data were taken as the baseline standard for later evaluation of revision surgical performance. The traditional pedicle screw was removed and the screw path was retained. The cortical bone trajectory screw was used for secondary screw placement on the vertebral body to achieve lumbar refixation. The axial pull-out force, stability, and lumbar motion range of the revised screw were analyzed by the finite element method. 
    RESULTS AND CONCLUSION: (1) The screw axial pull-out force of the cortical bone trajectory revision group was 25.6% higher than that of the traditional pedicle initial group. (2) In the lower, left, and right working conditions, the load-displacement ratio of screws in the cortical bone trajectory revision group increased by 18.5%, 41.3%, and 35.0%, respectively, compared with the traditional pedicle initial group. The load-displacement ratio of screws in the cortical bone trajectory revision group was slightly higher than that in the traditional pedicle initial group under the above condition, but there was no statistically significant difference (P > 0.05). (3) In anterior and posterior flexion conditions, lumbar motion range in the cortical bone trajectory revision group was increased by 45.5% and 36.1% compared with the traditional pedicle initial group, but there was no statistically significant difference in left bend, right bend, and axial rotation conditions (P > 0.05). (4) There were no statistically significant differences in screw axial pull-out force, screw load-displacement ratio, and lumbar motion range between the cortical bone trajectory revision group and cortical bone trajectory initial group (P > 0.05). (5) The mechanical data exhibited that although the revised nail track bone was damaged or lost to a certain extent, the mechanical properties of the cortical bone trajectory revision group were still better than those of the traditional pedicle initial group to a certain extent. Moreover, there was no significant difference in the mechanical properties between the cortical bone trajectory revision group and the cortical bone trajectory initial group. It provides a reference for revision surgery of lumbar internal fixation with cortical bone trajectory technique in patients with failed traditional pedicle fixation.  
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    Finite element analysis of interspinous fixation-assisted endoscopic interbody fusion in treatment of severe lumbar spinal stenosis#br#
    Liu Jiang, Zhang Hanshuo, Ding Yiwei, Jiang Qiang, Li Tusheng, Huang Jie, Yang Guangnan, Ding Yu
    2024, 28 (24):  3789-3795.  doi: 10.12307/2024.611
    Abstract ( 162 )   PDF (1446KB) ( 56 )   Save
    BACKGROUND: In clinical application, simple interspinous fixation without additional interbody fusion has similar fixation effects to pedicle screw and rod fusion internal fixation, and can effectively reduce the range of motion of the responsible segment and the stress of the articular process. However, after simple placement of the new interspinous fusion fixation device BacFuse, the stress at the root of the spinous process is relatively concentrated, and the spinous fracture is prone to occur. If an intervertebral fusion cage is inserted in conjunction with interspinous fixation, Von Mises stress can theoretically be dispersed to reduce the risk of spinous fracture. However, there are few studies on biomechanics and finite element analysis. 
    OBJECTIVE: To observe the biomechanical stability of interspinous fixation-assisted endoscopic interbody fusion in the treatment of severe lumbar spinal stenosis. 
    METHODS: The normal finite element model M0 of the L4-L5 segment of the lumbar spine was established by Mimics, Geomagic, Solidworks, and ANSYS software based on the lumbar CT images of a 26-year-old adult male volunteer excluding spinal diseases. On the basis of M0, the immediate model M1 after endoscopic decompression combined with interbody fusion, the interspinous fixation device (BacFuse) model M2 after endoscopic decompression, and the interspinous fixation (BacFuse) model M3 after endoscopic-assisted interbody fusion were established. The same stress was applied to the upper surface of the L4 vertebral body in the four groups, and the lower surface of the L5 vertebral body was fixed and supported. The range of motion and the extreme Von Mises stress of the endplate bone and the posterior ligament complex of the vertebral body were analyzed under six working conditions of flexion, extension, left/right bending, and left/right rotation.    
    RESULTS AND CONCLUSION: (1) Compared with model M0, the range of motion value of model M1 increased significantly under six working conditions. Model M2 and model M3 had a significant reduction in range of motion. (2) Compared with model M0, the maximum stress of the vertebral body in model M1 did not change significantly under the six working conditions. The maximum stress at the rear of the M2 vertebral body increased significantly. (3) Compared with model M1, the maximum stress of model M3 did not change significantly under the six working conditions. Compared with model M2, the maximum stress of model M3 decreased significantly. (4) Compared with the model M0, the extreme Von Mises stress of the L4 and L5 endplates of the model M1 was significantly increased. The extreme Von Mises stress in L4 and L5 endplates of models M2 and M3 decreased slightly. Compared with model M1, the Von Mises stress of the bone under the L4 and L5 endplate of models M2 and M3 was significantly reduced. (5) It is concluded that the implantation of BacFuse can effectively reduce the bone stress under the endplate during simple interbody fusion, decrease the risk of cage subsidence, diminish the risk of facet joint fracture on the decompression side, and provide a good stable environment for interbody fusion. The placement of an intervertebral fusion cage can reduce the stress of the root of the spinous process, which is beneficial to decrease the risk of fracture of the root of the spinous process. 
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    Three-dimensional finite element analysis of medial patellofemoral ligament reconstruction with transosseous and wire anchor fixation
    Zhao Gai, Liu Lingjun, Yin Hao, Ning Rende, Xu Bin
    2024, 28 (24):  3796-3800.  doi: 10.12307/2024.096
    Abstract ( 143 )   PDF (1205KB) ( 38 )   Save
    BACKGROUND: Reconstruction of the medial patellofemoral ligament is the primary and basic treatment for patellofemoral dislocation. Generally, autologous or allogeneic tendons are used to fix the patellofemoral podogram area and the femoral insertion, respectively. There are various fixation methods. Patellar lateral insertion fixation methods are relatively diverse, mainly traditional transosseous fixation and recent anchoring methods, including single tunnel, double-tunnel transosseous fixation, and two-wire anchor fixation. However, which fixation method is more effective in reducing patellofemoral joint stress and is more biomechanical has not been determined.
    OBJECTIVE: To observe the mechanical effects of patellofemoral joint and medial patellofemoral ligament reconstruction with transosseous and wire anchor fixation. 
    METHODS: A three-dimensional finite element model of the knee joint was constructed. The medial patellofemoral ligament was reconstructed by a single tunnel through the bony canal or two wire anchors at the medial edge of the patella. The femoral side was fixed by extrusion nails to the medial epicondyle of the femur and the midpoint of the adductor tubercle. We observed the effects of the two fixation methods on patellofemoral joint and medial patellofemoral ligament loading during knee flexion at 0°, 30°, 60°, 90°, and 120°.
    RESULTS AND CONCLUSION: (1) The stress on the patellofemoral joint was large when the knee was at flexion of 0-60°, peaked at 30°, and gradually decreased at 90° and 120°. The two fixation methods had little difference in the stress on the patellofemoral joint. (2) The stress on the medial patellofemoral ligament peaked at 30° and decreased significantly at 60°, and the load on the medial patellofemoral ligament was significantly greater at all angles with anchor fixation than with bony canal fixation. (3) The results showed that there was no significant difference in patellofemoral joint loading between the two fixation methods, but the stress on the medial patellofemoral ligament in anchoring was significantly greater than that in transosseous fixation.
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    Three-dimensional finite element analysis of effects of different bone densities on various intraarticular structures after unicompartmental knee arthroplasty
    Liu Mengfei, Ma Pengcheng, Yin Can, Jiang Kan, Ju Xiaochen
    2024, 28 (24):  3801-3806.  doi: 10.12307/2024.613
    Abstract ( 168 )   PDF (1330KB) ( 72 )   Save
    BACKGROUND: Osteoporosis is a common comorbidity in patients with knee osteoarthritis. The impact of osteoporosis on the prognosis of unicompartmental knee arthroplasty is a trending topic of current research.
    OBJECTIVE: To investigate the effect of different bone densities on the stress value and stress distribution of each structure in the joint after unicompartmental knee arthroplasty using finite element analysis, and to evaluate the correlation between osteoporosis and complications. 
    METHODS: CT and MRI were adopted to obtain the lower limb image data of a volunteer. Geomagic Studio, Ansys workbench, and Mimics were used to establish a finite element model of the knee joint with normal sclerotin condition (T-value ≥ -1.0). The finite element model of the knee joint with osteopenia (-2.5 < T-value < -1.0) and osteoporosis (T-value ≤ -2.5) was established by changing the elastic modulus, and the validity was verified. The Boolean operation was used to simulate unicompartmental knee arthroplasty, and the unicompartmental knee arthroplasty models of three groups of sclerotin conditions were established. A 1 000 N vertical downward load was applied to the center of the femoral condyle of the three models. The stress data of the meniscus, the tibial cartilage, the polyethylene liner surface, and the surfaces of the cortical bone and the cancellous bone under the tibial prostheses, as well as the strain data of the polyethylene liner and the cancellous bone under tibial prostheses, were also observed and compared.
    RESULTS AND CONCLUSION: (1) Compared with the normal sclerotin group and the osteopenia group, the peak stress of the meniscus and the polyethylene liner surface was larger, and the peak stress of the tibial cartilage was smaller in the osteoporosis group. (2) In the three models, the high-stress value of the cortical bone under the tibial prostheses increased with osteopenia, and the stress was concentrated on the internal edge of the cortical bone. The high-stress value of the cancellous bone under the tibial prostheses decreased with osteopenia, and the stress was concentrated on the posteromedial side of the cancellous bone and the curved bottom of the keel groove. (3) The strain data on the polyethylene liner and cancellous bone under tibial prostheses in the osteoporosis group were greater than those in the normal sclerotin and osteopenia groups. (4) Osteoporosis can cause biomechanical abnormalities of the internal structure of the knee joint after the treatment of unicompartmental knee arthroplasty, which may increase the incidence of complications and the risk of re-surgery.
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    Biomechanical analysis on Vancouver BI periprosthetic femoral fractures fixed by a customized anatomical plate system
    Wang Jiaqi, Luo Xiaozhong, Tong Yi, Lu Xiaobo, Shi Weixiang, Zhou Xin, Wu Gang, Ding Yong, Zhang Caidong
    2024, 28 (24):  3807-3813.  doi: 10.12307/2024.622
    Abstract ( 155 )   PDF (1951KB) ( 50 )   Save
    BACKGROUND: At present, the use of a locking bone plate combined with steel wire or steel cable for the treatment of periprosthetic femoral fracture often adopts monocortical fixation, which is not stable and the proximal end of the bone cannot be achieved anatomically fitted by plate. The customized anatomical plate system can effectively solve this problem.
    OBJECTIVE: To explore the biomechanical strength of a customized anatomical plate system in fixation of Vancouver BI periprosthetic femoral fracture.
    METHODS: CT thin layer scanning data of normal femurs of 1 006 cases were selected and input into the MIMICS 21.0 software to establish the three-dimensional reconstruction model of the femur, which was set as the three-dimensional reconstruction group. 56 complete human femoral specimens were selected as the femoral specimen group. The measured results of the two groups for femoral anatomical appearance were compared. If there was no significant difference between the two groups, the approximate appearance of a customized anatomical plate system was designed based on the measurement results in MIMICS 21.0 software and NX11.0 software. The customized anatomical plate system was designed and prepared according to the above measurement results. Eight pairs of frozen human femurs were selected to make Vancouver BI periprosthetic femoral fracture, which of the left were thin layer scanned by dual-source CT to obtain data. The data were transferred to determine the customized anatomical plate system model by the above design software. Eight sets of customized anatomical plate systems were ultimately produced, relying on the instrument company. The eight pairs of models were numbered 1-8. The left side was fixed with the customized anatomical plate system (customized anatomical plate system group); the right side was fixed with a metal locking plate system-large locking plate (claw plate group). L1-L4 and R1-R4 were subjected to vertical short-cycle loading test and vertical loading test. L5-L8 and R5-R8 were subjected to horizontal short-cycle loading test and four-point bending test. The vertical loading test and four-point bending test were used to collect bending load, bending displacement, and bending strain. Two short cycle loading tests were used to collect strain displacement to compare the maximum load, maximum displacement, bending stiffness, and short-period displacement resistance of the two kinds of bone plates.
    RESULTS AND CONCLUSION: (1) There were no significant differences in all indexes between the three-dimensional reconstruction group and the femoral specimen group (P > 0.05). Individual customized anatomical plate system was designed based on the measurement results combined with digital software. (2) In the vertical loading test, the maximum load was higher (P=0.015), the maximum bending displacement was smaller (P=0.014), and the bending stiffness was higher (P=0.005) in the customized anatomical plate system group compared with the claw plate group. (3) In the four-point bending test, the maximum load was higher (P=0.023), the bending stiffness was higher (P=0.005), and the maximum bending displacement was not significant (P=0.216 > 0.05) in the customized anatomical plate system group compared with the claw plate group. (4) In the vertical short-cycle loading test, the average level of bending displacement in the customized anatomical plate system group (0.23±0.10 mm) was significantly lower than that in the claw plate group (0.44±0.02 mm) 
    (P < 0.05). (5) There was no significant difference in the average level of bending displacement between the two groups in the horizontal short cycle loading test (P > 0.05). (6) It is concluded that the customized anatomical plate system has personalized anatomical characteristics, and the fixation of Vancouver BI periprosthetic femoral fracture is more stable, which has certain significance for clinical treatment. 
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    Biomechanical difference of different fixation methods in bone healing of distal tibial comminuted fractures analyzed by finite element method
    Yan Huadong, Zhang Zhong, Zhao Gang, Li Jie, Song Hua, Sun Jianhua, Liu Zhi, Wang Mingming
    2024, 28 (24):  3814-3821.  doi: 10.12307/2024.607
    Abstract ( 164 )   PDF (4522KB) ( 49 )   Save
    BACKGROUND: The treatment of distal tibial comminuted fractures with soft tissue injury has always been challenging. The new retrograde tibial nailing and supercutaneous locking plate are important treatment methods, but their strain and stress shielding at the fracture end during different periods of fracture healing and different load conditions have not been reported. 
    OBJECTIVE: To explore the biomechanical stability of retrograde tibial nailing and supercutaneous locking plate in different periods of fracture healing by finite element analysis to offer a scientific foundation for clinical application and rehabilitation exercise.
    METHODS: The finite element model of distal tibial comminuted fracture was established by utilizing the CT data of the tibia from a 40-year-old healthy male. Retrograde tibial nailing, supercutaneous locking plate, and callus models were assembled in accordance with the principle of fracture fixation. The finite element analysis was performed using ANSYS software to compare the displacement of the fracture end, the stress shielding of the tibia, the stress of the callus, and the stress distribution of the tibia and the fixation device during different periods of fracture healing.
    RESULTS AND CONCLUSION: (1) The relative displacement of the tibial fracture decreased gradually with the healing of the fracture, and the displacement decreased significantly after 3 months. At 0 and 1 months after operation, the vertical displacement and total displacement of the supercutaneous locking plate group were higher than those in the retrograde intramedullary nail group. The Z-axis displacement (horizontal medial and lateral displacement) of the two fixation methods was more obvious than the X-axis and Y-axis, and the Z-axis displacement of supercutaneous locking plate group was the most obvious. The maximum Z-axis displacement of the two fixation methods was located on the outside of the tibia, and the minimum displacement was located on the inside of the tibia. (2) The stress shielding rate at different periods of fracture healing gradually decreased with time. The stress shielding rate of the retrograde intramedullary nail was higher than that of the supercutaneous locking plate at different stages of fracture healing. After 3 months, the stress shielding rate of the supercutaneous locking plate was reduced to about 4%, and the stress shielding rate of the retrograde intramedullary nail was reduced to about 40%. (3) The stress of the stress concentration site of the callus in the two fixation methods increased with the increase of the load, and the stress of the callus in the supercutaneous locking plate group was always greater than that in the retrograde intramedullary nail group. The maximum stress distribution of the callus was approximately equally distributed among the two modes of fixation, both in the lateral portion of the tibia. (4) As the fracture healed, the maximum stress of the tibia in the two groups decreased gradually, and the stress in the supercutaneous locking plate group was always greater than that in the retrograde intramedullary nail group. The average stress of the maximum stress area of the tibia in the supercutaneous locking plate group under 1 500 N load was 285 MPa, while that in the retrograde intramedullary nail group was 26 MPa. (5) As the fracture healed, the stress of the fixation device in the two groups decreased gradually, and the stress in the supercutaneous locking plate group was significantly higher than that in the retrograde intramedullary nail group. After 3 months, the stress of the two fixation devices decreased significantly. (6) It is indicated that in the early stage of fracture healing, the strain on the fracture end in the retrograde intramedullary nail group is small, and the maximum stress of the tibia is moderate, allowing early loaded. The fractured ends in the supercutaneous locking plate group had too large strain and too large maximum stress of the tibia, which needed to be partially loaded under protection and could not be fully loaded. In the middle and late stages of fracture healing, the tibial retrograde intramedullary nail and the supercutaneous locking plate could be completely loaded, and the stress shielding rate of the supercutaneous locking plate was significantly lower than the tibial retrograde intramedullary nail.
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    Application of balance technique and measurement osteotomy technique under Offset Repo-Tensor in total knee arthroplasty
    Huang Xueli, Luo Ruiqin, Chen Sheng, Li Xiaowu, Chen Haibo, Zeng Qingqiang, Zheng Zhihui
    2024, 28 (24):  3822-3826.  doi: 10.12307/2024.609
    Abstract ( 176 )   PDF (1120KB) ( 39 )   Save
    BACKGROUND: At present, measurement osteotomy technique and gap balance technique are the two main surgical methods in total knee arthroplasty. Both methods have their advantages and disadvantages. By adjusting the osteotomy angle, the gap balance technique can reduce the release of soft tissue and obtain a more balanced flexion and extension space. The clinical efficacy of gap balance technique is superior, but this surgical method lacks tools and is easily influenced by the surgeon’s surgical experience and subjective judgment, with more errors. Measurement osteotomy technique has a short learning curve, but it relies on anatomic markers and is prone to many complications due to inaccurate positioning. In recent years, many instrument companies have successively developed and launched tools that can improve the quality of surgery. However, there are still few reports about the tool. 
    OBJECTIVE: To compare the clinical efficacy of gap balance technique and measurement osteotomy technique under Offset Repo-Tensor in total knee arthroplasty, and explore the value of Offset Repo-Tensor in total knee arthroplasty. 
    METHODS: The medical records of 85 patients with total knee arthroplasty were collected and divided into two groups according to the operation method. Group A consisted of 44 patients who underwent total knee arthroplasty using a gap balance technique combined with Offset Repo-Tensor. Group B consisted of 41 patients who underwent total knee arthroplasty using measurement osteotomy technique. Surgical time, American Knee Society Score, knee range of motion, changes in lower limb alignment, and postoperative complications were compared between the two groups to evaluate the clinical efficacy of gap balance technique combined with Offset Repo-Tensors in total knee arthroplasty.
    RESULTS AND CONCLUSION: (1) All 85 patients were followed up. (2) Postoperative knee range of motion in both groups was higher than that before surgery (P < 0.05), and the improvement in group A was more significant than that in group B (P < 0.05). (3) American Knee Society Score in both groups after surgery was higher than that before surgery (P < 0.05), and the American Knee Society Score in group A was higher than that in group B at 2 weeks, 1, 3 months, and the last follow-up (P < 0.05). (4) The operation time of group A was slightly shorter than that of group B, but the difference was not significant (P > 0.05). (5) The lower limb alignment in both groups was improved after operation, but there was no significant difference between the two groups (P > 0.05). (6) The complication rate of group A (2%) was lower than that of group B (7%), but there was no significant difference between the two groups (P > 0.05). (7) It is indicated that compared with the measurement osteotomy technique, the combination of Offset Repo-Tensor and gap balance technique can elevate the clinical effect and improve the function and motion range of the knee joint.
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    Effect of varus and valgus angles of tibial prosthesis on short-term outcome of fixed bearing unicompartmental knee arthroplasty
    Wang Hu, Feng Shuo, Zhang Qiang, Chen Jiahao, Chen Xiangyang
    2024, 28 (24):  3827-3832.  doi: 10.12307/2024.090
    Abstract ( 157 )   PDF (1137KB) ( 36 )   Save
    BACKGROUND: Previous studies on the effects of valgus and varus angles of tibial component on short-term postoperative outcomes after mobile bearing unicompartmental knee arthroplasty have been reported in and outside China. However, there are few reports on the effect of the valgus and varus angles of tibial component on short-term postoperative outcomes after fixed bearing unicompartmental knee arthroplasty. 
    OBJECTIVE: To investigate the effect of valgus and varus angles of tibial component on short-term clinical outcomes in patients with medial knee osteoarthritis undergoing fixed bearing unicompartmental knee arthroplasty.  
    METHODS: 120 patients (122 knees) who underwent fixed bearing unicompartmental knee arthroplasty for medial knee osteoarthritis in Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University from August 2020 to January 2023 were selected as the study subjects. Two physicians measured the varus angle of femoral prosthesis, valgus and varus angles of tibial prosthesis, flexion and extension angles of femoral prosthesis, and posterior inclination angle of tibial prosthesis after unicompartmental knee arthroplasty based on postoperative X-ray. After excluding the influence of the other three angles, the measurement results of the tibial component varus angle were divided into three groups: <-2°,-2° to 2°, >2°, which were denoted as groups 1, 2, and 3, respectively. The range of knee motion, the hospital for special surgery knee score, the American knee society score, and forgotten joint score were recorded and compared before and after the operation.   
    RESULTS AND CONCLUSION: (1) A total of 120 patients (122 knees) were enrolled in this study. They were divided into three groups according to the size of the valgus and varus angles of the tibial prosthesis after operation: 37 patients in the first group, 60 patients in the second group, and 23 patients in the third group. There was no significant difference between the three groups in terms of baseline information such as age, gender, and side of surgery (P > 0.05). (2) Patients were followed up for 3-30 months after arthroplasty. (3) The hospital for special surgery knee score of the second group was higher than that of the first group (P=0.015) and the third group (P=0.012). The American knee society score of the second group was significantly higher than that of the first group (P=0.014) and the third group (P < 0.001). The forgotten joint score of the second group was higher than that of the first group (P=0.033) and the third group (P=0.016). (4) After fixed bearing unicompartmental knee arthroplasty, when the valgus angle of tibial prosthesis was  -2° to 2°, which can achieve better short-term clinical results, the degree of prosthesis self-realization is higher.
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    Effect of adductor canal block and single sciatic nerve block combined with analgesic drugs on pain after total knee arthroplasty
    Geng Haoyang, Liu Wenping, Wang Guorui, Liu Bin, Wang Wei, Ma Zhanqiao, Wang Jianhua
    2024, 28 (24):  3833-3838.  doi: /10.12307/2024.606
    Abstract ( 146 )   PDF (847KB) ( 49 )   Save
    BACKGROUND: Total knee arthroplasty is an effective treatment for late-stage osteoarthritis, but postoperative pain and joint function recovery are the main challenges. Nerve block and mixed drug injection are two common pain relief methods, but the effect of their combined use is still unclear. 
    OBJECTIVE: To investigate the effects of ultrasound-guided continuous adductor canal block+single sciatic nerve block+“cocktail” mixed drug analgesia on postoperative pain relief and joint function recovery in total knee arthroplasty. 
    METHODS: 120 patients with osteoarthritis admitted to Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine from January to May 2022 were randomly divided into two groups (n=60). The observation group received ultrasound-guided continuous adductor canal block+single sciatic nerve block+”cocktail” mixed drug analgesia. The control group received ultrasound-guided continuous adductor canal block+single sciatic nerve block. The differences in visual analog scale score, hospital for special surgery score, pain mediators, expression levels of inflammatory factors, the occurrence of adverse reactions, and postoperative barehanded muscle strength test were compared between the two groups.  
    RESULTS AND CONCLUSION: (1) The visual analog scale scores at rest and exercise were lower in the observation group than those in the control group at 6, 8, 12, 24, 48, and 72 hours postoperatively (P < 0.05). (2) Hospital for special surgery scores at 1 and 3 months postoperatively were significantly higher in the observation group than those in the control group (P < 0.05). (3) In terms of pain mediators and inflammatory factors, the expression levels were significantly lower in the observation group than those in the control group (P < 0.05). (4) There was no statistically significant difference in terms of adverse effects and postoperative barehanded muscle strength examination between the two groups (P > 0.05). (5) In total knee arthroplasty, ultrasound-guided continuous adductor canal block and single sciatic nerve block, together with a “cocktail” mixed drug analgesia injected into the joint cavity, can provide excellent analgesia, facilitate the recovery of joint function, and relieve postoperative pain and inflammation with a high degree of safety.
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    Mid- and long-term state after total hip arthroplasty versus hemiarthroplasty for femoral neck fractures in the elderly: evaluation using propensity score matching method
    Li Zhipeng, Huan Dawei, Yuan Zhaofeng, Ding Kai, Qiu Yue, Xia Tianwei, Shen Jirong
    2024, 28 (24):  3839-3844.  doi: 10.12307/2024.616
    Abstract ( 126 )   PDF (1061KB) ( 60 )   Save
    BACKGROUND: Arthroplasty is the primary treatment for displaced femoral neck fractures in the elderly, and the choice of total hip arthroplasty versus hemiarthroplasty is currently the subject of considerable debate.
    OBJECTIVE: To compare the mid- and long-term survival status of total hip arthroplasty versus hemiarthroplasty under a direct anterior approach for displaced femoral neck fractures in the elderly based on the propensity score matching method. 
    METHODS: One hundred and forty-seven elderly patients (≥ 65 years of age) with displaced femoral neck fractures were admitted from January 2016 to January 2021, of whom 88 had total hip arthroplasty (total hip arthroplasty group) and 59 had artificial femoral head replacement (hemiarthroplasty group). For the patients’ preoperative comorbidities, the age-corrected Charlson Comorbidity Scale was used to quantify the scores and calculate patient frailty. The propensity score matching method was used to match the two groups 1:1 and to compare the operation time, bleeding, postoperative hospitalization time, hospitalization cost, nutritional index, postoperative complications, and mortality between the two groups after matching. Postoperative survival time was determined by Kaplan-Meier Survival analysis. 
    RESULTS AND CONCLUSION: (1) After propensity score matching, a total of 42 matched pairs were successful in both groups, and the preoperative data of patients in both groups were balanced and comparable after matching (P > 0.05). (2) Compared with the hemiarthroplasty group, operation time (79.71 minutes vs. 59.07 minutes, P < 0.001), bleeding volume (839.64 mL vs. 597.83 mL, P=0.001), and hospitalization cost (56 508.15 yuan vs. 41 702.85 yuan, P < 0.001) were significantly higher in the total hip arthroplasty group. However, the mortality rate was lower in the total hip arthroplasty group than in the hemiarthroplasty group (36% vs. 57%, HR=0.44, 95%CI: 0.23-0.87, P=0.018), and the mean survival time was longer in the total hip arthroplasty group than in the hemiarthroplasty group (59.4 months vs. 43.7 months, P=0.024). (3) There were no statistically significant differences in postoperative hospitalization time, preoperative and postoperative nutritional indicators, and overall postoperative complication rate between the two groups (P > 0.05). However, in terms of postoperative pain, the incidence of pain was significantly higher in the hemiarthroplasty group than that in the total hip arthroplasty group (24% vs. 7%, P=0.035). (4) Overall, total hip arthroplasty has a better prognosis for survival, while hemiarthroplasty is more appropriate for patients with poor physical fitness. At the same time, postoperative pain may largely affect the quality and survival time of patients after hip arthroplasty.
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    Accuracy of sacroiliac screw placement in robot-assisted navigation
    Zhang Wenhui, Wang Chunli, Fan Lizhen, Yang Yuping, Zhang Jinlong, Zhang Hui, Liu Jie, Tai Huiping
    2024, 28 (24):  3845-3849.  doi: 10.12307/2024.098
    Abstract ( 158 )   PDF (1314KB) ( 23 )   Save
    BACKGROUND: Orthopedic robots have been widely used in clinical practice, and relevant reports have shown that they have many advantages such as minimal trauma and short surgical time. However, there is currently no clear report on how accurate they are.
    OBJECTIVE: To evaluate the accuracy of robot-assisted sacroiliac screw insertion.
    METHODS: A total of 131 patients with sacroiliac joint fracture and dislocation and sacral fracture admitted to the Department of Trauma Surgery, Gansu Provincial Hospital from January 2020 to April 2023 were retrospectively collected, including 131 S1 screws and 46 S2 screws, totaling 177 screws. They were divided into two groups based on whether robot-assisted navigation was performed. There were 63 cases of sacroiliac screws inserted under robot-assisted navigation (observation group), with 36 males and 27 females, aged 19-72 years, with a mean age of (45.3±17.6) years. Among them, 39 cases were fixed with only S1 screws, while 24 cases were fixed with S1S2 screws, resulting in a total of 87 sacroiliac screws. Under C-arm fluoroscopy, 68 cases of sacroiliac screws were inserted with bare hands (control group), including 41 males and 27 females, aged 23-67 years, with a mean age of (42.6±21.3) years. Among them, 46 cases were fixed with simple S1 screws, while 22 cases were fixed with S1S2 screws, resulting in a total of 90 sacroiliac screws. A postoperative CT scan was performed to evaluate the number of S1 screws, S2 screws, total screw level, and calculate accuracy based on the method introduced by SMITH et al. 
    RESULTS AND CONCLUSION: (1) In the observation group, 62 S1 screws were accurately placed (62/63), with an accuracy rate of 98%. 24 S2 screws were accurately placed (24/24), with an accuracy rate of 100%. The total number of screws accurately placed was 86 (86/87), with an accuracy rate of 99%. (2) In the control group, 58 S1 screws were accurately inserted (58/68), with an accuracy rate of 85%. 19 S2 screws were accurately inserted (19/22), with an accuracy rate of 86%. The total number of screws accurately inserted was 77 (77/90), with an accuracy rate of 86%. (3) There was a statistically significant difference in the accuracy of the S1 screw, S2 screw, and total screw between the two groups (P < 0.05). It is suggested that the placement of sacroiliac screws under robot navigation has higher accuracy compared to manual placement under C-arm fluoroscopy, but still has a lower error rate in placement.
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    Distribution characteristics of humeral head screws in treatment of proximal humeral fractures with proximal humerus internal locking system plate
    Hu Liuchao, Luo Yiwen, Huang Jiewen, Lan Sibin, Wu Zhifang
    2024, 28 (24):  3850-3854.  doi: 10.12307/2024.621
    Abstract ( 154 )   PDF (924KB) ( 30 )   Save
    BACKGROUND: Proximal humerus internal locking system locking plate is the most commonly used fixation method for proximal humeral fractures, but its failure rate is still high in clinical practice. Reasonable screw placement is an important factor affecting the stability of internal fixation.
    OBJECTIVE: To investigate the distribution of humeral head screws in the treatment of proximal humeral fractures with proximal humerus internal locking system plate and its influence on internal fixation failure.
    METHODS: From January 2017 to December 2021, data from patients with proximal humeral fractures undergoing proximal humerus internal locking system plate in Third Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively analyzed. A total of 124 patients were enrolled, including 16 males and 108 females, at the age of ≥60 years. According to whether there was internal fixation failure after operation, they were divided into normal group (n=101) and internal fixation failure group (n=23). The patient’s age, gender, fracture type, the integrity of the medial column, plate height, neck-shaft angle, whether the talus screw was inserted, and the number of humeral head screws, were collected. The humeral head was divided into eight zones according to the postoperative digital radiography anteroposterior film, and the distribution characteristics of the screws in each zone were collected, and the heat map of the screw distribution was drawn.
    RESULTS AND CONCLUSION: (1) There were no significant differences between the two groups in age, gender, fracture type, the integrity of the medial column, plate height, neck-shaft angle, whether to insert talus screws, and the number of humeral head screws (P > 0.05). (2) The heat map showed that the humeral head screws were evenly distributed in the normal group, mainly scattered in zones 4, 6, and 7. However, the screw distribution in the internal fixation failure group was not uniform, mainly concentrated in zones 4 and 6. In addition, in the ideal area of talus screws (7/8 zone), there were significantly more screws in the normal group than in the internal fixation failure group. (3) It is indicated that in the treatment of proximal humeral fractures with proximal humerus internal locking system plate, the uniform distribution of humeral head screws is the key to ensuring the internal fixation effect. A reasonable distribution of humeral head screws helps to improve the treatment effect and the success rate of internal fixation.  
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    Modified calcaneal plate combined with suture anchors in treatment of comminuted fracture of split-type greater tuberosity of humerus (Liu-Gang type IV)
    Liu Gang, Zhang Baolu, Li Ruichen, Hou Xiaomei, Luo Hong, Lai Canhao, Li Qingyuan, Liang Xia, Bao Dingsu, Fu Shijie, Zeng Shengqiang
    2024, 28 (24):  3855-3861.  doi: 10.12307/2024.612
    Abstract ( 156 )   PDF (1791KB) ( 12 )   Save
    BACKGROUND: Numerous scholars have previously researched certain greater tuberosity fractures and the procedures used to treat them. Few researchers, however, have studied the comminuted split fracture of the greater tuberosity of the humerus (Liu-Gang type IV) with rotator cuff tear in great detail.
    OBJECTIVE: To compare the clinical therapeutic effect of open repair position modified calcaneal plate combined with suture anchors and proximal humeral internal locking system (PHILOS) plate in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears (Liu-Gang type IV).
    METHODS: Case data of 30 patients with comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears (Liu-Gang type IV) from May 2012 to May 2022 were retrospectively analyzed. They were divided into the modified calcaneal plate combined with suture anchor group (group A) and the PHILOS with #2 Johnson group (group B), with 15 cases in each group. Intraoperative blood loss, surgical time, and incision length of all patients were recorded. Pain visual analog scale score, Constant-Murley score, as well as shoulder joint abduction, forward flexion, external rotation, and dorsal expansion activities during the last follow-up (> 1 year) were evaluated. 
    RESULTS AND CONCLUSION: (1) The surgical incision length and operation time were shorter, and blood loss was less in group A than those in group B (P < 0.05). (2) No significant difference in visual analog scale score and Constant-Murley score was detected between the two groups (P > 0.05). (3) During the last follow-up, forward flexion in group A was better than that in group B (P < 0.05). No significant difference in abduction, external rotation, and dorsal expansion was determined between group A and group B (P > 0.05). (4) In terms of complications, there was 1 case of shoulder joint pain and discomfort in group A (7%), 2 cases of subacromial impingement syndrome, 2 cases of upward movement of nodules, and 2 cases of shoulder joint pain (40%) in group B. There were significant differences in complication rates between the two groups (P=0.031). (5) In summary, the modified calcaneal plate combined with suture anchors in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears (Liu-Gang type IV) could better restore the forward flexion function of the shoulder joint and has a small incision, less blood loss, shorter operation time and fewer complications. 
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    A controlled trial of elastic fixation and absolute fixation for treatment of ankle fractures with lower tibiofibular instability
    Zhang Guohui, Tian Weifeng, Li Hua, Wang Quan, Liu Yanhui, Guan Yulong, Xiao Chunlai
    2024, 28 (24):  3862-3866.  doi: 10.12307/2024.608
    Abstract ( 158 )   PDF (978KB) ( 41 )   Save
    BACKGROUND: Although traditional screw fixation has been successful in treating ankle fractures, rigid fixation solutions tend to restrict ankle movement and delay fracture healing, whereas elastic fixation is more compatible with human mechanics and has unique advantages in patients with ankle fractures. 
    OBJECTIVE: To compare the clinical effectiveness of elastic fixation and absolute fixation in repairing ankle fractures in the elderly with lower tibiofibular instability. 
    METHODS: The clinical data of 108 elderly ankle fractures with lower tibiofibular instability in Hengshui People’s Hospital from August 2019 to August 2021 were retrospectively collected. They were divided into screw group and elastic fixation group (n=54 per group) according to the surgical protocol, and traditional screw internal fixation and elastic internal fixation were performed respectively. The perioperative indicators, surgical results, economic benefits, and American orthopedic foot and ankle society scores were collected and compared between the two groups. Serum tumor necrosis factor-α, interleukin-8 levels, ankle cavity width, depth, and lower tibiofibular space were compared before and after surgery. 
    RESULTS AND CONCLUSION: (1) The full weight-bearing time was shorter in the elastic fixation group than that in the screw group; the operating angle was greater in the elastic fixation group than that in the screw group, and the complication rate was lower in the elastic fixation group than that in the screw group (P < 0.05). (2) Serum tumor necrosis factor-α and interleukin-8 levels in the elastic fixation group were lower than those in the screw group 3 days after surgery (P < 0.05). (3) American orthopedic foot and ankle society scores in the two groups were higher than those before surgery at 6 and 12 months after surgery, and the depth and width of the inferior tibiofibular space and ankle cavity were lower than those before surgery (P < 0.05); but no significant difference was detected between the two groups (P > 0.05). (4) There was no significant difference in the excellent and good rate between the two groups at 12 months after surgery (P > 0.05). (5) There was no significant difference in the comparison of direct non-medical costs, direct medical costs, and total costs between the two groups (P > 0.05). (6) It is indicated that elastic fixation for the repair of ankle fractures with lower tibiofibular instability in the elderly can obtain effective outcomes, which can shorten the time of complete weight-bearing, diminish complications, and alleviate inflammatory stress. 
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    Comparison of three kinds of palmar approach plate implantation for treatment of unstable distal radius fractures
    Huang Xiaoxia , Peng Cong, Aikobayer·Kudir, Teng Yong, Zhao Yan
    2024, 28 (24):  3867-3872.  doi: 10.12307/2024.603
    Abstract ( 183 )   PDF (910KB) ( 9 )   Save
    BACKGROUND: In the past, it was necessary to cut off the pronator quadratus muscle in the treatment of distal radius fractures. Failure to repair the pronator quadratus muscle can lead to a series of complications.  
    OBJECTIVE: To explore the clinical efficacy of different methods of preserving the pronator quadratus muscle combined with a palmar steel plate in the treatment of distal radius fractures.
    METHODS: Clinical data of 66 patients with distal radius fractures were retrospectively included, divided into the traditional Henry approach group (group A), the split brachioradialis tendon approach group (group B), and the posterior pronator quadratus muscle approach group (group C), with 22 patients in each group. Postoperative internal fixation, fracture healing, and postoperative complications were observed in the three groups. The visual analog scale score of postoperative wrist pain and forearm rotation angle were compared among the three groups. The Dienst Joint Scale was used to evaluate the wrist function of patients.
    RESULTS AND CONCLUSION: (1) The surgical time, intraoperative blood loss, and fracture healing time of groups B and C were significantly lower than those of group A (P < 0.01). There was no significant difference in intraoperative blood loss and fracture healing time between groups B and C, but the surgical time was shorter in group B. (2) The anteroposterior and lateral wrist X-ray examination 3 days and 1 and 3 months after surgery exhibited that there were no significant differences in radial height, palm angle, and ulnar deviation angle among the three groups (P > 0.05). No significant difference was detected in various indicators during the same phase among the three groups (P > 0.05). (3) At a follow-up of 12 months after surgery, there were no significant differences in visual analog scale scores and forearm rotation angle among the three groups. However, the evaluation results at 1 and 3 months after surgery demonstrated significant differences in visual analog scale scores and forearm rotation angle among the three groups (P < 0.05). Among them, group C had a lower visual analog scale score and a larger forearm rotation angle. (4) According to the Dienst joint scoring standard, the excellent and good rate of wrist joint function evaluation was 86%(19/22), 91%(20/22), and 95%(21/22) in groups A, B, and C, respectively 12 months after surgery. (5) All patients did not experience any postoperative vascular or neurological damage or surgical site infection. Group A had three cases of tendon irritation, two cases of traumatic arthritis, and two cases of carpal tunnel syndrome. In group B, tendon irritation occurred in 1 case and joint stiffness in 1 case. There was 1 case of traumatic arthritis and 1 case of carpal tunnel syndrome in group C. (6) It is suggested that different surgical methods for treating distal radius fractures have achieved good clinical results. Placing a steel plate under the pronator muscle can alleviate early postoperative pain, promote early activity, and restore normal life. The brachioradialis tendon approach has more advantages in exposing intraoperative fractures and can shorten the surgical time.
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    Uniaxial endoscopic intervertebral fusion combined with pedicle screw fixation in treatment of lumbar degenerative diseases
    Tang Long, Zheng Jiazhuang, Wang Fandong, Liu Yuanbin, Song Zhaojun, Zhang Zhi, Wang Miao, Zhou Yong, Liu Huiyi, Chen Yu
    2024, 28 (24):  3873-3878.  doi: 10.12307/2024.100
    Abstract ( 162 )   PDF (1271KB) ( 108 )   Save
    BACKGROUND: With the rapid development of minimally invasive spinal surgery and enhanced recovery after surgery, endoscopic intervertebral fusion techniques have gradually emerged and been widely used in clinical practice in recent years. 
    OBJECTIVE: To analyze the early clinical efficacy of uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the treatment of lumbar degenerative diseases. 
    METHODS: 135 patients with lumbar degenerative diseases treated by uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the Suining Central Hospital from October 2020 to December 2021 were enrolled in this study. There were 59 males and 76 females, aged 47-79 years. The lower limb and lumbar pain was evaluated by visual analog scale and lumbar function was assessed by Oswestry disability index before the operation, 1 week, 1, and 6 months after the operation, and at the end of follow-up. The overall pain recovery of patients was evaluated by the scoring criteria for low back pain surgery of Spine Group of Chinese Orthopedic Association and the lumbar physiological curvature and intervertebral fusion were evaluated on lumbar lateral X-ray preoperatively and at the end of follow-up. 
    RESULTS AND CONCLUSION: (1) The 135 patients were followed up for (17.8±3.0) months after surgery. There was 1 case of endplate injury, 1 case of cerebrospinal fluid leakage, 1 case of nerve root injury, 1 case of intervertebral cage subsidence and displacement, 1 case of chronic infection, and 1 case of pedicle screw rupture. The complication rate was 5.2%. (2) The lumbar visual analog scale score and Oswestry disability index significantly decreased in the waist and lower limbs at various time points postoperatively compared with those preoperatively in 135 patients (P < 0.05). The scoring criteria for low back pain surgery of the Spine Group of the Chinese Orthopedic Association were significantly better at the last follow-up than that preoperatively in 135 patients (P < 0.05). (3) At the last follow-up, there was no significant difference in physiological curvature of lumbar vertebra as compared with that preoperatively in 135 patients (P > 0.05), with a fusion rate of 95.8%. (4) It is concluded that uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the treatment of lumbar degenerative diseases has shown satisfactory early clinical results and is a highly safe minimally invasive spinal surgery mode.
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    Correlation between sagittal curvature parameters and pain threshold for neck-shoulder muscles in degenerative cervical spondylosis
    Yang Yunxiao, Huang Chenglan, Hou Yutong, Yao Yuan, Zhao Yu Xu, Yuanjing, Yang Zezheng, Wang Jinwu
    2024, 28 (24):  3879-3884.  doi: 10.12307/2024.097
    Abstract ( 140 )   PDF (883KB) ( 77 )   Save
    BACKGROUND: Patients with degenerative cervical spondylosis often suffer from changed varicosity of the cervical spine, unbalanced neck-shoulder muscular strength, and descending power.
    OBJECTIVE: To probe into the correlation between sagittal curvature parameters and pain threshold for neck-shoulder muscles in degenerative cervical spondylosis.
    METHODS: Totally 50 patients with degenerative cervical spondylosis received treatment at the 3D Printed Outpatient Center of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from January 2022 to March 2023 were included in the study. After excluding the 10 patients of cervical lateral projection that failed to meet the measurement conditions, the cervical lateral projections were shot to measure the following iconography parameters: Borden value and C2-7 Cobb angle as well as pain thresholds on the midpoint of the superior trapezius muscle in bilateral bundles and at 1 cm beside the C5-6 interspike. The correlation between sagittal curvature parameters and pain threshold of neck-shoulder muscles in degenerative cervical spondylosis was analyzed.
    RESULTS AND CONCLUSION: (1) The Borden value of sagittal curvature showed a moderately positive correlation with the bundle pain threshold in the left upper trapezius muscle, the bundle pain threshold in the right upper trapezius muscle, and the pain threshold at the 1 cm of the left side beside the C5-6 interspike (r=0.498, P < 0.01; r=0.448, P < 0.05; r=0.405, P < 0.05) and a weak positive correlation with the pain threshold at the 1 cm of the right side beside the C5-6 interspike (r=0.322, P < 0.05). (2) The C2-7 Cobb angle showed a weak positive correlation with the left squared myalgia threshold (r=0.355, P < 0.05), and there was no correlation with the pain threshold of the left trapezius muscle and the pain threshold at the 1 cm of both sides beside the C5-6 interspike. (3) There was a correlation between the pain threshold of the neck-shoulder muscles, and a high correlation between the pain threshold of the left and right muscles and the pain threshold within the left and right side muscles, indicating that the neck-shoulder muscles are consistent and may be related to the coordination of the neck-shoulder movements.
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    Micro-CT analysis of distribution and structural characteristics of bone trabeculae in the calcaneus
    Zhang Fengzhen, Sun Ruifen, Li Ziyu, Wang Xing, Li Kun, Li Zhijun, Zhang Shaojie
    2024, 28 (24):  3885-3889.  doi: 10.12307/2024.617
    Abstract ( 178 )   PDF (1190KB) ( 67 )   Save
    BACKGROUND: The calcaneus is located in the lower posterior part of the foot and is heavily stressed. Calcaneus is complex and irregular in shape, surrounded by thin cortical bone and filled with a large number of trabeculae. The study of the microstructure, movement, and distribution of trabeculae is helpful to improve the understanding of calcaneus fracture.
    OBJECTIVE: The image data of calcaneus were obtained by scanning the calcaneus specimens with micro-computed tomography, and the structure of trabecular bone in calcaneus was analyzed to explore the morphology, distribution and structural characteristics of trabecular bone in calcaneus.
    METHODS: Dry adult calcaneus specimens were continuously scanned by micro-computed tomography, and the images were obtained after scanning and stored in DICOM format. Image data were imported into Hiscan Analyzer software to display clear and complete images of the sagittal plane, coronal plane, and the horizontal plane of the adult calcaneus. The trabecular movement of bone was observed layer by layer. According to the trabecular movement characteristics, the sagittal plane of the calcaneus was divided into six parts. A 49-mm2 region of interest was selected for each part at the same thickness as 7 mm. The three-dimensional microstructure of calcaneus and trabecular bone was obtained after three-dimensional reconstruction. After binarization, the volume fraction, surface density, trabecular thickness, trabecular space, and trabecular number parameters of the trabecular bone in the region of interest were calculated by software.
    RESULTS AND CONCLUSION: (1) The cortical layer of the calcaneus was very thin and filled with a large amount of cancellous bone, and the cortical layer of the horn of Gissane was obviously thickened. (2) The trabecular volume fraction in the upper part of the calcaneus was greater than that in the anterior part of the lower part of the calcaneus, the central triangle, the posterior part of the lower part of the calcaneus, and the base of the calcaneus, and the trabecular volume fraction in the tubercle of the calcaneus was greater than that in the anterior part of the lower part of the calcaneus, the central triangle, the posterior part of the lower part of the calcaneus, and the base of the calcaneus. The surface density of the trabecular bone in the tubercle of the calcaneus was higher than that in the front of the lower calcaneus, the middle triangle area, and the bottom of calcaneus, and the surface density of the trabecular bone in the upper part of calcaneal bone, and the lower part of the calcaneus was higher than that in the middle triangle area. The thickness of the trabecular bone in the upper part of the calcaneus was greater than that in the tubercle of the calcaneal bone. The bone trabecular space in the middle triangle was larger than that in the upper part of the calcaneus and calcaneal tubercles. The number of bone trabeculae in the calcaneal tubercles was greater than that in the middle triangle area. (3) These results indicate that the trabeculae of rod bone were mainly distributed in the middle triangle area. The surface density of trabeculae was the smallest, the volume fraction was smaller, and the space between trabeculae was the largest. This part of the bone is relatively loose. The compression resistance is poor when subjected to high impact. The trabecular bone fractures first occur, which is a prone site for fractures.
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    Anatomical risk factors for tibial insertion avulsion fracture of anterior cruciate ligament based on MRI
    Huang Dong, Ge Jin, Liu Guangluan, Guo Zonglei, Wang Yehua
    2024, 28 (24):  3890-3896.  doi: 10.12307/2024.620
    Abstract ( 178 )   PDF (1097KB) ( 12 )   Save
    BACKGROUND: Anterior cruciate ligament avulsion fracture at tibial insertion is a special type of intra-articular fracture, which is mostly seen in sports injuries. At present, there are relatively few anatomical studies on this disease, but a large number of studies focus on the injury of the anterior cruciate ligament. It is generally believed that the increase in the posterior slope of the tibial plateau, the decrease of the depth of the medial tibial plateau, and the decrease in the width index of the femoral intercondylar notch are the risk factors for the injury of the anterior cruciate ligament. It is unclear whether avulsion fractures of the anterior cruciate ligament at the tibial insertion point are also related to it.
    OBJECTIVE: To investigate the correlation between the avulsion fracture of the anterior cruciate ligament at the tibial insertion and the posterior tibial slope, the medial tibial depth, the notch width index of the femoral intercondylar fossa, and the coronal slope angle of the tibial plateau. 
    METHODS: A retrospective analysis was made on 101 patients who were admitted to the Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University due to anterior knee pain from January 2019 to December 2022. Totally 51 patients with tibial insertion avulsion fracture of anterior cruciate ligament who received arthroscopy treatment were taken as the observation group, and 50 patients with anterior knee pain but no knee joint injury confirmed by physical examination and imaging examination were taken as the control group in the same period. The posterior tibial slope, anatomical parameters such as the medial tibial depth, and the notch width index of the femoral intercondylar fossa , were statistically analyzed for the anatomical risk factors leading to the tibial insertion avulsion fracture of the anterior cruciate ligament.
    RESULTS AND CONCLUSION: (1) There was no significant difference between the two groups in the comparison of the lateral posterior tibial slope, the posterior slope ratio of the lateral/medial tibial plateau, the notch width index of the femoral intercondylar fossa, and the coronary slope angle of the tibial plateau (P > 0.05). The medial posterior tibial slope in the observation group was significantly higher than that in the control group (P < 0.05). The medial tibial depth in the observation group was significantly lower than that in the control group (P < 0.05). (2) Multifactor logistic regression analysis showed that the medial posterior tibial slope and the medial tibial depth were independent risk factors for tibial insertion avulsion fracture of anterior cruciate ligament (P < 0.05). (3) The receiver operating characteristic curve shows that the medial posterior tibial slope and the medial tibial depth had certain predictive values for the tibial insertion avulsion fracture of the anterior cruciate ligament. (4) It is indicated that the increased medial posterior tibial slope and the shallower medial tibial depth are the anatomical risk factors for the avulsion fracture of the tibial insertion of the anterior cruciate ligament.
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    Effect of support surface stability on balance in the elderly with mild cognitive impairment under different visual input conditions
    Qi Liuxin, Zhou Mian, Wang Xiangyu, Sun Wei, Wang Jiangna
    2024, 28 (24):  3897-3902.  doi: 10.12307/2024.602
    Abstract ( 157 )   PDF (974KB) ( 75 )   Save
    BACKGROUND: Stability of the support surface and visual input are important factors affecting static balance, but most of the studies on the balance ability of elderly with mild cognitive impairment have focused on the stable hard support surface, and the control of static balance on the unstable support surface under different visual input conditions is not known.
    OBJECTIVE: To investigate the static balance ability of the elderly with mild cognitive impairment on soft and hard support surfaces under different visual input conditions.
    METHODS: Twenty-one elderly people with mild cognitive impairment and nineteen elderly people with normal cognition were selected for the study, and the Kistler three-dimensional dynamometer was used to conduct four tests: standing with two feet on hard support surface with eyes open, standing with two feet on soft support surface with eyes open, standing with two feet on hard support surface with eyes closed, standing with two feet on soft support surface with eyes closed, and standing with two feet on soft support surface with eyes closed, and the duration of each test was 30 seconds. The plantar center of pressure data were collected and compared between the two groups under different visual conditions on the soft and hard support surfaces.
    RESULTS AND CONCLUSION: (1) Under the condition of visual input, the total excursions (soft support surface: P=0.003), the total excursions-medial-lateral sides (soft support surface: P=0.001, hard support surface: P < 0.001) and the 95% confidence ellipse area (soft support surface: P=0.001, hard support surface: P < 0.001) of the center of pressure in the elderly with mild cognitive impairment on the soft and hard support surfaces were significantly higher than those of the elderly with normal cognition. (2) In the absence of visual input, the root mean square distance (P=0.014), the root mean square distance-medial-lateral sides (P=0.014), and the 95% confidence ellipse area (P=0.001) of center of pressure in the elderly with mild cognitive impairment on the soft support surfaces were significantly higher than those of the elderly with normal cognition, but there were no significant differences between the groups on the hard support surface (P > 0.05). (3) These findings confirm that compared with the elderly with normal cognition who could make full use of visual sensory input to maintain body balance on the soft and hard support surfaces, mild cognitive impairment elderly presented a deficit in balance function. In particular, mild cognitive impairment elderly relied more on ankle proprioception to maintain balance when visual interference was present, suggesting that mild cognitive impairment elderly should focus on strengthening ankle proprioceptive training. 
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    Predictors of a forgotten joint after medial open wedge high tibial osteotomy
    Huang Yiwei, Peng Bo, Zhang Chen, Ge Hao, Li Jiahao, Li Yijin, Chen Jinlun, Feng Wenjun, Zeng Yirong
    2024, 28 (24):  3903-3909.  doi: 10.12307/2024.610
    Abstract ( 147 )   PDF (1360KB) ( 39 )   Save
    BACKGROUND: Medial open wedge high tibial osteotomy is an effective procedure for preserving the knee joint in patients with medial compartmental osteoarthritis. Previous studies have demonstrated that the forgotten joint score provides a lower ceiling effect and consistency of medial open wedge high tibial osteotomy outcomes compared to traditional assessment tools.
    OBJECTIVE: To identify predictive factors associated with the occurrence of a forgotten joint after medial open wedge high tibial osteotomy.
    METHODS: 117 patients with medial open wedge high tibial osteotomy who were treated at First Affiliated Hospital of Guangzhou University of Chinese Medicine were selected, including 35 males and 82 females, with an average age of 61 years. They were followed up for at least 2 years. Patients were divided into a forgotten joint group (n=28) and a non-forgotten joint group (n=89) by evaluating whether they achieved forgotten joint after surgery. Univariate and multivariate logistic regression analyses were performed with preoperative patient characteristics and surgery-related factors as potential predictors. 
    RESULTS AND CONCLUSION: (1) There were significant differences in the proximal medial tibial angle between the two groups before surgery (P < 0.05). There were significant differences in the forgotten joint score, Knee Injury and Osteoarthritis Outcome Score, knee society knee score, function score, and patients joint perception between the two groups after surgery (P < 0.05). There was a significant difference between the hip-knee-ankle angle and the medial proximal tibial angle after operation (P < 0.05). (2) Univariate Logistic regression analysis showed that the medial proximal tibial angle had a significant influence on the forgotten joint before operation [OR=0.755, 95%CI(0.635-0.897), P < 0.001]. There were significant effects on the forgotten joint of hip-knee-ankle angle and medial proximal tibial angle [OR=1.546, 95%CI(1.242-1.924), P < 0.001; OR=0.815, 95%CI(0.713-0.931), P=0.003]. (3) Multivariate logistic regression analysis showed that preoperative K-L grade 1 was a favorable factor for obtaining forgotten joints. Preoperative medial proximal tibial angle and postoperative hip-knee-ankle angle were independent predictors of forgetting joints, and they had a curvilinear relationship with the probability of achieving forgetting joints. When preoperative medial proximal tibial angle increased by 1°, the probability of achieving a forgotten joint decreased by 27.7% [OR=0.723, 95%CI(0.593-0.882), P < 0.001]. Conversely, when postoperative hip-knee-ankle angle increased by 1°, the probability of achieving a forgotten joint increased by 46.4% [OR=1.464, 95%CI(1.153-1.860), P=0.002]. (4) The results showed that patients with preoperative knee osteoarthritis K-L grade 1, small medial proximal tibial angle (< 85.5°), and large postoperative hip-knee-ankle angle (> 176.0°) were predictors of forgotten joint.
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    Role and mechanism of interleukin-8 in bone regeneration
    Luo Peng, Wang Yi, Wang Ansu, Dang Yi, Ma Yaping, Zhang Yi, Wang Xin
    2024, 28 (24):  3910-3914.  doi: 10.12307/2024.615
    Abstract ( 158 )   PDF (1190KB) ( 78 )   Save
    BACKGROUND: Interleukin-8 is an important cytokine that has been found to play an important role in bone regeneration through multiple pathways.
    OBJECTIVE:  To comprehensively review the action mechanism of interleukin-8 effects on bone regeneration to provide ideas for the following studies on interleukin-8. 
    METHODS: By searching the China National Knowledge Infrastructure database for articles published from January 1999 to February 2023 and PubMed database for articles published from January 1985 to February 2023 reporting the role of interleukin-8 in bone-associated cells and vascularisation. Chinese and English search terms were “interleukin-8, bone repair, bone metabolism, mesenchymal stem cells, osteoblasts, osteoclasts, vascularization”. The initial review yielded 508 articles in English and Chinese, and a total of 51 articles were included for review and analysis according to the inclusion and exclusion criteria. 
    RESULTS AND CONCLUSION: According to the existing research, interleukin-8 can promote bone cell regeneration and assist bone healing through multiple pathways, which is mainly divided into three aspects: (1) Promote the proliferation and differentiation of bone cells such as mesenchymal stem cells and osteoblasts, and promote the development of cells in the direction of promoting bone healing; (2) interleukin-8 can promote angiogenesis and provide sufficient nutrition and oxygen for bone tissue, thus further improving the quality and stability of bone healing. (3) The appearance of interleukin-8 facilitates the expression of hypoxia-inducible factor-1α, vascular endothelial growth factor, and matrix metalloproteinase, which can create a microenvironment conducive to bone regeneration, thus promoting the regeneration and repair of bone tissue. In summary, interleukin-8 plays an important role in bone healing by promoting osteoblast proliferation and differentiation, facilitating angiogenesis and improving the mechanical properties of bone regeneration, as well as influencing bone metabolism through osteoclasts, mesenchymal stem cells, and other action sites. 
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    Regulating oxidative stress with natural products for treating osteoporosis
    Yan Binghan, Li Zhichao, Su Hui, Xue Haipeng, Xu Zhanwang, Tan Guoqing
    2024, 28 (24):  3915-3921.  doi: 10.12307/2024.089
    Abstract ( 176 )   PDF (1249KB) ( 79 )   Save
    BACKGROUND: More and more studies have shown that oxidative stress should play an important role in the treatment of osteoporosis. Oxidative stress should cause the accumulation of oxidation activity, which will damage bone-related cells. Finally, it causes the imbalance of bone resorption and bone formation, resulting in a decrease in bone volume and the destruction of the slight structure. Research in recent years has found that some natural products can regulate oxidative stress to treat osteoporosis. The characteristics of extensive sources and small side effects have obvious advantages in the treatment of osteoporosis, and the efficacy is objective.
    OBJECTIVE: To discuss the mechanism of natural product regulation of oxidation stress in treatment of osteoporosis, conduct a review based on the latest related research progress, provide reference and ideas for more natural products to treat osteoporosis in the future, and provide data support for the clinical application of natural compounds in the treatment of osteoporosis.
    METHODS: “oxidative stress, free radical, antioxidant, phytotherapy, plant extracts, medicinal plants, herbal medicine, osteoporosis, bone density, bone loss” were used as the keywords in PubMed, Web of Science, Embase, Cochrane, VIP, CBM, WanFang, and CNKI databases to search relevant articles published from January 2010 to February 2023. Inclusion and exclusion criteria were developed, and 64 relevant articles were selected by reading titles, abstracts, and full texts.
    RESULTS AND CONCLUSION: (1) Some natural products have antioxidant effects and can regulate osteogenic differentiation, osteoblast bone matrix mineralization, osteoclast-mediated bone resorption, proliferation, differentiation, activity, and apoptosis of bone-related cells by improving oxidative stress, thus affecting bone metabolism. (2) These natural products with antioxidant effects play a role in treating osteoporosis by improving bone remodeling balance. (3) The research on the combination of a variety of natural products to improve osteoporosis remains to be explored. (4) The use of natural products to regulate oxidative stress may become a powerful weapon for the clinical treatment of osteoporosis in the future.
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    Meta-analysis of the incidence and related factors for cervical spine instability in patients with rheumatoid arthritis
    Xu Chenghan, Zhuo Hanjie, Chai Xubin, Huang Yong, Zhang Bowen, Chen Qin, Hao Yupeng, Li Lin, Zhou Yingjie
    2024, 28 (24):  3922-3929.  doi: 10.12307/2024.087
    Abstract ( 180 )   PDF (3049KB) ( 61 )   Save
    OBJECTIVE: At present, there are many reports on the related factors associated with the incidence of cervical spine instability in patients with rheumatoid arthritis, but there are problems such as small sample size and many confounding factors, and the research results of various studies on the same related factors are also different. This article analyzed the factors related to cervical spine instability in patients with rheumatoid arthritis by means of a systematic review. 
    METHODS: Articles related to cervical spine instability in patients with rheumatoid arthritis were collected by searching both Chinese and English databases until March 2023. The outcome of cervical spine instability in patients with rheumatoid arthritis was used as the grouping criterion to abstract basic information, baseline patient characteristics, laboratory-related tests, medication use, and other relevant risk factors. Meta-analysis was done using Stata 14.0 software. 
    RESULTS: (1) Sixteen relevant studies, all of moderate or above quality, were included, including seven studies with case-control studies and nine with cross-sectional studies. The overall incidence of cervical spine instability in patients with rheumatoid arthritis was 43.08%. (2) Meta-analysis showed: Related risk factors included female (OR=0.60, 95%CI: 0.44-0.82, P=0.002); age at disease onset (SMD=-0.52, 95%CI: -0.86 to -0.18, P=0.003); duration of disease (SMD=0.58, 95%CI: 0.14-1.02, P=0.01); body mass index (OR=0.74, 95%CI: 0.63-0.88, P=0.001); rheumatoid factors positive univariate analysis subgroup (OR=1.33, 95%CI:1.02 to 1.72, P=0.04), C-reactive protein (SMD=0.26, 95%CI: 0.16-0.35, P=0.00), erythrocyte sedimentation rate (SMD=0.15, 95%CI: 0.002-0.29, P=0.047), anti-cyclic-citrullinated peptide antibodies (OR=1.73, 95%CI: 1.19-2.51, P=0.004), 28-joint Disease Activity Score (SMD=0.20, 95%CI: 0.04-0.37, P=0.02), destruction of peripheral joints (OR=2.48, 95%CI: 1.60-3.85, P=0.00), and corticosteroids (OR=1.91, 95%CI: 1.54-2.37, P=0.00) were strongly associated with the development of rheumatoid arthritis-cervical spine instability. Female and corticosteroid use were independently associated with the occurrence of rheumatoid arthritis-cervical spine instability. 
    CONCLUSION: Based on clinical evidence from 16 observational studies, the overall incidence of rheumatoid arthritis-cervical spine instability was 43.08%. However, the incidence of cervical spine instability in rheumatoid arthritis patients varied greatly among different studies. Gender (female) and the use of corticosteroids were confirmed as independent correlation factors for the onset of cervical spine instability in patients with rheumatoid arthritis. The results of this study still provide some guidance for early clinical recognition, diagnosis, and prevention of rheumatoid arthritis-cervical spine instability.
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    Effect of balance training on chronic ankle instability: a meta-analysis
    Wang Yuetong, Peng Liang, Su Yuying, Liu Jiajun
    2024, 28 (24):  3930-3936.  doi: 10.12307/2024.094
    Abstract ( 202 )   PDF (1104KB) ( 74 )   Save
    OBJECTIVE: Chronic ankle instability is mainly characterized by symptoms such as muscle weakness, intermittent pain, and repeated sprains, which seriously affect exercise and daily life. Loss of proprioception, prolongation of fibular reaction time, and weakening of valgus force may be the main symptoms of chronic ankle instability, so exercise intervention can effectively improve the symptoms related to ankle instability. Meta-analysis was used to quantitatively evaluate the effect of balance training on the rehabilitation intervention of chronic ankle instability, providing a reliable theoretical basis and practical basis for chronic ankle instability patients to scientifically formulate exercise prescriptions.
    METHODS: The randomized controlled trial of balance training on symptom rehabilitation and dynamic equilibrium of patients with chronic ankle instability was retrieved on CNKI, VIP, Web of Science, and PubMed. The literature was published from the inception to November 23, 2022. Two reviewers were included to evaluate the quality of the included literature based on the physical therapy evidence scale. The primary outcome measure is the Self Functional Rating Scale, and the secondary outcome measure is the Star Shift Balance Test, both of which are continuous variables. Forest mapping, meta-regression, subgroup analysis, sensitivity analysis, and publication bias evaluation were performed on the included literature using RevMan 5.3 and Stata-SE 15 software.  
    RESULTS: (1) A total of 18 articles of randomized controlled trials were screened and 641 patients with chronic ankle instability were included in the study. Overall, the methodological quality of the literature was relatively high. (2) Meta-analysis results showed that balance training improved the functional rehabilitation effect of chronic ankle instability patients (SMD=0.82, 95%CI:0.41-1.23, P < 0.000 1). Meta-regression exhibited that intervention time might be the main reason for heterogeneity (P=0.008). (3) The subgroup analysis results revealed that 6 weeks of intervention (SMD=0.98, 95%CI:0.31-1.65, P=0.03), more than 3 interventions per week (SMD=0.87, 95%CI:0.30-1.44, P=0.003), and each intervention time less than 20 minutes (SMD=0.89, 95%CI:0.61-1.66, P < 0.000 1) were the best rehabilitation plans to improve the functional rehabilitation effect of chronic ankle instability patients. (4) Meta-analysis results also showed that balance training improved the stretching degree of the anterior side (SMD=0.56, 95%CI:0.31-0.80, P < 0.05), posterior inner side (SMD=0.88, 95%CI:0.45-1.32, P < 0.05), and posterior outer side (SMD=0.84, 95%CI:0.22-1.46, P < 0.05) of the star shift balance test.
    CONCLUSION: Current clinical evidence shows that balance training can improve ankle instability symptoms and elevate dynamic equilibrium ability in chronic ankle instability patients. It is recommended to intervene more than 3 times a week, with each intervention lasting less than 20 minutes, to achieve better rehabilitation effects. 
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