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28 November 2024, Volume 28 Issue 33 Previous Issue   

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Effect of total ligament superimposed injury on biomechanical characteristics of the lumbar spine Wang Duoduo, Lyu Jie, Guo Panjing, Ding Lijun, Cao Jinfeng, Zhou Nan, Lyu Qiang 2024, 28 (33):  5249-5256.  doi: 10.12307/2024.658 Abstract ( 87 )   PDF (1453KB) ( 12 )   Save BACKGROUND: Ligaments are an important structure for stabilizing the lumbar spine, and they are prone to degenerative changes with age. Currently, there is limited research on lumbar ligaments. OBJECTIVE: To investigate the effect of different combinations of ligament injuries on biomechanical characteristics of lumbar spine under four motion states of forward bending, backward extension, lateral bending, and torsion under a certain sequence of ligament injuries. METHODS: A finite element model of the L4-L5 segment of the lumbar spine was established, and corresponding moments were applied to simulate four motion states of forward bending, backward extension, lateral bending, and torsion. The combined injuries of the ligaments were performed in order to obtain the motion range of each vertebra and the stress of each ligament. RESULTS AND CONCLUSION: (1) Every time a ligament was removed, the remaining ligament stress would increase. Under all four working conditions, capsular ligament would experience the highest stress, especially during forward bending. With the removal of ligaments, the range of motion of the vertebrae was also continuously increasing. (2) When flexing forward, after removing the first ligament capsular ligament, the average stress change in the remaining ligament was the highest, followed by the removal of supraspinous ligament. After removing capsular ligament, the change rate of range of motion was the highest, while after removing posterior longitudinal ligament, the change rate of range of motion was the lowest. (3) When extending backward, all ligaments had the highest rate of stress change after removing capsular ligament, the highest rate of range of motion change after removing capsular ligament, and the lowest rate of range of motion change after removing posterior longitudinal ligament. (4) When bending, the stress change rate of interspinous ligament decreased after removing intertransverse ligament, while supraspinous ligament increased more. After removing capsular ligament and interspinous ligament, the range of motion change rate increased significantly. (5) During lateral bending, after removing capsular ligament, the stress change rate of the remaining ligament was much higher than that of other ligament damage combinations, and the  range of motion change rate was the highest after removing capsular ligament. In other cases, the range of motion change rate did not exceed 8%. (6) If the root ligament is damaged, the remaining ligaments will undergo stress compensation. Ligament damage will affect the stability of the lumbar spine, with minimal impact in cases of lateral curvature. Patients with lumbar instability should avoid forward flexion and backward extension movements, which can make it easier to detect the pathological condition of the ligaments. (7) Capsular ligament is an important structure for maintaining lumbar stability, and supraspinous ligament plays a significant role in anterior flexion, maintaining the integrity of the entire lumbar ligament. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of characteristics of spinal cord compression in patients with early cervical spondylotic myelopathy under dynamic position Li Chengwei, Zhang Yisheng, Li Zhifei, Zhong Yuanming, Meng Jiwen, Liang Qinqiu, Chen Hualong 2024, 28 (33):  5257-5264.  doi: 10.12307/2024.073 Abstract ( 51 )   PDF (2153KB) ( 6 )   Save BACKGROUND: Cervical spondylotic myelopathy is a progressive disease leading to dysfunction in the middle-aged and elderly, and early diagnosis is difficult. In recent years, some clinical scholars have found that dynamic magnetic resonance imaging technology can detect spinal cord compression in a dynamic position earlier, but its specific biomechanical mechanism needs to be clarified.  OBJECTIVE: To investigate the biomechanical compression characteristics of early cervical spondylotic myelopathy in hyperextension and flexion position, and to verify the effectiveness of dynamic magnetic resonance imaging in the diagnosis of early cervical spondylotic myelopathy.  METHODS: A retrospective analysis was made on the patients who underwent cervical dynamic magnetic resonance imaging in the Department of Orthopedics of First Affiliated Hospital of Guangxi University of Chinese Medicine from January to June 2022. 16 subjects were selected and divided into two groups. The pathological group included 8 patients with early cervical spondylotic myelopathy with hypertrophy of ligamentum flavum as the main sign, with 5 male patients and 3 female patients. The normal group included 8 normal degenerative people, with 4 male patients and 4 female patients. All patients were photographed with cervical CT plain scan, magnetic resonance imaging plain scan, and dynamic magnetic resonance imaging plain scan. This study was divided into the following three parts: (1) collect the dynamic magnetic resonance imaging image DCOM data of two groups of subjects, and collect the cervical vertebra CT and neutral magnetic resonance imaging image DCOM data to understand the bone and soft tissue of the two groups of subjects in the neutral position. (2) Based on the DCOM data of magnetic resonance imaging and CT plain scan, the three-dimensional finite element models of lower cervical vertebra (C3-7) of normal degenerative population and early cervical spondylotic myelopathy patients were established by reverse engineering software. The equivalent stress and equivalent elastic strain of the spinal cord and posterior dura were analyzed, and the distribution of stress and strain was observed. (3) After obtaining the stress and strain data, the data between groups were compared to analyze the mechanical characteristics of spinal cord compression caused by early cervical spondylotic myelopathy in a dynamic position and to verify the effectiveness of dynamic magnetic resonance imaging in the diagnosis of early cervical spondylotic myelopathy. RESULTS AND CONCLUSION: (1) When simulating the posterior extension, flexion and neutral position of the lower cervical vertebrae (C3-7) in the two groups, the values of stress and strain in the posterior part of the spinal cord were in the following order: extension > flexion > neutral (P < 0.05). The strain values from large to small were as follows: extension > flexion > neutral (P < 0.05). (2) Compared with the normal degenerative population model, the equivalent stress and strain of the spinal cord in the pathological group were higher than those in the normal group under two degrees of freedom of flexion and extension (P < 0.05). The distribution area of stress and strain in the posterior part of the spinal cord was irregular. (3) In the neutral position, there was no significant difference in the strain value of the spinal cord between the two groups (P > 0.05), and the strain distribution was uniform and regular. (4) It is indicated that in the cervical extension position, the dural sac and the posterior part of the spinal cord were compressed and deformed in the early cervical spondylotic myelopathy patients with the hypertrophy of ligamentum flavum as the main sign, and the degree of compression deformation of the spinal cord was significantly higher than that in the anterior flexion position and neutral position. In the neutral position, there were no obvious signs of spinal cord deformation in patients with early cervical spondylotic myelopathy. This study verified the role of dynamic magnetic resonance imaging in the diagnosis of early cervical spondylotic myelopathy from the point of view of biomechanics. Figures and Tables | References | Related Articles | Metrics

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Mechanical performance and collapse risk prediction of avascular necrosis of femoral head under walking movement Gao Yongchang, Fu Yantao, Zhao Xin, Cui Qingfeng, Zhang Zhifeng, Chen Shibin 2024, 28 (33):  5265-5269.  doi: 10.12307/2024.661 Abstract ( 46 )   PDF (1145KB) ( 6 )   Save BACKGROUND: Avascular necrosis of the femoral head is a refractory orthopedic disease that seriously affects the normal life of patients. Hip preservation is recommended for young patients due to the limited prosthesis longevity and revision. Accurate prediction of the mechanical properties of the necrotic area in the early stage and then intervention is the key to hip preservation. OBJECTIVE: To establish a dynamic contact mechanics finite element model of necrotic femoral head based on human hip CT data and predict effects of both necrotic volume magnitude and its position on biomechanics of the necrotic region under walking movement.  METHODS: CT data of a volunteer were collected and then geometry model of the hip was rebuilt. Finite element model of the necrotic femoral head was established using the Abaqus software. Nine different necrotic femoral models were constructed by combined both three different necrotic volume magnitudes (small, medium and big volume) and three different necrotic positions (coincided with, medium deviated with and kept away from the line of the force). The Von Mises of the necrotic region for all models were predicted under both 3 000 N static load and dynamical loads of one whole ISO walking gait cycle. The collapse risk for all models was evaluated based on collapse criterion.  RESULTS AND CONCLUSION: (1) More approaching of the necrotic region to the line of force and bigger collapse volume made the maximum Von Mises increasing. This also enlarged the collapse risk of the necrotic region. (2) For different load types, walking movement increased the maximum Von Mises of the necrotic region than that of the value under static load under the same necrotic volume and location. (3) In conclusion, dynamic load would result in increasing of the maximum Von Mises of the necrotic region comparing to static load during exercise. Therefore, the risk of local collapse will increase due to greater Von Mises. However, the overall collapse risk is lower than that of static load due to the dynamic change of bearing area. This factor should be carefully considered by surgeons when they evaluate the mechanical performance of the necrotic femoral head.  Figures and Tables | References | Related Articles | Metrics

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Stress changes of knee joint with different degrees of medial collateral ligament injury Jiang Yaqiong, Lu Tan, Xu Biao, Yang Junliang, Yin Yujiao 2024, 28 (33):  5270-5275.  doi: 10.12307/2024.660 Abstract ( 46 )   PDF (1380KB) ( 10 )   Save BACKGROUND: The incidence of medial collateral ligament injuries in the knee joint is easy to lead to secondary meniscus and cartilage damage, and long-term chronic damage can lead to the occurrence of osteoarthritis. At present, there are few studies on the mechanics of meniscus and articular cartilage injury caused by medial collateral ligament rupture.  OBJECTIVE: To investigate the effect of different degrees of medial collateral ligament injury on the biomechanics of meniscus and cartilage of knee joint. METHODS: The CT and MRI examinations of the knee joint of a healthy volunteer were performed to obtain the image data. The scanning data were imported into Mimics, Geomagic, and Solidworks software in turn. After registration and fusion, a 3D model of normal knee joint was established. On this basis, models of medial collateral ligament injury in different degrees of knee joint were simulated, which were divided into four groups, including: (1) medial collateral ligament was intact; (2) deep medial collateral ligament fracture; (3) superficial medial collateral ligament fracture; (4) complete rupture of medial collateral ligament. Finally, Ansys software was introduced to apply three modes of loads to the knee joint: (1) 10 N·m valvaration torque was applied to the top of the femur. (2) A 4 N·m internal torque was applied to the top of the femur. (3) A 4 N·m external torque was applied to the top of the femur. The effects of four groups of models on knee biomechanics under different loads were analyzed. RESULTS AND CONCLUSION: (1) In the extension position of the knee joint, when a 10 N·m valgus torque was applied to the knee joint, the overall stress of the posterolateral meniscus increased with different degrees of medial collateral ligament injuries, while the stress of the articular cartilage did not change significantly. The peak stress of the posterolateral meniscus increased significantly with superficial medial collateral ligament rupture. (2) In the knee extension position, when a 4 N·m internal rotation torque was applied to the knee joint, the overall stress of the medial and lateral meniscus increased after different degrees of medial collateral ligament injury. When superficial medial collateral ligament rupture occurred, the peak stress of the meniscus shifted from the anterior horn of the medial meniscus to the anterior horn of the lateral meniscus. (3) In the knee extension position, applying a 4 N·m external rotation torque to the knee joint, the peak stress of the posterolateral meniscus increased more significantly than that of the medial meniscus, and the stress of the articular cartilage changed less. (4) These results show that the risk of meniscus injury secondary to superficial medial collateral ligament rupture is much higher than that of deep medial collateral ligament rupture when the knee is in extension, and the lateral meniscus is more vulnerable to injury than the medial meniscus. Both superficial medial collateral ligament and deep medial collateral ligament play an important role in the rotational stability of the knee joint.  Figures and Tables | References | Related Articles | Metrics

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Action mechanism of gluteus medius width ratio in progression of non-traumatic femoral head necrosis by finite element analysis Yuan Yingjia, Jiang Yulai, Li Jin, Wang Ke, Wang Yu, Lin Tianye, Zhang Qingwen, He Wei, Wei Qiushi 2024, 28 (33):  5276-5282.  doi: 10.12307/2024.652 Abstract ( 57 )   PDF (1447KB) ( 7 )   Save BACKGROUND: The gluteus medius not only abducts the hip joint, but also plays an important role in limiting the external movement of the femoral head. At present, there is a lack of research on the correlation between gluteus medius status and non-traumatic femoral head necrosis.  OBJECTIVE: To investigate the relationship between the gluteus medius width ratio and the medial space ratio of the hip joint and the progression of non-traumatic femoral head necrosis, and to explore the effect of gluteus medius atrophy on the surface and necrotic zone stress of the femoral head necrosis through finite element analysis.  METHODS: Retrospective analysis of unilateral non-traumatic femoral head necrosis patients admitted to Third Affiliated Hospital of Guangzhou University of Chinese Medicine was performed. All patients were followed up for an average of more than 2 years. They were divided into a collapsed group and a non-collapsed group based on whether there was collapse of the femoral head during the follow-up. Medial space ratio, gluteus medius width ratio, Sharp angle, gluteus medius length ratio, and gluteus medius activation angle were measured and calculated. The differences in these indicators were compared between the two groups. At the first visit and follow-up at 3, 6, 12, and 24 months, the medial space ratio and gluteus medius width ratio were measured and calculated to explore the changes of these two indicators in the course of non-traumatic femoral head necrosis. In addition, using three-dimensional finite element analysis, a Japanese Investigation Committee classification C1 type femoral head necrosis model was constructed based on CT data. At the same time, based on MRI data, a model of the gluteus medius muscle was constructed and divided into a gluteus medius muscle atrophy group (gluteus medius width ratio: 74%-76%) and a gluteus medius muscle normal group (gluteus medius width ratio: 94%-96%). Each group constructed 10 models, with 6 degrees of freedom of the distal femur constrained to zero. 600 N pressures were applied along the Z-axis to the upper surface of the sacrum. The stress distribution, maximum stress values on the surface and necrotic area of the femoral head, and the maximum displacement of the necrotic area were compared between two groups of models.  RESULTS AND CONCLUSION: (1) A total of 153 patients (67 males and 86 females) with 153 hips were included in this study. (2) At the 24-hour follow-up, the medial space ratio of the collapsed group was significantly higher than that of the non-collapsed group (P < 0.05). The gluteus medius width ratio of the collapsed group was significantly lower than that of the non-collapsed group (P < 0.05). There was no statistically significant difference in Sharp angle, gluteus medius activation angle, and gluteus medius length ratio between the two groups (P > 0.05). (3) Since the follow-up time exceeded 3 months, the gluteus medius width ratio of the collapsed group was lower than that of the non-collapsed group (P < 0.05). Since the follow-up time exceeded 12 months, the medial space ratio of the collapsed group was higher than that of the non-collapsed group (P < 0.05). (4) Pearson correlation analysis showed a significant positive correlation between follow-up time and medial space ratio in the collapsed group (P < 0.05), and a significant negative correlation between follow-up time and gluteus medius width ratio (P < 0.05). The regression coefficient of gluteus medius width ratio was larger than that of medial space ratio. (5) The group with middle gluteal muscle atrophy showed significant stress concentration on the surface of the femoral head, and the stress zone was significantly located on the outside. The maximum stress on the surface of the femoral head in the group with middle gluteal muscle atrophy was significantly greater than that in the group with normal middle gluteal muscle (P < 0.05). There was significant stress concentration in the necrotic area of the middle gluteal muscle atrophy group, and the maximum stress was located at the edge of the necrotic area. The maximum stress and maximum displacement in the necrotic area of the middle gluteal muscle atrophy group were significantly greater than those of the normal group (P < 0.05). (6) It is indicated that gluteus medius width ratio is an effective indicator for evaluating changes in gluteal muscle atrophy. In the progression of non-traumatic femoral head necrosis, atrophy of the gluteus medius muscle first occurs, followed by widening of the medial hip joint space. The mechanical mechanism may be that the atrophy of the gluteus medius muscle affects the stability of the hip joint, leading to external displacement of the femoral head, and increasing stress and displacement on the surface and necrotic area of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Design and finite element analysis of a new type of plate for hyperextension varus tibial plateau fractures Liang Zhongshuai, Wang Renchong, Zhang Lu, Hu Juzheng, Shi Zhanying, Xie You, Mao Chunhua 2024, 28 (33):  5283-5288.  doi: 10.12307/2024.657 Abstract ( 31 )   PDF (1346KB) ( 6 )   Save BACKGROUND: There is currently no anatomic locking plate suitable for the anteromedial platform, so the medial locking plate of the tibial plateau is usually placed forward to fix anteromedial compression fractures caused by hyperextension varus injury. Due to the inability of the locking screw to achieve vertical fixation of the fracture line, coupled with the influence of the patellar ligament, the clinical results are still unsatisfactory. OBJECTIVE: To compare the biomechanical performance of a new type of plate with traditional internal fixation methods in treating hyperextension varus tibial plateau fractures through finite element analysis.  METHODS: CT data of 20 cases of hyperextension varus tibial plateau fractures were collected, and their morphological characteristics, such as medial posterior tibial slope, the medial articular fracture angle, surface area, and anterior cortical height were measured. A 24-year-old male volunteer with a height of 175 cm and a weight of 65 kg was selected, and his tibial CT data were imported into Mimics 21.0 software to generate a 3D model. Then, internal fixation models were imported into SolidWorks 2017 software. New type of plate, medial locking plate, posterior medial locking plate, and 6.5 mm hollow screws fixed data models were established based on the measured morphological data. Ansys 17.0 software was used to load stress on the four fixation models and compare their biomechanical performance. RESULTS AND CONCLUSION: (1) With the increase of axial load, the peak stresses of different internal fixation models approximately increased proportionally. At 500 N, the peak stress values were as follows: screw group (6.973 7 MPa) < new steel plate group (14.733 MPa) < medial locking plate group (16.445 MPa) < posterior medial locking plate group (25.199 MPa). (2) The peak stresses of the fracture block were as follows: at 500 N, screw group (3.657 9 MPa) < new steel plate group (4.510 8 MPa) < medial locking plate group (5.225 9 MPa) < posterior medial locking plate group (6.181 2 MPa). (3) With the increase of axial load, the displacement of the fracture block and internal fixation approximately increased proportionally, and the displacement distribution characteristics showed no significant changes. At 500 N, the steel plate displacement values were as follows: new steel plate group (1.030 7 mm) < medial locking plate group (1.503 mm) < screw group (2.096 5 mm) < posterior medial locking plate group (2.258 2 mm). At 500 N, the fracture block displacement values were as follows: new steel plate group (0.212 8 mm) < medial locking plate group (0.311 54 mm) < screw group (0.427 79 mm) < posterior medial locking plate group (0.454 98 mm). (4) It is concluded that in the treatment of hyperextension varus tibial plateau fractures, the stability and mechanics of the new steel plate are superior to traditional internal fixation methods.  Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of three-dimensional frame screws and minimally invasive plate for fixation of Sanders III calcaneal fractures Kong Dewei, Song Chao, Wu Liang, Wu Ming, Gong Lulu, Wang Jiaqi, Pan Hongyuan, Fan Xinbin, Zhang Yan 2024, 28 (33):  5289-5294.  doi: 10.12307/2024.651 Abstract ( 37 )   PDF (1526KB) ( 5 )   Save BACKGROUND: Satisfactory clinical results have been achieved in the treatment of Sanders III calcaneal fractures by percutaneous compression fixation with three-dimensional frame screws. However, whether the stability of minimally invasive plate internal fixation can be achieved in terms of biomechanics, and the advantages and disadvantages after comparison are still unknown. OBJECTIVE: To investigate the fixation effect of different internal fixation devices on Sanders III calcaneal fractures by finite element analysis.   METHODS: A finite element model of Sanders III calcaneal fracture was made based on CT data of a 26-year-old healthy male volunteer. The calcaneal fracture models were fixed by minimally invasive three-dimensional frame screws and minimally invasive Y-plate. The longitudinal loads of 350 and 700 N were applied respectively. The displacement and stress distribution of the two models were analyzed, and the stability of each model was compared.  RESULTS AND CONCLUSION: (1) The peak stress of bone block and implant in the minimally invasive three-dimensional frame screw model was significantly lower than that in the minimally invasive minimally invasive plate model. The average stress of bone block and implant in the three-dimensional frame screw model was also significantly lower than that in the minimally invasive plate model. (2) The maximum displacement of the two models was located at the medial side of the articular surface of the posterior talus, and the maximum displacement of the three-dimensional frame screw model was smaller than that of the minimally invasive plate model. (3) The longitudinal displacement between the anterior fragment and the medial fragment of the minimally invasive plate model was smaller, and the transverse and vertical displacement between the medial fragment and the middle fragment of the three-dimensional group screw model was smaller. (4) It is concluded that both of the two internal fixation models can provide satisfactory fixation effect. The three-dimensional frame screw model can provide better transverse and vertical stability with more uniform stress distribution and smaller comprehensive displacement of bone fragments, while the minimally invasive plate has more advantages in maintaining longitudinal stability. Figures and Tables | References | Related Articles | Metrics

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Machine learning to analyze risk factors for postoperative failure of proximal humeral fractures with medial column instability Xu Daxing, Ji Muqiang, Tu Zesong, Xu Weipeng, Xu Weilong, Niu Wei 2024, 28 (33):  5295-5301.  doi: 10.12307/2024.665 Abstract ( 43 )   PDF (1280KB) ( 11 )   Save BACKGROUND: Internal fixation and open reduction with locking plate is the main treatment for proximal humeral fractures with medial column instability. However, reduction failure is one of the main postoperative complications, and accurate risk factor assessment is beneficial for screening high-risk patients and clinical decision selection. OBJECTIVE: To construct four types of prediction models by different machine learning algorithms, compare the optimal model to analyze and sort the risk variables according to their weight scores on the impact of outcome, and explore their significance in guiding clinical diagnosis and treatment. METHODS: 262 patients with proximal humeral fractures with medial column instability, aged (60.6±10.2) years, admitted to Foshan Hospital of Traditional Chinese Medicine between June 2012 and June 2022 were included. All patients underwent open reduction with locking plate surgery. According to the occurrence of reduction failure at 5-month follow-up, the patients were divided into a reduction failure group (n=64) and a reduction maintenance group (n=198). Clinical data of patients were collected, and model variables and their classification were determined. The data set was randomly divided into a training set and a test set according to a 7:3 ratio, and the optimal hyperparameters were obtained in the training set according to a 5-fold cross-over test. Four machine learning prediction models of logistic regression, random forest, support vector machine, and XGBoost were constructed, and the performance of different algorithms was observed in the test set using AUC, correctness, sensitivity, specificity, and F1 scores, so as to comprehensively evaluate the prediction performance of the models. The best-performing model was evaluated using SHAP to assess important risk variables and to evaluate its clinical guidance implications. RESULTS AND CONCLUSION: (1) There were significant differences between the two groups in deltoid tuberosity index, fracture type, fracture end with varus deformity before operation, fragment length of inferior metaphyseal of humerus, postoperative reduction, cortical support of medial column of proximal humerus, and insertion of calcar screw (P < 0.05). (2) The best-combined performance of the four machine models was XGBoost. The AUC, accuracy, and F1 scores were 0.885, 0.885, and 0.743, respectively; followed by random forest and support vector machine, with both models performing at approximately equal levels. Logistic regression had the worst combined performance. The SHAP interpretation tool was used in the optimal model and results showed that deltoid tuberosity index, medial humeral column cortical support, fracture type, fracture reduction quality, and the status of the calcar screw were important influencing fators for postoperative fracture reduction failure. (3) The accuracy of using machine learning to analyze clinical problems is superior to that of traditional logistic regression analysis methods. When dealing with high-dimensional data, the machine learning approach can solve multivariate interaction and covariance problems well. The SHAP interpretation tool can not only clarify the importance of individual variables but also obtain detailed information on the impact of dummy variables in each variable on the outcome. Figures and Tables | References | Related Articles | Metrics

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Quantitative analysis of three-dimensional deformity indexes of the first metatarsal bone after osteotomy and orthosis for hallux valgus deformity Zhao Xiaoliang, Sun Meilan, Yan Tianyuan, Zhang Shizhe, Niu Guochang, Guan Yulong, Li Hua 2024, 28 (33):  5302-5307.  doi: 10.12307/2024.687 Abstract ( 47 )   PDF (1063KB) ( 8 )   Save BACKGROUND: The displacement change parameters of the bone structure of the first metatarsal bone at the two-dimensional level of hallux valgus deformity are of great significance for clinical diagnosis and treatment, while the quantitative analysis of the three-dimensional deformity index may have some influences on the postoperative efficacy. OBJECTIVE: To explore the quantitative change of the three-dimensional deformity index of the first metatarsal bone after routine osteotomy and orthosis for hallux valgus deformity and to provide reference for clinical work. METHODS: 100 patients with hallux valgus deformity (foot) in Hengshui People’s Hospital from October 2020 to April 2023 were selected and all of them underwent conventional osteotomy and orthosis. Foot function was assessed by the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale 6 months after surgery. Anterolateral X-rays of the foot in weight-bearing position and CT images in simulated weight-bearing position were taken before surgery and 6 months after surgery. The three-dimensional deformity indexes of the first metatarsal bone before and after surgery were quantitatively analyzed in patients with different ages, genders and therapeutic effects, including first-second intermetatarsal angle, hallux valgus angle, distal metatarsal articular angle, tibial sesamaid position, and first metatarsal rotation α angle. The value of the difference of three-dimensional deformity indexes of the first metatarsal bone before and after operation in evaluating the curative effect was analyzed. RESULTS AND CONCLUSION: (1) Six months after operation, the American Orthopedic Foot and Ankle Society score was 75-98 (88.25±4.14) points, among which 56 cases were excellent, 28 cases were good, 14 cases were average, and 2 cases were poor. The excellent and good rate was 84% (84/100). (2) Compared with the preoperative results, first-second intermetatarsal angle, hallux valgus angle, distal metatarsal articular angle, tibial sesamaid position, and first metatarsal rotation α angle were significantly improved in patients of different ages and genders 6 months after surgery (P < 0.05). First-second intermetatarsal angle, hallux valgus angle, distal metatarsal articular angle, tibial sesamaid position, and first metatarsal rotation α angle were all lower in patients with good curative effect 6 months after surgery than those with poor curative effect, and the difference before and after surgery was greater than those with poor curative effect (P < 0.05). (3) The area under the curve of the difference evaluation of the first metatarsal three-dimensional deformity index before and after surgery was above 0.7, and the area under the curve of the combined evaluation of all indexes was the largest (0.902), which was significantly greater than the first metatarsal rotation α angle and distal metatarsal articular angle (P < 0.05). (4) The quantitative analysis of the three-dimensional deformity index of the first metatarsal in patients with hallux valgus deformity is related to the postoperative effect, which has important guiding significance for improving the accuracy and comprehensiveness of preoperative evaluation and improving the treatment plan. Figures and Tables | References | Related Articles | Metrics

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Causal association of micronutrients with osteonecrosis: evidence from a bidirectional Mendelian randomization trial Li Wei, Chai Jinlian, Jia Haifeng, Li Hanzheng, Sun Tiefeng, Liang Xuezhen 2024, 28 (33):  5308-5314.  doi: 10.12307/2024.686 Abstract ( 87 )   PDF (1743KB) ( 11 )   Save BACKGROUND: Osteonecrosis is a common refractory disease in clinical practice, and observational studies have suggested that micronutrients may have a prognostic role in osteonecrosis. However, the specific causal association between micronutrients and osteonecrosis is not known. OBJECTIVE: To explore the causal association between micronutrients and osteonecrosis by Mendelian randomization using summary data from a large population-based genome-wide association study (GWAS) for clinical diagnosis and treatment. METHODS: The required exposure and outcome data (calcium, magnesium, iron, vitamin E, carotenoids, retinol & osteonecrosis) were extracted from the IEU OpenGWAS database, GWAS catalog database, and FinnGen database. Data were analyzed by bidirectional Mendelian randomization with inverse-variance weighted as the primary study method, and weighted median method, simple mode method, weighted mode method, and MR-Egger regression to complement the results. The reliability of the data was then verified through sensitivity analyses.  RESULTS AND CONCLUSION: (1) The results found a positive correlation between serum iron concentration and osteonecrosis, while no correlation was found for other micronutrients. There was no reverse causality in all the data. (2) The results of sensitivity analysis showed a robust causality. (3) By Mendelian randomization method, this study provided evidence of causality between serum iron concentration and osteonecrosis, and understanding the causality of micronutrient elements on osteonecrosis can help in the clinical diagnosis and treatment of osteonecrosis, which is of great clinical significance.  Figures and Tables | References | Related Articles | Metrics

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Osteoporotic vertebral compression fracture predicted by functional cross-sectional area of paravertebral muscles Zhang Wensheng, Song Zhenjie, Guo Haiwei, Wu Chunfei, Yang Handi, Li Ying, Li Wenchao, Liu Hongjiang, Yang Xiaoguang, Yuan Chao 2024, 28 (33):  5315-5319.  doi: 10.12307/2024.641 Abstract ( 59 )   PDF (1084KB) ( 10 )   Save BACKGROUND: Osteoporosis vertebral compression fracture is a common fracture secondary to osteoporosis, and there is currently a lack of effective predictive indicators and methods for osteoporosis vertebral compression fracture. OBJECTIVE: To investigate the predictive effects of paravertebral muscle degeneration, functional cross-sectional area, and percentage of fat infiltration on osteoporotic vertebral compression fractures. METHODS: The 224 patients with osteoporosis diagnosed from January 2018 to June 2022 were included. They were followed up for more than 2 years. They were divided into fracture group and non-fracture group according to the presence and absence of vertebral fracture. The detailed information of demographics, body mass index, bone mineral density and so on were collected. The functional cross-sectional area and percentage of fat infiltration of bilateral Psoas major muscle and extensor dorsi (Erector spinae muscles muscle and multifidus muscle) at the level of lower endplate of L2 vertebral body were measured and calculated.  RESULTS AND CONCLUSION: (1) 224 patients were ultimately included, of which 126 had fractures as the fracture group and 98 had no fractures as the non-fracture group. There was no statistically significant difference in age, gender, height, body mass, body mass index, and fracture segment between the two groups (P > 0.05). (2) The bone mineral density of the fracture group was significantly lower than that of the non-fracture group (P < 0.05). Functional cross-sectional areas of Psoas major muscle and extensor dorsi in the fracture group were significantly lower than those in the non-fracture group (P < 0.05). The percentage of fat infiltration of the extensor dorsi in the fracture group was significantly higher than that in the non-fracture group (P < 0.05). There was no significant difference in percentage of fat infiltration of Psoas major muscle between the two groups (P > 0.05). (3) Receiver operating characteristic analysis showed that the vertebral bone mineral density, percentage of fat infiltration of extensor dorsi, functional cross-sectional area of extensor dorsi and percentage of fat infiltration of Psoas major muscle were 0.903 g/cm2, 35.426%, 418.875 mm2, and 6.375%, respectively. The areas under curve were 0.634, 0.755, 0.876, and 0.585, respectively. (4) These findings indicate that paravertebral muscle degeneration is strongly associated with the occurrence of osteoporotic vertebral compression fractures. The functional cross-sectional area of extensor dorsi muscle can effectively predict the occurrence of osteoporotic vertebral compression fractures, which is helpful for early prevention and treatment of osteoporotic vertebral compression fractures. Figures and Tables | References | Related Articles | Metrics

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Mechanism by which miR-34a-5p/PLCD3 axis regulates osteoarthritis progression Ying Pu, Xu Yue, Lu Tong, Xue Yi, Miao Yiming 2024, 28 (33):  5320-5325.  doi: 10.12307/2024.653 Abstract ( 55 )   PDF (1112KB) ( 9 )   Save BACKGROUND: Molecular mechanisms targeting the miRNA/mRNA axis to regulate osteoarthritis disease process have been studied. We identified the mRNA: phospholipase C delta 3 (PLCD3) and its target miRNA(miR-34a-5p) with clinical predictive value through previous bioinformatics studies, while experiments to verify their specific roles and mechanisms in regulating osteoarthritis are still lacking. OBJECTIVE: To investigate the regulatory role and mechanism of miR-34a-5p/PLCD3 axis on osteoarthritis progression.  METHODS: The synovium of 15 patients with knee osteoarthritis was selected as the osteoarthritis group, and the synovium of 15 young patients with internal fixation of patellar fracture caused by trauma during the same period was selected as the control group. The expression of PLCD3 and miR-34a-5p in the synovium was detected by real-time PCR. Human fibroblast like synovial cells-osteoarthritis (HFLS-OA) cells were treated by cell transfection and divided into miR-34a-5p mimic group, pCDH-PLCD3 group, miR-34a-5p mimic+pCDH-PLCD3 group, miR-34a-5p inhibitor group, si-PLCD3 group, and miR-34a-5p inhibitor+si-PLCD3 group. The relationship between PLCD3 and miR-34a-5p expression was detected by real-time PCR. The effects of HFLS-OA cell viability and cell migration in each group were detected by CCK-8 assay and cell scratch test. Western blot assay was used to detect the expression level of apoptosis marker protein. The expression of inflammatory factors was detected by ELISA. RESULTS AND CONCLUSION: (1) PLCD3 was a direct target of miR-34a-5p, and the expression levels of PLCD3 and miR-34a-5p were negatively correlated. (2) Upregulation of PLCD3 promoted proliferation of HFLS-OA cells and inhibited cell migration. The up-regulation of miR-34a-5p significantly inhibited the activity of HFLS-OA cells and enhanced cell migration. Overexpression of miR-34a-5p significantly increased the levels of Casp3 and Casp9 proteins in HFLS-OA cells, while overexpression of PLCD3 showed the opposite trend. (3) PLCD3 overexpression significantly increased the expression of interleukin 6 and tumor necrosis factor alpha in HFLS-OA cells, while miR-34a-5p mimics showed protective activity. (4) The miR-34a-5p/PLCD3 axis may affect the progression of osteoarthritis by regulating the inflammatory process or apoptosis of synovial cells. Figures and Tables | References | Related Articles | Metrics

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Causal effects of serum trace elements and nutrients on osteonecrosis: a Mendelian randomization analysis Liu Yi, Liu Yuan, Liu Jinbao, Li Nianhu, Zhu Weiming, Xu Bo 2024, 28 (33):  5326-5332.  doi: 10.12307/2024.654 Abstract ( 71 )   PDF (2600KB) ( 15 )   Save BACKGROUND: Multiple clinical observational studies have suggested a close relationship of serum trace elements and nutrients with osteonecrosis, but it remains unclear whether there is a genetic causal effect between serum trace elements and nutrients on osteonecrosis.  OBJECTIVE: To investigate the causal effects of serum trace elements and nutrients on osteonecrosis using the Mendelian randomization approach.  METHODS: The exposure factors of serum trace elements and vitamins with mononucleotide polymorphisms were obtained from the published UK Biobank database and publicly available databases of genome-wide association studies. The outcome event of osteonecrosis was derived from the FinnGen Biobank database. Mendelian randomization methods were employed to explore the causal relationship between seven trace elements and three nutrients with osteonecrosis. Causal inference was conducted using inverse variance weighting, MR-Egger, and weighted median methods. F-statistic was calculated to ensure the robustness of instrumental variables. Cochran's Q test and leave-one-out method were used for heterogeneity testing. MR-Egger regression and MR-PRESSO were employed for horizontal pleiotropy testing. PhenoScanner database was utilized to remove mononucleotide polymorphisms with horizontal pleiotropy to ensure the reliability of the results. RESULTS AND CONCLUSION: Causal relationships were found between serum selenium, phosphate, vitamin C, vitamin E, and osteonecrosis through Mendelian randomization analysis. Serum selenium, vitamin C, and vitamin E were found to have a protective effect on osteonecrosis, while excessive intake of phosphate increased the risk of osteonecrosis. No heterogeneity or horizontal pleiotropy was observed during the study, and Mendelian randomization statistical power (Power value > 80%) indicated the reliability of the aforementioned four results. These findings have important clinical implications for the development of targeted preventive and therapeutic measures for osteonecrosis. Figures and Tables | References | Related Articles | Metrics

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Application advantages of Brainlab Knee 3 navigation combined with gap balance in total knee arthroplasty Sun Jinghua, Qi Zhiming, Ruan Wenli, Zhang Jiaguo, Yang Zhitong 2024, 28 (33):  5333-5339.  doi: 10.12307/2024.655 Abstract ( 43 )   PDF (1010KB) ( 8 )   Save BACKGROUND: In recent years, computer-assisted navigation has gradually attracted attention in the medical field. Some scholars have reported that the clinical effects of computer navigation in total knee arthroplasty vary. To explore the clinical effect of the new generation of Brainlab Knee 3 navigation system, this study is conducted. OBJECTIVE: To analyze the application effect of computer navigation system (Brainlab Knee 3) combined with gap balance technology in total knee arthroplasty.  METHODS: A total of 71 patients received total knee arthroplasty at the Department of Joint Surgery of Dalian Second People’s Hospital from November 2020 to May 2021. In the navigation group, 35 patients underwent total knee arthroplasty by computer navigation combined with gap balance. In the traditional group, 36 patients underwent osteotomy with traditional surgical instruments. The difference between medial and lateral joint spaces, knee range of motion, hospital for special surgery knee score, hip-knee-ankle angle, deviation values of coronal femoral component angle, coronal tibial component angle, and sagittal tibial component angle were compared between the two groups.   RESULTS AND CONCLUSION: (1) In the navigation group, the differences of intraoperative medial and lateral joint gap at knee extension 0, 1, and 2 mm were found in 19, 14, and 2 cases, respectively. The gap difference was 0 mm in 18 cases, 1 mm in 15 cases and 2 mm in 2 cases at 90° degree knee flexion. In the traditional group, the gap difference at knee extention was 0 mm in 10 cases, 1 mm in 20 cases, and 2 mm in 6 cases. The gap difference at 90 degree knee flexion was 0 mm in 10 cases, 1 mm in 15 cases and 2 mm in 8 cases. (2) The operation time in the navigation group was longer than that in the traditional group (P < 0.05), and two patients in the navigation group developed lower limb intermuscular vein thrombosis after surgery, and none of the patients in the traditional group had complications. (3) The range of motion between the two groups increased significantly at 6 and 12 months after surgery, and the range of motion in the navigation group was higher than that in the traditional group (P < 0.05). (4) At 12 months after surgery, the hospital for special surgery knee scores of both groups increased significantly, and the hospital for special surgery knee score in the navigation group was higher than that in the traditional group (P < 0.05). (5) At 6 months after surgery, the deviation values of hip-knee-ankle angle, coronal femoral component angle, coronal tibial component angle, and sagittal tibial component angle of navigation group were significantly lower than those in the traditional group (P < 0.05). (6) The results showed that computer navigation technique combined with gap balance in total knee arthroplasty had advantages in postoperative range of motion, lower limb alignment and the accuracy of tibial prosthesis component position, and joint function recovered well.  Figures and Tables | References | Related Articles | Metrics

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Risk factors of delirium after total knee arthroplasty in elderly patients and establishment of nomogram prediction model Lin Ying, Liao Qi, Yan Laixiu, Lai Jianhong 2024, 28 (33):  5340-5345.  doi: 10.12307/2024.656 Abstract ( 45 )   PDF (900KB) ( 9 )   Save BACKGROUND: Postoperative delirium is one of the serious complications after total knee arthroplasty, usually occurring 1-5 days after surgery, with confusion and cognitive impairment as the main manifestations, which is not conducive to the recovery of joint function in elderly patients. At present, the risk factors affecting delirium after total knee arthroplasty in the elderly are not clear, and there is a lack of clinical prediction studies to directly present them for promotion and application. OBJECTIVE: To explore the risk factors of delirium after total knee arthroplasty in elderly patients and establish a prediction model of nomogram.  METHODS: Medical record data of 116 elderly patients receiving total knee arthroplasty treated in Ganzhou Hospital of Traditional Chinese Medicine, Jiangxi University of Chinese Medicine from January 2019 to December 2021 were retrospectively analyzed, of which 29 elderly patients with delirium after total knee arthroplasty were selected as the observation group, and the remaining 87 elderly patients without delirium after total knee arthroplasty were selected as the control group. Preoperative general clinical data, laboratory examination results, and surgical data were compared between the two groups. Multivariate Logistic regression analysis was used to analyze risk factors for delirium after total knee arthroplasty in elderly patients. The receiver operating characteristic curve was used to analyze the independent risk factors and obtain the best cut-off value. The nomogram model was constructed by R software.  RESULTS AND CONCLUSION: (1) There were significant differences in age, cerebrovascular accident history, preoperative hospital stay, preoperative albumin, hemoglobin, American Society of Anesthesiologists classification, operation time, anesthesia time, and intraoperative blood transfusion volume between the two groups (P < 0.05). (2) Multivariate Logistic regression analysis showed that old age, long hospital stay before surgery, high American Society of Anesthesiologists classification grade, and long operation time were risk factors for postoperative delirium in elderly knee arthroplasty patients, while high albumin and high hemoglobin were protective factors for postoperative delirium in elderly knee arthroplasty patients. (3) The areas under the curve of age, preoperative hospital stay, albumin, hemoglobin, American Society of Anesthesiologists classification grade, and operation time were 0.784, 0.706, 0.853, 0.762, 0.617, and 0.542, respectively. The optimal cut-off values were 75 years, 7 days, 40 g/L, 125 g/L, 3 and 200 minutes, respectively. (4) After internal data for verification, the consistency index was 0.974. The actual curve of the model was in good agreement with the ideal curve. (5) These results indicate that this nomogram model based on old age, long hospital stay, high American Society of Anesthesiologists classification grade, low albumin, low hemoglobin, and long operation time has far-reaching clinical significance for early identification, early warning and diagnosis of delirium risk in elderly patients after total knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Topical application of vancomycin in prevention of early incision infection in total knee arthroplasty Li Zhengyuan, Hao Lin, Chen Shenghong, Peng Kai, Wang Jun, Yin Zongsheng 2024, 28 (33):  5346-5350.  doi: 10.12307/2024.668 Abstract ( 46 )   PDF (895KB) ( 7 )   Save BACKGROUND: The use of vancomycin in total knee arthroplasty is a controversial strategy for the prevention of incisional infection. At present, there is little evidence to evaluate the efficacy of this preventive measure in China. OBJECTIVE: To evaluate the efficacy of local vancomycin in the prevention of early postoperative incision infection during total knee arthroplasty.  METHODS: 120 patients with osteoarthritis of the knee who received unilateral total knee arthroplasty for the first time at Department of Joint Surgery of First Affiliated Hospital of Anhui Medical University from March to June 2022 were included in this study. They were randomly divided into the observation group and the control group, with 60 cases in each group. All patients gave informed consent to the treatment plan. In the observation group, 1 g of vancomycin was applied intraoperatively; in the control group, no vancomycin was applied intraoperatively. Erythrocyte sedimentation rate, C-reactive protein, fever rate on seven consecutive days after surgery, degree of knee joint swelling, cumulative drainage volume, and incidence of periprosthetic joint infection were recorded in two groups of patients on days 1, 3, and 5 after surgery so as to evaluate the efficacy of topical vancomycin in total knee arthroplasty for the prevention of incision infection in the early postoperative period.  RESULTS AND CONCLUSION: (1) The differences in erythrocyte sedimentation rate and C-reactive protein between the two groups on days 1, 3, and 5 after surgery were not significant (P > 0.05). (2) The difference in fever rate between the two groups for 7 consecutive days after surgery was not significant (P > 0.05). (3) There was no significant difference in the degree of postoperative knee swelling and cumulative drainage flow between the two groups (P > 0.05). (4) The difference in the incidence of periprosthetic joint infection one year after surgery was not significant between the two groups (P > 0.05). (5) The results suggest that the local use of vancomycin in total knee arthroplasty has not shown significant efficacy in preventing incision infection in the early postoperative period.  Figures and Tables | References | Related Articles | Metrics

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Inverted triangle cannulated screw assisted transverse lag screw and femoral neck system fixation for Pauwels III femoral neck fractures Shen Shi, Xu Yulin, Li Yujie, Xu Xuepeng, Xiang Feifan, Ye Junwu, Zhuo Naiqiang 2024, 28 (33):  5351-5356.  doi: 10.12307/2024.675 Abstract ( 45 )   PDF (1178KB) ( 9 )   Save BACKGROUND: Pauwels III femoral neck fracture is a typical unstable fracture characterized by high vertical shear force and high incidence of postoperative complications. At present, there are many fixation methods for Pauwels III fracture, and there is no clear conclusion as to which internal fixation is the best fixation method for Pauwels III femoral neck fracture in young adults. OBJECTIVE: To compare the clinical effect of three inverted triangle cannulated screws assisted transverse lag screws and femoral neck system in fixing Pauwels III femoral neck fractures of young adults. METHODS: From May 2021 to December 2022, 21 young and middle-aged patients with Pauwels III femoral neck fracture were treated with three inverted triangle cannulated screws assisted by transverse lag screws and femoral neck system in Affiliated Hospital of Southwest Medical University. Of them, 9 patients were treated with three inverted triangle cannulated screws and one transverse lag screws perpendicular to the fracture line as the 3+1 cannulated screw group and 12 patients were treated with femoral neck system as the femoral neck system group. The two fixation methods were compared in terms of operation time, intraoperative blood loss, total incision length, intraoperative fluoroscopy times, fracture healing time, and limb function.  RESULTS AND CONCLUSION: (1) All patients were followed up. Patients in the 3+1 cannulated screw group were followed up for 10-25 months, with a mean of (17.44±4.30) months. The patients in the femoral neck system group were followed up for 8-24 months, with a mean of (15.58±4.68) months. (2) The intraoperative fluoroscopy times and Harris score at 3 months postoperatively in the femoral neck system group were better than those in the 3+1 cannulated screw group, and the difference was statistically significant (P < 0.05). The intraoperative blood loss, total incision length, and femoral neck shortening distance in the 3+1 cannulated screw group were better than those in the femoral neck system group, and the differences were statistically significant (P < 0.05). There was no significant difference in operation time, fracture healing time, and Harris score at the last follow-up between the two groups (P > 0.05). (3) It is indicated that three inverted triangle cannulated screws assisted transverse lag screw and femoral neck system can achieve good clinical effects in the treatment of young and middle-aged Pauwels III femoral neck fracture. The femoral neck system has fewer intraoperative fluoroscopy times and better early overall stability, while the 3+1 cannulated screw is more minimally invasive, easier to operate. Both fixation methods are worthy of clinical application and promotion, and can be selected according to the actual clinical situation. Figures and Tables | References | Related Articles | Metrics

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Subcutaneous endplate bone graft reduction combined with percutaneous pedicle screw fixation for A3+B2 thoracolumbar burst fractures Sun Houjie, Han Jianhua, Cai Xiaojun, Li Daijun, Fan Rui 2024, 28 (33):  5357-5363.  doi: 10.12307/2024.666 Abstract ( 28 )   PDF (1442KB) ( 3 )   Save BACKGROUND: Bone grafting is one of the important steps in the treatment of thoracolumbar burst fractures. Because the fracture involves the spinal canal or is accompanied by spinal cord nerve damage, severe fracture bleeding and other factors, minimally invasive bone grafting for thoracolumbar burst fractures is restricted. At present, the minimally invasive treatment of thoracolumbar burst fractures is limited to percutaneous screw fixation under the tunnel. Minimally invasive percutaneous bone grafting of injured vertebrae is rarely reported, and percutaneous precise bone grafting under the endplate has not yet been reported.  OBJECTIVE: To investigate the clinical effect of subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fractures.  METHODS: From June 2017 to December 2021, 90 patients with A3+B2 type asymptomatic thoracolumbar burst fracture were randomly divided into 3 groups according to admission time. In group A, 33 patients received the bone graft funnel accurately placed through the pedicle channel by percutaneous puncture under C-arm fluoroscopy, bone graft support reduction under the fracture endplate, percutaneous pedicle screw fixation. In group B, 30 patients received multifissure intermuscular approach through pedicle bone graft support reduction combined with pedicle screw fixation. In group C, 27 patients received percutaneous pedicle screw short-segment fixation under postural reduction. All patients were followed up for at least 18 months after surgery. The clinical data of the three groups, including preoperative, postoperative and last follow-up Cobb angle, anterior edge height ratio and visual analog scale pain score, were compared and analyzed.  RESULTS AND CONCLUSION: (1) There were no significant differences in age, sex, injury segment and causative factors among the three groups (P > 0.05). (2) All patients at follow-up had no neurological impairment, no obvious lumbar posterior deformity or intractable low back pain. (3) The operation time of group C was less than that of group A and group B (P < 0.05). Intraoperative blood loss was less in group A and group C than in group B (P < 0.05). (4) There were no significant differences in the anterior edge height ratio and Cobb angle among the three groups (P > 0.05). Postoperative data in groups A and B were better than that in group C. At last follow-up, group A and group B outperformed group C (P < 0.05). The height and Cobb angle of the vertebral body lost in the three groups were smaller in groups A and B than those in group C (P < 0.05). (5) Visual analog scale pain score was better in groups A and C than that in group B after surgery (P < 0.05). There was no significant difference in visual analog scale pain score among the three groups at last follow-up (P > 0.05). (6) In group C, there was one case of loose internal fixation and displacement in 1 month after surgery, and the vertebral height was lost again with back pain, and after strict bed rest for 6 weeks, the vertebral height loss was not aggravated, the pain was relieved, and the internal fixation was removed after 1 year, and the height loss at the last follow-up was not aggravated. There were no cases of failure of internal fixation in groups A and B. (7) It is indicated that subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fracture has the advantages of less trauma, less bleeding and light postoperative pain symptoms, and the effect of injury vertebral reduction and height maintenance is the same as the reduction through pedicle bone grafting support and short segment fixation with pedicle screws through the multifidus space approach. Figures and Tables | References | Related Articles | Metrics

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Atlantoaxial dislocation treated by posterior atlantoaxial lateral mass interarticular release, posterior screw reduction and fusion with bone graft Shen Qingfeng, Li Lingbo, Xia Yingpeng, Ma Shibo 2024, 28 (33):  5364-5369.  doi: 10.12307/2024.649 Abstract ( 44 )   PDF (1396KB) ( 6 )   Save BACKGROUND: Atlantoaxial dislocation is often facilitated by interlaminar bone grafting. However, there are relatively few reports on the treatment of complex atlantoaxial dislocation with posterior atlantoaxial lateral mass interarticular release and fusion.  OBJECTIVE: To explore the safety and effectiveness of atlantoaxial dislocation treated by simple posterior atlantoaxial lateral block interarticular release and fusion.  METHODS: We retrospectively analyzed the clinical data of 30 patients with atlantoaxial dislocation who were treated from January 2017 to July 2021, all of whom suffered from reducible atlantoaxial dislocation. Posterior atlantoaxial lateral mass interarticular release and fusion were performed in all patients. During the surgery, patented instruments were used to release the atlantoaxial lateral mass joint, and posterior screw reduction and fixation were used with bone grafting in the lateral mass joint space. The postoperative follow-up period was 6 to 24 months, mean (13.0±5.4) months. During the follow-up period, cervical MRI was reviewed to observe the decompression of the upper cervical spine. X-ray films and CT scans were reviewed to observe the reduction of the upper cervical spine, as well as the internal fixation for looseness and breakage. CT scans were reviewed to assess interlateral block implant fusion. The Japanese Orthopaedic Association score was used to evaluate the improvement of spinal cord function. The neck disability index and the quality of life scale were used to assess the improvement of daily life function. The atlanto-anterior interspace and atlanto-planar spinal effective space were used to evaluate atlantoaxial repositioning and decompression.   RESULTS AND CONCLUSION: (1) The surgery of 30 patients went smoothly, and no serious complications such as spinal nerve and vertebral artery injuries occurred during the operation. Postoperative review of cervical MRI showed that the spinal cord compression was lifted. X-ray film and CT showed that the atlanto-anterior gap was significantly reduced; the effective space of atlantoaxial spinal cord was significantly increased, and neurological dysfunctional symptoms were significantly reduced. (2) During the follow-up period, X-ray film and CT showed that the internal fixation was solid; no broken nails or rods occurred, and there was no recurrence of atlantoaxial dislocation. (3) The Japanese Orthopaedic Association scores, neck disability index, and quality of life scores were significantly improved at the last follow-up compared with the preoperative period (P < 0.05). The average improvement rate of Japanese Orthopaedic Association scores at the last follow-up was 73.1%. The average neck disability index was 8.80%. All of the patients had a continuous bone-scalp connection between atlantoaxial lateral block joints to achieve osseous fusion. (4) These findings indicate that the use of simple posterior atlantoaxial lateral block interarticular release and fusion for the treatment of atlantoaxial dislocation can significantly increase the fusion rate and shorten the fusion time. Figures and Tables | References | Related Articles | Metrics

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Feasibility of constructing a diagnostic classification model for cervical instability by magnetic resonance imaging radiomics Lu Guangqi, Cui Ying, Li Jing, Yu Zhangjingze, Zhu Liguo, Yu Jie, Zhuang Minghui 2024, 28 (33):  5370-5374.  doi: 10.12307/2024.659 Abstract ( 35 )   PDF (1246KB) ( 6 )   Save BACKGROUND: Previous studies on cervical instability failed to explain the dynamic and static interaction relationship and pathological characteristics changes in the development of cervical lesions under the traditional imaging examination. In recent years, the emerging nuclear magnetic resonance imaging (MRI) radiomics can provide a new way for in-depth research on cervical instability.  OBJECTIVE: To investigate the application value of MRI radiomics in the study of cervical instability.  METHODS: Through recruitment advertisements and the Second Department of Spine of Wangjing Hospital, China Academy of Chinese Medical Sciences, young cervical vertebra unstable subjects and non-unstable subjects aged 18-45 years were included in the cervical vertebra nuclear magnetic image collection. Five specific regions of interest, including the intervertebral disc region, the facet region, the prevertebral muscle region, the deep region of the posterior cervical muscle group, and the superficial region of the posterior cervical muscle group, were manually segmented to extract and screen the image features. Finally, the cervical instability diagnosis classification model was constructed, and the effectiveness of the model was evaluated using the area under the curve.  RESULTS AND CONCLUSION: (1) A total of 56 subjects with cervical instability and 55 subjects with non-instability were included, and 1 688 imaging features were extracted for each region of interest. After screening, 300 sets of specific image feature combinations were obtained, with 60 sets of regions of interest for each group. (2) Five regions of interest diagnostic classification models for cervical instability were initially established. Among them, the support vector machine model for the articular process region and the support vector machine model for the deep cervical muscle group had certain accuracy for the classification of instability and non-instability, and the average area under the curve of ten-fold cross-validation was 0.719 7 and 0.703 3, respectively. (3) The Logistic model in the intervertebral disc region, the LightGBM model in the prevertebral muscle region, and the Logistic model in the superficial posterior cervical muscle region were generally accurate in the classification of instability and non-instability, and the average area under the curve of ten-fold cross-validation was 0.650 4, 0.620 7, and 0.644 2, respectively. (4) This study proved the feasibility of MRI radiomics in the study of cervical instability, further deepened the understanding of the pathogenesis of cervical instability, and also provided an objective basis for the accurate diagnosis of cervical instability. Figures and Tables | References | Related Articles | Metrics

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Effect of different fusion devices on cervical sagittal parameters after anterior cervical discectomy and fusion for cervical spondylotic myelopathy Ren Hangling, Song Na, Xu Daxia, Li Zonghuan, Zhang Zhi, Zhang Jingtao 2024, 28 (33):  5375-5382.  doi: 10.12307/2024.669 Abstract ( 49 )   PDF (1542KB) ( 6 )   Save BACKGROUND: The impact of anterior cervical surgery on the sagittal balance parameters of the cervical spine is gradually being paid attention to. Currently, there is a lack of clear and feasible clinical guidelines for the selection of surgical methods for two-level cervical spondylosis, aiming to find the most suitable fixation method that is more beneficial for this type of patient. OBJECTIVE: To compare the effects of different fusion devices for anterior cervical decompression on the changes of cervical sagittal parameters after surgery for adjacent two-level cervical spondylotic myelopathy.  METHODS: A total of 44 patients with adjacent two-level cervical spondylotic myelopathy underwent anterior cervical discectomy and fusion from March 2018 to September 2020 in Liaocheng People’s Hospital were retrospectively analyzed in the study, and they were divided into zero-p group (23 cases) and cage group (21 cases). All patients underwent anteroposterior X-ray, three-dimensional CT reconstruction and MRI examination before operation. At the last follow-up, the anteroposterior X-ray films of cervical spine were taken. The sagittal balance parameters of the cervical spine were measured before and after surgery, including cervical lordotic angle (C2-7 Cobb), C2-C7 sagittal vertical axis, segmented lordotic angle and T1 slope. The surgical time, intraoperative bleeding, last follow-up intervertebral fusion, and postoperative swallowing disorders were recorded, and Japanese Orthopaedic Association score on the patient was evaluated before and after surgery. The changes in cervical sagittal parameters before and after surgery were calculated and their differences were compared between the two groups. RESULTS AND CONCLUSION: (1) Both groups of patients successfully completed the surgery and received follow-up. The zero-p group had shorter surgical time and less intraoperative bleeding compared to the cage group, but the difference was not statistically significant (P > 0.05). (2) The incidence rate of postoperative swallowing disorders in the cage group (7/21, 33%) was higher than that in the zero-p group (3/23, 13%), and the difference was statistically significant (P < 0.05). (3) At the last follow-up, the clinical efficacy of the two groups was the same; all patients had bone fusion. Comparison within the group showed that the sagittal parameters of the cervical spine in both groups improved compared to before surgery (P < 0.05). There was no statistically significant difference in sagittal parameters between groups (P > 0.05), and there was no statistically significant difference in changes in C2-C7 sagittal vertical axis, C2-7 Cobb angle, and T1 slope between the two groups (P > 0.05). However, the segmented lordotic angle changes in the zero-p group were smaller than those in the cage group, and the difference was statistically significant (P < 0.05). (4) It is indicated that the use of zero-p and titanium plate combined with cage during anterior cervical discectomy and fusion surgery can effectively improve cervical sagittal balance. Titanium plate combined with cage intervertebral fusion can better reconstruct the patient’s cervical lordosis and curvature. The selection of fusion devices should also comprehensively consider the occurrence of surgical complications. Figures and Tables | References | Related Articles | Metrics

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Role and significance of deep learning in intelligent segmentation and measurement analysis of knee osteoarthritis MRI images Yu Guangwen, Xie Junjie, Liang Jiajian, Liu Wengang, Wu Huai, Li Hui, Hong Kunhao, Li Anan, Guo Haopeng 2024, 28 (33):  5382-5387.  doi: 10.12307/2024.677 Abstract ( 51 )   PDF (1193KB) ( 19 )   Save BACKGROUND: MRI is important for the diagnosis of early knee osteoarthritis. MRI image recognition and intelligent segmentation of knee osteoarthritis using deep learning method is a hot topic in image diagnosis of artificial intelligence. OBJECTIVE: Through deep learning of MRI images of knee osteoarthritis, the segmentation of femur, tibia, patella, cartilage, meniscus, ligaments, muscles and effusion of knee can be automatically divided, and then volume of knee fluid and muscle content were measured. METHODS: 100 normal knee joints and 100 knee osteoarthritis patients were selected and randomly divided into training dataset (n=160), validation dataset (n=20), and test dataset (n=20) according to the ratio of 8:1:1. The Coarse-to-Fine sequential training method was used to train the 3D-UNET network deep learning model. A Coarse MRI segmentation model of the knee sagittal plane was trained first, and the rough segmentation results were used as a mask, and then the fine segmentation model was trained. The T1WI and T2WI images of the sagittal surface of the knee joint and the marking files of each structure were input, and DeepLab v3 was used to segment bone, cartilage, ligament, meniscus, muscle, and effusion of knee, and 3D reconstruction was finally displayed and automatic measurement results (muscle content and volume of knee fluid) were displayed to complete the deep learning application program. The MRI data of 26 normal subjects and 38 patients with knee osteoarthritis were screened for validation. RESULTS AND CONCLUSION: (1) The 26 normal subjects were selected, including 13 females and 13 males, with a mean age of (34.88±11.75) years old. The mean muscle content of the knee joint was (1 051 322.94±2 007 249.00) mL, the mean median was 631 165.21 mL, and the mean volume of effusion was (291.85±559.59) mL. The mean median was 0 mL. (2) There were 38 patients with knee osteoarthritis, including 30 females and 8 males. The mean age was (68.53±9.87) years old. The mean muscle content was (782 409.18±331 392.56) mL, the mean median was 689 105.66 mL, and the mean volume of effusion was (1 625.23±5 014.03) mL. The mean median was 178.72 mL. (3) There was no significant difference in muscle content between normal people and knee osteoarthritis patients. The volume of effusion in patients with knee osteoarthritis was higher than that in normal subjects, and the difference was significant (P < 0.05). (4) It is indicated that the intelligent segmentation of MRI images by deep learning can discard the defects of manual segmentation in the past. The more accuracy evaluation of knee osteoarthritis was necessary, and the image segmentation was processed more precisely in the future to improve the accuracy of the results. Figures and Tables | References | Related Articles | Metrics

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Effect of MRI preoperative quantitative assessment of the range of talus osteochondral injury on surgical selection and medium- to long-term follow-up results Liu Hongda, Yan Rongliang, Gao Yan, Chen Jianghua, Qu Pingyan, Wang Lei, Peng Yi, Cao Lihai, Du Xiaojian, Qu Jiafu 2024, 28 (33):  5388-5395.  doi: 10.12307/2024.667 Abstract ( 42 )   PDF (1446KB) ( 11 )   Save BACKGROUND: Talus cartilage injury is a common motor system disease. This type of injury will affect the patient’s daily life and work ability, and may worsen the condition if left untreated. Surgical treatment is commonly used, but the selection of surgical methods and the evaluation of medium- and long-term follow-up results have always been difficult clinical problems. OBJECTIVE: To explore the influence of T1ρ technique on the range of quantitative evaluation of talus osteochondral injury on the choice of surgical method and the results of medium- and long-term follow-up. METHODS: A total of 154 patients with osteochondral injury of talus admitted to The Second Hospital of Tangshan from January 2019 to August 2022 were retrospectively selected as the study subjects. The lesion site of talus was examined by MRI before operation, and the T1ρ and T2 values of different types were compared. Different surgical methods were selected according to the different T1ρ values. Group A (n=73) was treated with microfracture surgery with T1ρ < 45 ms; group B (n=81) was treated with autogenous bone and cartilage transplantation with T1ρ ≥ 45 ms. The general clinical characteristics and curative effects of patients under different surgical methods were compared; the important factors of postoperative recurrence were analyzed by multivariate Logistic regression, and the relationship between T1ρ value and postoperative recurrence was analyzed by restricted cubic spline graph, y=1-1/(1+e-z) regression equation to build a prediction model. The stability of the model was verified by cross-checking method.  RESULTS AND CONCLUSION: (1) Classification of talus osteochondral injury in 154 patients (type I: 36 cases; type II: 37 cases; type III: 40 cases; type IV: 41 cases), T1ρ and T2 values of the four groups were statistically significant (P < 0.05); pairwise comparison was also statistically significant (all P < 0.05). (2) After treatment of 154 patients, 7 cases (4.6%) had local swelling, 3 cases (2.0%) had pain aggravation, and 5 cases (3.3%) had wound infection. There were 2 cases (1.3%) with poor cartilage healing. (3) After treatment, there were statistically significant differences between groups A and B in terms of American Orthopaedic Foot & Ankle Society score, visual analog scale score, plantar flexor motion range, dorsoextension motion range, subchondral bone marrow edema volume, interleukin-6, interleukin-8, C-reactive protein, procalcitonin, platelet-derived growth factor, transforming growth factor-β1, and efficacy (P < 0.05). The total effective rate of group B (90%) was higher than that of group A (85%) (P < 0.05). (4) Age (OR=1.589, 95%CI: 0.305-1.252, P=0.036), interleukin-6 (OR=1.737, 95%CI: 0.974-5.254, P=0.049), interleukin-8 (OR=1.385, 95%CI: 1.066-4.355, P=0.034), C-reactive protein (OR=1.957, 95%CI: 1.323-2.178, P=0.035), transforming growth factor-β1 (OR=1.459, 95%CI: 0.897-2.455, P=0.038), T1-ρ (OR=1.687, 95%CI: 0.854-3.321, P=0.026), T2 (OR=1.843, 95%CI: 0.657-2.454, P=0.036), complications (OR=1.719, 95%CI: 0.654-3.464, P=0.019), and classification of osteochondral injury of talus (OR=3.789, 95%CI: 1.023-5.897, P=0.028) were independent risk factors for postoperative recurrence. Microfracture surgery (OR=0.751, 95%CI: 0.321-1.264, P=0.012) and autogenous bone and cartilage grafting (OR=0.649, 95%CI: 0.246-1.356, P=0.023) were independent protective factors for recurrence after medium- and long-term follow-up. (5) When T1ρ value ≤35 ms, the risk of postoperative recurrence decreased rapidly, and when T1ρ value > 35 ms, the risk of postoperative recurrence increased rapidly. (6) Further stepwise regression analysis showed that these nine risk factors were most closely associated with postoperative recurrence, and the formula for postoperative recurrence was obtained. The probability of postoperative recurrence was calculated using the regression equation. When P=0.75, the maximum value of Jorden index was 77.728, indicating that the model has a better prediction effect. (7) It is indicated that the quantitative evaluation of T1ρ before operation can effectively guide the selection of surgical methods, improve the success rate of surgery and the quality of life of patients. Figures and Tables | References | Related Articles | Metrics

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Bibliometric and visual analysis of domestic and foreign scoliosis orthoses Yuan Yanli, Pan Yuejun, Guan Tianmin, Cheng Kai, Wang Xiangheng 2024, 28 (33):  5396-5402.  doi: 10.12307/2024.642 Abstract ( 43 )   PDF (2071KB) ( 11 )   Save BACKGROUND: Scoliosis mainly refers to sequence abnormalities in the coronal, sagittal, and axial positions of the spine, with a Cobb angle of ≥ 10°. The patients may experience symptoms such as unequal shoulder height and back asymmetry. Severe cases may affect the patient’s cardiopulmonary function, thereby affecting their daily life. Conservative treatment can control the progression of scoliosis and avoid later surgery. Scoliosis orthosis is currently a commonly used and effective treatment measure in conservative treatment. OBJECTIVE: To summarize and analyze the current research status, hotspots, and trends of scoliosis orthoses both domestically and internationally, providing reference for related research. METHODS: Using bibliometrics and visual analysis as tools, and using a comparison between China and foreign countries as a method, this paper analyzes the literature on scoliosis orthosis journals in the past decade. Based on bibliometrics, the current status of research on scoliosis orthoses is determined. Citespace software is used to analyze key words and identify the current hotspots and future trends in scoliosis orthosis research.  RESULTS AND CONCLUSION: (1) At present, the number of literature on scoliosis orthoses is still on a fluctuating upward trend. China and the United States are the main countries for research, with a literature share of over 40%. However, the average citation rate of foreign language literature by Chinese scholars is relatively low. (2) The basic fields of domestic research are mainly surgery and pediatrics, while orthotics and clinical neurology are mainly studied abroad. Among them, there is also a certain number of documents in domestic Chinese medicine, indicating that China is also engaged in the combination of Chinese and Western treatment of scoliosis. The National Natural Science Foundation of China has the highest proportion in the aspect of Chinese and foreign literature, reflecting the importance of the fund attaches to the research of scoliosis orthosis. (3) The authors with the highest number of publications are Qiu Yong and Negrini Stefano, and the most published institutions are the Spinal Surgery Department of Gulou Hospital affiliated to Nanjing University Medical College and UDICE-French Research University. Domestic and foreign authors and institutions have certain communications about this, but not closely, which requires relevant institutions and scholars to further explore and study. (4) From the research hotspots and future trends, the main treatment type is adolescent idiopathic scoliosis, while the production method of the short-column side bending orthosis is three-dimensinoal printing, and the main treatment index is convex progression. The ultimate purpose of treatment is to improve the quality of life of the patients. Figures and Tables | References | Related Articles | Metrics

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Exoskeleton-assisted walking rehabilitation for spinal cord injury: CiteSpace analysis of research hotspots Xu Yi, Deng Yubin 2024, 28 (33):  5403-5412.  doi: 10.12307/2024.674 Abstract ( 58 )   PDF (2162KB) ( 14 )   Save BACKGROUND: Spinal cord injury is a serious hazard. Walking dysfunction affects the patients’ quality of life most. Researches on assisted-walking with exoskeleton robots on patients with spinal cord injury have become increasingly active. OBJECTIVE: To map scientific researches of exoskeleton-assisted walking after spinal cord injury using the CiteSpace software, and to discuss the state of art, cutting-edges in the past 10 years, and trends of research in this field, in hope of providing insights for future investigations and clinical applications. METHODS: Using the Web of Science core database to conduct subject term search by Boolean logical operators, the language English was selected, search strategy: TS=“spinal cord injury OR SCI” AND “walk OR walking” AND “robot OR exoskeleton OR (exoskeleton-assisted walking) OR EAW”. The knowledge graph software CiteSpace 6.2.R4 was used to de-emphasize the high-quality literature. The high-quality literature obtained after reweighting was subjected to visualization analysis of hotspots and international frontier trends, such as the number of publications, country/research institution cooperation, high-influence authors/literature co-citation, keyword co-occurrence/clustering/emergence, and the scientific knowledge graph was mapped. RESULTS AND CONCLUSION: (1) A total of 544 high-quality articles were included, and the number of articles and total citation frequency in this field have shown an increasing trend in the past 10 years. (2) The top 3 countries in terms of number of publications are the USA, China, and Italy, and the top 3 research institutions are the U.S. Department of Veterans Affairs, the U.S. Veterans Health Administration, and the Swiss Federal Institute of Technology Domian. (3) The authors with the highest citation frequency (167) and betweenness centrality (0.13) are Professor Esquenazi A, University of Pennsylvania, USA, showing a high influence in this field. (4) The analysis of the top 5 cited documents in terms of citation frequency and betweenness centrality shows that: the current research on walking rehabilitation for spinal cord injury patients equipped with powered exoskeleton devices focuses on the judgment of the safety of walking rehabilitation training in real-life environments such as institutions and homes, analysis of the advantages and disadvantages of walking rehabilitation training, design of individualized training programs, and the advantages and disadvantages of the application of powered exoskeleton devices in assisted walking for patients with complete loss of locomotor function in thoracic vertebrae and the segments below, the factors affecting the effectiveness of assisted walking, and the potential for application. (5) In recent years, research in this field has focused on individuals, gait, powered exoskeleton, body weight support, functional electrical stimulation, rehabilitation, assistive technology, ambulation, recovery, and so on. (6) Early research in this field was mostly applied to stroke patients, and the frontier includes weight loss support, reciprocating gait orthosis, functional electrical stimulation and other technical means. Spinal cord injury exoskeleton-assisted walking rehabilitation research has shown an upward trend in recent years, and the focus of attention to the development of adaptive control as the mechanism of the medical lower extremity exoskeleton equipment, safety enhancement, the application of the potential to tap into the cutting-edge direction of the change, the research and detection means on the joint function of the near-infrared spectroscopic imaging and other high-end technologies, focusing on the quality of life of the patient to enhance the ability of athletic training, and to improve the body’s structure of the field of the future hotspots and the frontier of the research. Figures and Tables | References | Related Articles | Metrics