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28 December 2024, Volume 28 Issue 36 Previous Issue   

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Effect of restored height on neighboring vertebrae after vertebral body strengthening: a finite element analysis Shang Peng, Cui Lunxu, Ma Benyuan, Hou Guanghui, Song Wanzhen, Liu Yancheng 2024, 28 (36):  5741-5746.  doi: 10.12307/2024.679 Abstract ( 164 )   PDF (1362KB) ( 19 )   Save BACKGROUND: Vertebral compression fracture is a common disease in the current orthopedic field. However, the occurrence of re-fracture in neighboring vertebrae after surgery is a problem that cannot be ignored, which has a serious impact on the normal life of patients.  OBJECTIVE: The aim of this study is to establish four postoperative models with different recovery heights using computed tomography images. By using finite element analysis, we derived the stresses on the neighboring vertebrae at different recovery heights and further explored the importance of postoperative recovery of the height of the injured vertebrae. METHODS: A finite element model of the thoracolumbar spine (T11-L3) was established and validated, on the basis of which four postoperative finite element models of L1 with different recovery heights of 100%, 80%, 60%, and 40% were constructed, in which the cement capacity varied with the recovery height. The specific models are as follows: Model 1 was the postoperative model with normal recovery height, and the cement capacity was 8.3 mL. Model 2 was the postoperative model in which 20% of the anterior height of the L1 was removed and the posterior convexity angle became 10.41°, and the cement capacity was 6.9 mL. Model 3 was the postoperative model in which 40% of the anterior height of the L1 was removed and the posterior convexity angle became 20.17°, and the cement capacity was 4.7 mL. Model 4 was a postoperative model with 60% of the L1 anterior height removed and the posterior convexity angle changed to 28.85°, with a cement capacity of 3.6 mL. For evaluation of the postoperative model, we applied a moment of 7 Nm and an axial force of 500 N. The followings were recorded and analyzed: peak stresses in the L2 upper endplate and T12 lower endplate; peak stresses in the L2 and T12 cancellous bone.  RESULTS AND CONCLUSION: (1) The highest peak stresses for each condition of the L2 upper endplate, T12 lower endplate, L2 cancellous bone, and T12 cancellous bone occurred in Model 1 and Model 4. In particular, the T12 lower endplate, except for the posterior extension condition, the anterior flexion, left and right lateral bending, and left and right rotation conditions all reached their highest peak stresses in Model 4, with stresses of 50.3, 33.1, 44.9, 34.3, and 31.9 MPa. (2) Based on the peak stresses in the adjacent vertebral endplates and cancellous bone, after excluding Model 1 and Model 4, the minimum peak stresses for most of the conditions appeared in the Model 2, and the minimum peak stresses appeared in the Model 2 in 66.6% of the cases, especially in the upper endplates of the L2 and cancellous bone except for the posterior extension condition, the minimum peak stresses all appeared on the Model 2. (3) Therefore, controlling the recovery height at about 100% and 40% of the original height was a dangerous recovery height, which had a greater impact on the neighboring vertebrae. Controlling the recovery height at about 80% of the original height may be a more ideal choice. With a recovery height of about 80% of the original height, the adjacent vertebrae are subjected to less stress, thus reducing the risk of re-fracture of the adjacent vertebrae in the patient. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of biomechanical effect of lumbar range of motion on the implants after lumbar fusion Li Ke, Cao Shuai, Zhang Qiongchi, He Xijing, Li Haopeng, Li Jie 2024, 28 (36):  5747-5752.  doi: 10.12307/2024.662 Abstract ( 104 )   PDF (1704KB) ( 22 )   Save BACKGROUND: At present, lumbar interbody fusion is widely used in the treatment of a variety of lumbar diseases. However, how to reduce postoperative complications such as pseudarthrosis formation, screw loosening and fracture, and cage failure remains a serious challenge. OBJECTIVE: To analyze the effect of total lumbar range of motion on the stress or strain of bone grafts, cage, and screw-rod system, so as to better guide patients to carry out lumbar activities to reduce the risks of pseudarthrosis formation and instrumentation failure.  METHODS: An intact human L1-S1 finite element model was constructed using Mimics, 3-Matic, HyperMesh, and Abaqus software and the transforaminal lumbar interbody fusion was simulated. The average strain of the interbody bone grafts and the peak stresses of the cage and screw-rod system were compared before and after applying the bending moment, and the changing trend with the total range of motion was analyzed. The stress nephogram was drawn to observe the stress distribution.   RESULTS AND CONCLUSION: (1) Compared with applying the vertical compression load alone, the average strain of the interbody bone grafts, peak stresses of the cage and screw-rod system after applying bending moment increased by 2.6%-55.3%, 65.6%-166.8%, and 36.0%-353.4%, respectively. (2) With the increase of total range of motion, the average strain of the interbody bone grafts increased nonlinearly and produced the maximum value under left and right axial rotation, while the peak stresses of the cage and screw-rod system increased linearly and produced the maximum value under left and right lateral bending. (3) The stress distribution of the interbody bone grafts and cage was related to the loading condition. The stress of the screw-rod system was mainly concentrated in the interfaces of the screw-bone and screw-rod. (4) Therefore, increasing axial rotation activity after operation may reduce the risk of pseudarthrosis formation, while reducing lateral bending activity may reduce the failure of the cage and screw-rod system. Figures and Tables | References | Related Articles | Metrics

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Correlation between lumbar spine and pelvic parameters in Lenke type 5 adolescent idiopathic scoliosis Hou Yutong, Huang Chenglan, Yang Yunxiao, Li Ya, Guo Peiwu, Yu Wenqiang, Zhao Yu, Wang Zanbo, Zeng Hong, Ma Zhenjiang, Lu Dezhi, Wang Jinwu 2024, 28 (36):  5753-5758.  doi: 10.12307/2024.676 Abstract ( 88 )   PDF (990KB) ( 9 )   Save BACKGROUND: The study of the lumbar spine and pelvis in patients with Lenke type 5 lordosis is limited to the coronal and sagittal planes, and the three-dimensional relationship between the scoliosis and the pelvis has not yet been clarified. OBJECTIVE: To analyze the effect of lumbar scoliosis on the pelvis in patients with Lenke type 5 lordosis and to study the correlation between the lumbar spine and the three-dimensional spatial position of the pelvis. METHODS: Imaging data of 60 patients with Lenke type 5 lordosis scoliosis admitted to the 3D Printing Reception Center of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to September 2023 were retrospectively analyzed, including Cobb angle, coronal pelvic tilt, lumbar lordosis, left and right pelvic hip width ratio (sacroiliac-anterior superior iliac spine), spinal rotation angle, pelvic tilt, sacral slope, pelvic incidence, coronal deformity angular ratio, sagittal deformity angular ratio, C7 plumb line-center sacral vertical line, apical vertebral translation, and coronal sacral inclination. The information was summarized as a database. SPSS 22.0 software was used to analyze the data related to the lumbar spine and pelvis of the patients with Lenke type 5 primary lumbar curvature adolescent idiopathic scoliosis using Spearman’s correlation analysis and linear regression. RESULTS AND CONCLUSION: (1) Cobb angle was highly positively correlated with coronal deformity angular ratio, apical vertebral translation, and spinal rotation angle (r=0.91, r=0.841, r=0.736). (2) Coronal deformity angular ratio was highly positively correlated with apical vertebral translation (r=0.737), moderately positively correlated with C7 plumb line-center sacral vertical line (r=0.514), and moderately negatively correlated with sagittal deformity angular ratio (r=-0.595). (3) There was a high positive correlation between lumbar lordosis and sagittal deformity angular ratio (r=0.942) and a moderate negative correlation with coronal deformity angular ratio (r=-0.554). (4) There was a moderate positive correlation between Cobb angle with coronal pelvic tilt and coronal sacral inclination (r=0.522, r=0.534) and a moderate positive correlation between C7 plumb line-center sacral vertical line and coronal pelvic tilt (r=0.507). Apical vertebral translation with coronal pelvic tilt and coronal sacral inclination showed a moderate positive correlation (r=0.507, r=0.506). Lumbar lordosis with sacral slope and pelvic incidence showed a moderate positive correlation (r=0.512, r=0.538). Sagittal deformity angular ratio was moderately positively correlated with sacral slope and pelvic incidence (r=0.614, r=0.621). (5) Studies have found that the relative position of the lumbar spine and the pelvis is closely related in the horizontal, sagittal and coronal planes. When the lumbar spine affects scoliosis and is rotated, the relative position of the pelvis will also change to compensate, which indicates that while correcting scoliosis, the correction of the pelvis cannot be ignored. Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of thoracic T10 bone tumor metastasis at different locations: three-dimensional finite element analysis Xia Guoren, Yu Hao, Jiang Shifeng, Peng Xin, Fu Xiao, Chen Qi, Yang Lizhuang, Wang Tengfei, Li Hai 2024, 28 (36):  5759-5765.  doi: 10.12307/2024.684 Abstract ( 61 )   PDF (2235KB) ( 15 )   Save BACKGROUND: With the innovation of examination technique, the number of patients with spinal metastases in different stages is increasing year by year. Percutaneous vertebroplasty is an important treatment for spinal metastases; however, there is no report on the biomechanical effect in different stages and different activities after operation. OBJECTIVE: To simulate thoracic T10 bone stress and displacement of the different locations of the tumor metastasis based on the three-dimensional finite element model. METHODS: According to thoracic three-dimensional CT images of a 30-year-old healthy male, Mimics software was used to construct a three-dimensional geometric model of thoracic vertebrae (T9-T11), including ribs, ligaments and intervertebral discs. Three-dimensional models of T9-T11 vertebral bodies and different parts of the posterior thoracic vertebrae invaded by thoracic metastatic tumors were simulated, including the control group with intact vertebral structure, unilateral metastasis involving the vertebral body area (experimental group 1), unilateral metastasis involving the vertebral body and pedicle area (experimental group 2), unilateral metastasis involving the vertebral body, pedicle and transverse process area (experimental group 3), and bilateral metastasis involving the vertebral body, pedicle and transverse process area (experimental group 4). Abaqus software was used to create a three-dimensional finite element model. The von Mises stress distribution and the displacement of the model were analyzed under the loading condition, buckling condition, extension condition, and rotation condition.  RESULTS AND CONCLUSION: (1) In the study of the maximum total displacement of loading points in different experimental groups under loading, flexion, extension, and rotation conditions, with the increase of metastatic tumor invasion site and invasion surface, the total displacement of loading points increased, and the overall stiffness decreased, especially the total displacement of loading points in experimental group 4 was the largest. (2) Under flexion condition, the maximum Von Mises stress value increased significantly after vertebral body and pedicle destruction, while the maximum Von Mises stress value was almost unchanged when the thoracocostal joint destruction was added. (3) On the basis of finite element analysis and simulation of bone tumor model, the elements in the bone cement region were set as a single set, and the bone cement region was set as the corresponding material properties to simulate bone cement filling. The results showed that the maximum total displacement under loading, flexion, extension, and rotation conditions was less than that of each experimental group. (4) The maximum stress values of the simulated percutaneous vertebroplasty patients in the loading, flexion, extension and rotation conditions were significantly lower than those of the femoral model. (5) It is concluded that the three-dimensional finite element model based on thoracic T9-T11 conducive to the biomechanics characteristics of thoracic vertebrae tumor metastasis, and on the basis of the thoracic vertebrae tumor metastasis model can accurately simulate load point after percutaneous vertebral body under different conditions of total displacement and the maximum Von Mises stress situation. Figures and Tables | References | Related Articles | Metrics

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Characteristics and significance of age-related changes in cervical uncinate process-related angle Zhang Dezhou, Wang Chaoqun, Shi Jun, Li Kun, Zhang Shaojie, Ma Yuan, Hou Erfei, Zhao Danyang, Hao Yunteng, Wang Simin, Li Xiaohe, Wang Haiyan, Li Zhijun, Wang Xing 2024, 28 (36):  5766-5772.  doi: 10.12307/2024.680 Abstract ( 73 )   PDF (1208KB) ( 10 )   Save BACKGROUND: As a unique structure of the cervical spine, the occurrence, development and progression of the uncovertebral joint directly affect the stability and range of motion of the cervical spine, and are also closely related to the pathogenesis of cervical spondylosis. A thorough understanding of the developmental characteristics of the uncovertebral joint is of great significance for the pathogenesis, diagnosis, and treatment of cervical spondylosis. OBJECTIVE: By using imaging and three-dimensional reconstruction technology to measure and observe the cervical uncinate process-related angle in a large sample of different age groups, the aim is to reveal the characteristics of its changes with age and vertebral growth, as well as its relationship with cervical spine stability.  METHODS: Using a retrospective research design, we collected 1 447 cases of raw CT imaging data that meet the study requirements for complete cervical spine segments. The raw data were imported into Mimics 21.0 software in DICOM format for post-processing and measurement of angle of uncinate process and sagittal angle of uncinate process. The data were grouped based on gender, age, and side. RESULTS AND CONCLUSION: (1) With the increase of vertebral sequence, the angle of uncinate process increased in a V-shaped shape, and the lowest peak was at C5. The overall population showed a sharp peak with the increase of age, and the peak value mostly occurred in the age range of 30-39 years. (2) The sagittal angle of the uncinate process increased like a fishhook with the increase of the vertebral sequence, and the overall angle of the uncinate process increased with age, and the peak value mostly occurred in the age range of 20-29 years. The uncinate process angle and sagittal angle showed only partial significant differences between sides and genders (P < 0.05). (3) It is concluded that the angle of the uncinate process increased with the increase of vertebral sequence in a V-shaped manner. The sagittal angle of the uncinate process increases like a fish hook with increasing vertebral order, while the two angles generally peak with increasing age. The angle of the uncinate process is about 131°, which may be closely related to the stability of the cervical spine, while the sagittal angle of the uncinate process is about 14°, and its function may play a certain role in limiting the excessive rotation of the cervical spine.  Figures and Tables | References | Related Articles | Metrics

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Relationship between three-dimensional measurement of acromion coverage and degenerative full-thickness rotator cuff tears Wang Gang, Gao Xuren, Qiu Shang, Li Gen, Zhang Xichen 2024, 28 (36):  5773-5778.  doi: 10.12307/2024.663 Abstract ( 47 )   PDF (980KB) ( 15 )   Save BACKGROUND: Acromion morphology is the most important external factor of degenerative rotator cuff tear, and studies on acromion morphology and acromion coverage have been continuing.  OBJECTIVE: To investigate the coverage of acromion on rotator cuff tissue in three-dimensional space, measure coronal and sagittal parameters, and explore the relationship of acromial overhang, acromioglenoid angle and acromial coverage angle with degenerative full-thickness rotator cuff tears. METHODS: A total of 56 patients diagnosed with full-thickness rotator cuff tears by shoulder arthroscopic surgery or MRI in the Affiliated Hospital of Xuzhou Medical University from January 2022 to June 2023 were retrospectively collected as the tear group, while 48 patients with non-rotator cuff tear were included as the control group. Clinical data and chest CT data of the patients of the two groups were collected, and the shoulder blades of the patients were reconstructed using Mimics software. Acromial overhang, acromioglenoid angle and acromial coverage angle were measured in 3-matic software. The differences between the measurement parameters were compared between the two groups. Binary Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the ability of the measurement parameters to predict rotator cuff tear. It is generally believed that the parameter had good diagnostic value when the area under the receiver operating characteristic curve was greater than 0.8. RESULTS AND CONCLUSION: (1) The mean acromial overhang in patients with rotator cuff tears was greater than that in controls (P < 0.001). The mean acromial coverage angle was also greater in patients with rotator cuff tears than in controls (P < 0.001). There was no significant difference in the acromioglenoid angle between the two groups (P > 0.05). (2) Binary Logistic regression analysis showed that acromial overhang and acromial coverage angle were both risk factors for rotator cuff tear (P < 0.05). (3) Receiver operating characteristic curve analysis indicated that the areas under the curve of acromial overhang and acromial coverage angle were 0.725 and 0.865, respectively, and the optimal cutoff values were 36.15 mm and 60.65°. (4) The results showed that the acromial overhang and acromial coverage angle were greater in patients with rotator cuff tears than in patients without rotator cuff tears. Both were associated with degenerative full-thickness rotator cuff tears, and they could be used to predict rotator cuff tears, and the acromial coverage angle was more effective in predicting rotator cuff tears. Figures and Tables | References | Related Articles | Metrics

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Prediction of critical energy release rate for cortical bone structure under different failure modes Fan Ruoxun, Wang Yitong, Jia Zhengbin 2024, 28 (36):  5779-5784.  doi: 10.12307/2024.694 Abstract ( 73 )   PDF (1211KB) ( 7 )   Save BACKGROUND: Critical energy release rate is a global fracture parameter that could be measured during the failing process, and its value may change under different failure modes even in the same structure. OBJECTIVE: To propose an approach to predict the critical energy release rate in the femoral cortical bone structure under different failure modes. METHODS: Three-point bending and axial compression experiments and the corresponding fracture simulations were performed on the rat femoral cortical bone structures. Different critical energy release rates were repeatedly assigned to the models to perform fracture simulation, and the predicted load-displacement curves in each simulation were compared with the experimental data to back-calculate the critical energy release rate. The successful fit was that the differences in the fracture parameters between the predicted and experimental results were less than 5%. RESULTS AND CONCLUSION: (1) The results showed that the cortical bone structure occurred tensile open failure under three-point bending load, and the predicted critical energy release rate was 0.16 N/mm. (2) The same cortical bone structure occurred shear open failure under axial compression load, and the predicted critical energy release rate was 0.12 N/mm, which indicates that the critical energy release rate of the same cortical bone structure under different failure modes was different. (3) A comprehensive analysis from the perspectives of material mechanical properties and damage mechanism was conducted to reveal the reasons for the differences in the critical energy release rate in the cortical bone structure under different failure modes, which provided a theoretical basis for the measurement of the energy release rate and the accurate fracture simulation. Figures and Tables | References | Related Articles | Metrics

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Postoperative pulmonary infection in elderly patients with hip fracture: construction of a nomogram model for influencing factors and risk prediction Wang Haotian, Wu Mao, Yang Junfeng, Shao Yang, Li Shaoshuo, Yin Heng, Yu Hao, Wang Guopeng, Tang Zhi, Zhou Chengwei, Wang Jianwei 2024, 28 (36):  5785-5792.  doi: 10.12307/2024.681 Abstract ( 66 )   PDF (1303KB) ( 18 )   Save BACKGROUND: Establishing a nomogram prediction model for postoperative pulmonary infection in hip fractures and taking early intervention measures is crucial for improving patients’ quality of life and reducing medical costs.  OBJECTIVE: To construct a nomogram risk prediction model of postoperative pulmonary infection in elderly patients with hip fracture, and provide theoretical basis for feasible prevention and early intervention.  METHODS: Case data of 305 elderly patients with hip fractures who underwent surgical treatment at Wuxi Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine between January and October 2020 (training set) were retrospectively analyzed. Using univariate and multivariate logistic regression analysis and Hosmer-Lemeshow goodness of fit test, receiver operating characteristic curve was utilized to analyze the diagnostic predictive efficacy of independent risk factors and joint models for postoperative pulmonary infections. Tools glmnet, pROC, and rms in R Studio software were applied to construct a nomogram model for predicting the risk of postoperative pulmonary infection in elderly patients with hip fractures, and calibration curves were further drawn to verify the predictive ability of the nomogram model. Receiver operating characteristic curves, calibration curves, and decision curves were analyzed for 133 elderly patients with hip fractures (validation set) receiving surgery at the same hospital from November 2022 to March 2023 to further predict the predictive ability of the nomogram model.  RESULTS AND CONCLUSION: (1) The postoperative pulmonary infection rate in elderly patients with hip fractures in this group was 9.18% (28/305). (2) Single factor and multivariate analysis, as well as forest plots, showed that preoperative hospitalization days, leukocyte count, hypersensitive C-reactive protein, and serum sodium levels were independent risk factors (P < 0.05). The Hosmer-Lemeshow goodness of fit test showed good fit (χ2=4.57, P=0.803). Receiver operating characteristic curve analysis was conducted on the independent risk factors and their joint models mentioned above, and the differentiation of each independent risk factor and joint model was good, with statistical significance (P < 0.05). (3) The graphical calibration method, C-index, and decision curve were used to validate the nomogram prediction model. The predicted calibration curve was located between the standard curve and the acceptable line, and the predicted risk of the nomogram model was consistent with the actual risk. (4) The validation set used receiver operating characteristic curve, graphic calibration method, and decision curve to validate the prediction model. The results showed good consistency with clinical practice, indicating that the model had a good fit. The nomogram risk prediction model constructed for postoperative pulmonary infection in elderly patients with hip fractures has good predictive performance. The use of the nomogram risk prediction model can screen high-risk populations and provide a theoretical basis for early intervention. Figures and Tables | References | Related Articles | Metrics

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Establishment and validation of a prediction model of hip fracture risk factors in elderly stroke patients Du Li, Ma Yiming, Zhao Hui, Cui Guiyun, Zu Jie 2024, 28 (36):  5793-5798.  doi: 10.12307/2024.671 Abstract ( 64 )   PDF (1110KB) ( 9 )   Save BACKGROUND: Prevention of fractures after stroke is very important, and there are currently no models to predict the occurrence of hip fractures after stroke. OBJECTIVE: To investigate the risk factors leading to hip fracture in stroke patients and to establish a risk prediction model to visualize this risk.  METHODS: A total of 439 stroke patients were selected from the Affiliated Hospital of Xuzhou Medical University from June 2014 to June 2017, including 107 males and 332 females, with a mean age of (71.38±9.74) years. They were divided into fracture group (n=35) and non-fracture group (n=404) according to the presence or absence of hip fracture. Univariate and multivariate analyses were used to determine the risk factors for hip fracture after stroke. The data were randomly divided into training set (70%) and test set (30%). Nomogram predicting the risk of hip fracture occurrence was created based on the results of the multifactor analysis, and performance was evaluated using receiver operating characteristic curve, calibration curves, and decision curve analysis. A web calculator was created to facilitate a more convenient interactive experience for clinicians.  RESULTS AND CONCLUSION: (1) Univariate analysis showed significant differences between the two groups in the number of falls, smoking, hypertension, glucocorticoids, number of strokes, Mini-Mental State Examination, visual acuity level, National Institute of Health Stroke Scale, Berg Balance Scale, and Stop Walking When Talking scale scores (P < 0.05). (2) Multivariate analysis showed that number of falls [OR=17.104, 95%CI (3.727-78.489), P=0.000], National Institute of Health Stroke Scale [OR=1.565, 95%CI(1.193-2.052), P=0.001], Stop Walking When Talking [OR=12.080, 95%CI(2.398-60.851), P=0.003] were independent risk factors positively associated with new hip fractures. Bone mineral density [OR=0.155, 95%CI(0.044-0.546), P=0.012] and Berg Balance Scale [OR=0.840, 95%CI(0.739-0.954), P=0.007] were negatively associated with new hip fractures after stroke. (3) The AUC values of nomogram were 0.956 and 0.907 in the training and test sets, respectively, and the calibration curves showed a high agreement between predicted and actual status with an area under the decision curve of 0.038 and 0.030, respectively. (4) These findings conclude that the number of falls, low bone mineral density, low Berg Balance Scale score, high National Institute of Health Stroke Scale score, and positive Stop Walking When Talking are risk factors for hip fracture after stroke. Based on this, a nomogram with high accuracy was developed and a web calculator (https://stroke.shinyapps.io/DynNomapp/) was created.  Figures and Tables | References | Related Articles | Metrics

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Influencing factors of adjacent vertebral refracture in elderly female patients with osteoporotic vertebral compression fracture and construction of a prediction model based on Nomogram Wang Xiaopeng, Zhong Rong, Zhong Yan, Lin Feng, Ye Shuxi 2024, 28 (36):  5799-5804.  doi: 10.12307/2024.664 Abstract ( 59 )   PDF (1051KB) ( 11 )   Save BACKGROUND: There have been many studies on adjacent vertebral fractures in elderly female patients with osteoporotic vertebral compression fractures, but their related risk factors are still in debate. There are also few studies on how to intuitively present their risks for clinical application.  OBJECTIVE: To analyze the risk factors of adjacent vertebral refracture in senile women with osteoporotic vertebral compression fracture and construct a Nomogram prediction model. METHODS: A total of 268 elderly female patients with osteoporotic vertebral compression fracture who came to Ganzhou People’s Hospital for treatment from January 2018 to November 2022 were selected and divided into study group (adjacent vertebral refracture, n=31) and control group (no adjacent vertebral refracture, n=237) according to whether adjacent vertebral refracture occurred 3 months after percutaneous vertebroplasty. General clinical data were compared between the two groups. Multivariate Logistic regression analysis was conducted to analyze the independent risk factors of adjacent vertebral refracture in elderly women with osteoporotic vertebral compression fracture. A Nomogram prediction model was constructed by R software “rms” package.  RESULTS AND CONCLUSION: (1) There were statistically significant differences in age, menopause age, body mass index, fracture history, number of fractured vertebra before surgery, bone cement leakage, bone density, postoperative kyphotic deformity angle, and preoperative Oswestry disability index between the two groups (P < 0.05). (2) Multivariate logistic regression analysis results showed that age (> 69 years old), menopause age (≤ 51 years old), body mass index (> 24.7 kg/m2), fracture history (presence), number of fractured vertebra before surgery (≥ 2), and postoperative kyphotic deformity angle (> 13°) were independent risk factors for adjacent vertebral refracture in elderly female osteoporotic vertebral compression fracture patients (P < 0.05). (3) Nomogram prediction model decision curve results displayed that when the risk threshold was > 0.09, this prediction model provided significant additional clinical net benefit. (4) These findings indicate that older age, lower menopause age, higher body mass index, history of fracture, more vertebra fractures before surgery, and larger kyphosis angle after surgery are independent factors for adjacent vertebral refracture in elderly women with osteoporotic vertebral compression fracture. This Nomogram prediction model will provide important strategic guidance for the prevention and treatment of adjacent vertebral refracture in elderly women with osteoporotic vertebral compression fracture. Figures and Tables | References | Related Articles | Metrics

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Sensitivity factor analysis of asymmetric gait quality evaluation model based on random forest algorithm Jiang Meijiao, Zhang Junxia, Shao Yangyang, Lu Fangfang, Yin Guofu, Yang Fang 2024, 28 (36):  5805-5810.  doi: 10.12307/2024.670 Abstract ( 55 )   PDF (911KB) ( 10 )   Save BACKGROUND: The assessment of asymmetric gait quality plays a pivotal role in guiding rehabilitation training; however, the link between gait quality and kinematic-kinetic gait parameters remains ambiguous. OBJECTIVE: To formulate a machine-learning model for evaluating gait quality based on gait parameters, identify factors sensitive to gait quality from asymmetric gait parameters, investigate the relationship between gait indicators and gait quality, and provide guidance for asymmetric gait training and rehabilitation. METHODS: An asymmetric gait database was established through the creation of asymmetric conditions. Kinematic and kinetic data were collected from 8 young and 8 elderly subjects (all male, right dominant population) during gait tests. Gait quality for each test data set was assessed using symmetry indices, resulting in the creation of a gait parameter-gait quality dataset. Utilizing the Random Forest algorithm, a gait quality evaluation model was developed and key quality parameter factors were identified through differential analysis. This model was iteratively refined. The model’s performance was evaluated through 10-fold cross-validation, and its effectiveness was verified using the cross-validation dataset. RESULTS AND CONCLUSION: (1) A gradient test was designed to categorize gait quality into optimal, suboptimal, intermediate, and poor groups, with 759, 329, 133, and 125 instances, respectively. (2) The application of the Random Forest algorithm in gait quality assessment was explored. A relationship model was established between gait indicators and gait quality, yielding a predictive model accuracy of 95.99%. (3) The 13 main parameters significantly influencing asymmetric gait quality were identified through the Random Forest model’s feature importance ranking. (4) An analysis of gait quality sensitivity factors using the 13 important parameters led to the identification of five key sensitivity indexes. The Random Forest model utilizing these sensitivity factors achieved a predictive accuracy of 94.20%.  Figures and Tables | References | Related Articles | Metrics

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Bioinformatics analysis of m6A-associated genes in steroid-induced osteonecrosis of the femoral head Linghu Xitao, Gui Jiaqi, Liang Zhuozhi, Wa Qingde, Huang Shuai 2024, 28 (36):  5811-5816.  doi: 10.12307/2024.698 Abstract ( 79 )   PDF (2816KB) ( 9 )   Save BACKGROUND: m6A modification has been confirmed to play an important role in the occurrence and development of osteonecrosis of the femoral head; however, the role of m6A modification patterns in steroid-induced osteonecrosis of the femoral head remains unknown.  OBJECTIVE: Bioinformatics analysis was performed based on the Gene Expression Omnibus (GEO) database to analyze the differential expression of the m6A gene in steroid-induced osteonecrosis of the femoral head, predict the downstream targeted miRNAs, and investigate the potential pathogenesis. METHODS: Expressing profiles of mRNA data of steroid-induced osteonecrosis of the femoral head were downloaded from GEO database (GSE123568). Differentially expressed genes (DEGs), Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed using the R software. After obtaining these differentially methylated m6A genes (m6A-DEGs), we analyzed GO function and KEGG pathway enrichment and compared the correlation among the m6A-DEGs typing according to gene expression. The protein-protein interaction network and core gene subnetwork of m6A-DEGs were constructed using Cytoscape software. The m6A-DEGs-associated potential miRNAs were predicted using the TargetScan, miRTarBase, and miRBD databases. Simultaneously, ChIPBase and hTFtarget databases were used to predict potential transcription factors of seven core genes, then m6A-miRNA and transcription factor-m6A regulatory networks were constructed separately. Finally, the expression levels of the seven core m6A-DEGs were verified by using the GSE74089 dataset. RESULTS AND CONCLUSION: (1) A total of 2 460 common DEGs were screened out from datasets, among which 1 455 genes were upregulated and 1 005 genes were downregulated. (2) A total of 14 m6A-DEGs were identified in the datasets. Among them, 11 m6A-DEGs were up-regulated and 3 m6A-DEGs were down-regulated. Differential gene expression was considered significant for m6A-DEGs in steroid-induced osteonecrosis of the femoral head (P < 0.05). Spearman correlation analysis showed a significant correlation between m6A-DEGs. (3) GO and KEGG enrichment analysis showed that m6A-DEGs were mainly enriched in myeloid cell differentiation and development, immune and cytokine receptor activity, osteoclast differentiation, AMPK signaling pathway and interleukin-17 signaling pathway. (4) The seven core genes of m6A-DEGs contained YTHDF3, YTHDF1, YTHDF2, ALKBH5, METTL3, HNRNPA2B1, and HNRNPC. A total of 44 miRNAs overlapping were detected in the miRTarBase, miRDB, and TargetScan databases. Totally 79 transcription factors overlapping were found in the ChIPBase and hTFtarget databases. (5) The expression levels of six core m6A-DEGs in the GSE74089 dataset were consistent with those in the GSE123568 dataset. (6) These findings confirm that the seven m6A-DEGs identified through bioinformatics techniques play a regulatory role in the expression of various miRNAs, transcription factors, AMPK, and interleukin-17 signaling pathways, and these genes have a significant impact on the differentiation and development of bone marrow cells as well as osteoclast differentiation in steroid-induced osteonecrosis of the femoral head. Consequently, these findings offer data support and establish a research direction for future investigations into the pathogenesis and targeted therapeutic strategies for steroid-induced osteonecrosis of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Factor analysis of pelvic tilt outcome after primary unilateral total hip arthroplasty Lu Lin, Chen Haicheng, Chen Chujie, Zhou Chi, Chen Zhenqiu 2024, 28 (36):  5817-5822.  doi: 10.12307/2024.688 Abstract ( 54 )   PDF (888KB) ( 8 )   Save BACKGROUND: Pelvic tilt, which is often seen in hip diseases, is also a common functional problem after total hip arthroplasty. OBJECTIVE: To investigate the mechanism of occurrence and recovery of pelvic tilt after unilateral total hip arthroplasty in patients with femoral head necrosis. METHODS: The clinical data of 100 patients with femoral head necrosis who underwent unilateral total hip arthroplasty in the Department of Femoral Head Necrosis, Bone Injury Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected retrospectively from June 2021 to February 2023. The patients were divided into three groups, namely, groups A (< 2°, n=48), B (2°-3°, n=34), and C (> 3°, n=18), according to the severity of pelvic tilt on postoperative 3 day. Statistical data were collected and compared between the pre- and postoperative periods of patients of these three groups in terms of the angle of the coronal plane of the pelvis tilt, the length of the gluteus medius muscles of the bilateral sides, the heights of the rotational centers of the femoral heads, the difference in the lengths of the gluteus medius muscles of the bilateral sides and the heights of the rotational centers of the femoral heads, and the ratio of changes in the angle of the pelvic tilt. Pearson correlation coefficient was used to examine the correlation between pelvic tilt angle and other indexes.  RESULTS AND CONCLUSION: (1) Pelvic tilt aggravation occurred in the short term after surgery. (2) The ratio of change in pelvic tilt angle from postoperative 3 days to postoperative 1 month time period differed between the groups, with group C > group B > group A. There was a difference between group C and the other groups in the time period from postoperative 1 to postoperative 3 months, with the ratio of change being the smallest in group C. There was no difference in the ratio of change between the groups in the time period from postoperative 3 days to postoperative 3 months. (3) The difference in bilateral gluteus medius muscles decreased gradually after surgery, and there was no difference in the comparison of bilateral gluteus medius muscles in the time period from postoperative 3 months. (4) The difference between bilateral centers of rotation increased after surgery, and the difference between bilateral heights at 3 months after surgery was smaller than that before surgery. (5) The pelvic tilt angle at 3 days after surgery, the duration of the disease and the pelvic tilt angle at 3 months after surgery were significantly correlated (all P=0.000), and the difference between bilateral gluteus medius muscles before surgery and the pelvic tilt angle at 3 days after surgery was significantly correlated (P=0.006) (6) The functional pelvic tilt occurred in the patients with femoral head necrosis after total hip arthroplasty. Correction of the pelvic tilt after surgery was based on the adaptive restoration of the functional pelvic tilt angle after surgery. Functional pelvic tilt arises as a compensatory adaptation of the organism based on the short-term postoperative reconstruction of bony structures and the survival of cumulative soft tissue damage. Figures and Tables | References | Related Articles | Metrics

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Relationship between low back pain and spinal-pelvic sagittal parameter changes in patients with hip-spine syndrome after total hip arthroplasty Ge Jin, Huang Dong, Yan Jinlian, Xu Zhengquan, Wang Yehua 2024, 28 (36):  5823-5827.  doi: 10.12307/2024.682 Abstract ( 68 )   PDF (837KB) ( 9 )   Save BACKGROUND: Many studies have shown that total hip arthroplasty will improve low back pain in patients with hip-spine syndrome. However, there are few studies on the relationship between postoperative low back pain improvement and changes in spinal-pelvic sagittal parameters. This study aims to reveal their connections between the two.  OBJECTIVE: To explore the relationship between the improvement of low back pain and changes in the spinal-pelvic sagittal parameters in patients with hip-spine syndrome after total hip arthroplasty.  METHODS: A retrospective analysis was performed on the clinical and imaging data of 93 end-stage hip disease patients who underwent primary total hip arthroplasty and combined with low back pain and were admitted to Affiliated Hospital of Xuzhou Medical University from January 2019 to January 2022. Spinal-pelvic sagittal parameters were measured on lateral lumbar X-rays before surgery and 1 year at the last follow-up: pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, pelvic incidence-lumbar lordosis (difference between pelvic incident angle and lumbar lordosis angle). Visual analog scale score, Oswestry disability index, and hip Harris score were recorded before and 1 year after arthroplasty. The patients were divided into two groups according to whether the change in visual analog scale scores 1 year after surgery reached the minimal clinically important difference for low back pain treatment, including 45 cases in the low back pain unimproved group and 48 cases in the low back pain improved group. The preoperative general data of patients, differences in spinal-pelvic sagittal parameters, Oswestry Disability Index and hip Harris score before and after surgery were compared between the two groups. RESULTS AND CONCLUSION: (1) There was no significant difference in age, gender, surgical side, body mass index, and etiology between the two groups (P > 0.05), and they were comparable. (2) There was no significant difference in visual analog scale scores before surgery (P > 0.05). The visual analog scale scores of the low back pain improved group were lower than those of the low back pain unimproved group 1 year after surgery (P < 0.01). (3) At 1 year after surgery, the lumbar lordosis of the low back pain unimproved group was significantly smaller than that before surgery, while the lumbar lordosis of the low back pain improved group was significantly smaller than that before surgery (P < 0.01). At the same time, the pelvic incidence-lumbar lordosis mismatch in the low back pain unimproved group was greater than before surgery, while the pelvic incidence-lumbar lordosis mismatch in the low back pain improved group was smaller than before surgery, with significant differences between the two groups (P < 0.01). There was no significant difference in the changes of other spinal-pelvic sagittal parameters between the two groups (P > 0.05). (4) Preoperative lumbar Oswestry disability index and hip Harris score were not significantly different between the two groups (P > 0.05). At 1 year after surgery, Oswestry disability index of the low back pain improved group was lower than that of the low back pain unimproved group and the hip Harris score was higher than that of the low back pain unimproved group (P < 0.05). (5) The results showed that the improvement of low back pain was related to changes in spinal-pelvic sagittal parameters in patients with hip-spine syndrome after total hip arthroplasty, showing reduced lumbar lordosis and pelvic incidence-lumbar lordosis mismatch. Moreover, patients with improved low back pain after surgery had better functional scores, indicating that total hip arthroplasty improved spinal alignment and spinal-pelvic sagittal balance. For patients with hip-spine syndrome, a total hip arthroplasty performed before the onset of lumbar disease can have a favorable effect on the lumbar spine. Figures and Tables | References | Related Articles | Metrics

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Unicompartmental knee arthroplasty in treatment of medial compartment osteoarthritis of knee joint: joint function and changes in inflammatory cytokines Li Yuxuan, Yuan Lingli, Xu Zhiyuan, Yan Tao, Zhang Zhongchuan, Xu Wendi, Zhu Xunbing 2024, 28 (36):  5828-5832.  doi: 10.12307/2024.746 Abstract ( 70 )   PDF (1288KB) ( 13 )   Save BACKGROUND: Unicompartmental knee arthroplasty has been paid more and more attention because of its advantages of fewer traumas, less blood loss, less complications, faster recovery, excellent knee function and high prosthetic survival rate. Most of the relevant reports focused on its clinical effect, but the changes in the levels of relevant inflammatory cytokines in patients after unicompartmental knee arthroplasty were rarely reported. OBJECTIVE: To investigate the effect of unicompartmental knee arthroplasty in patients with medial compartment osteoarthritis of the knee and the changes of interleukin-1, interleukin-6, and tumor necrosis factor-α levels.  METHODS: A total of 30 patients with medial compartment osteoarthritis of the knee who received unicompartmental knee arthroplasty from September 2021 to March 2023 and met the inclusion criteria were selected as the study subjects. Medial angle of proximal tibia, femoral and tibial angle, pain visual analog scale score, hospital for special surgery score, knee joint range of motion, synovial fluid interleukin-1, interleukin-6, and tumor necrosis factor-α levels before and after surgery were compared and statistically analyzed. RESULTS AND CONCLUSION: (1) All 30 patients had grade I wound healing. All patients were followed up for more than 6 months after surgery. There were no complications such as prosthesis loosening and dislocation of prosthesis liner in all patients. (2) The medial proximal tibia angle and the femoral and tibial angles measured after operation were significantly improved (P < 0.05). (3) The visual analog scale score, hospital for special surgery score and range of motion measured at 1, 3, and 6 months after operation were better than those before operation (P < 0.05), and showed a gradual improvement (P < 0.05). (4) The levels of interleukin-1, interleukin-6, and tumor necrosis factor-α in synovial fluid at 3 and 6 months after operation were decreased gradually compared with those before operation (P < 0.05) and showed a gradual downward trend at each time point after operation. (5) It is indicated that unicompartmental knee arthroplasty can effectively treat medial compartment osteoarthritis of the knee, significantly relieve pain, restore knee joint function, improve knee varus deformity and lower limb strength line, and reduce the levels of inflammatory cytokines interleukin-1, interleukin-6, and tumor necrosis factor-α in joints to a certain extent. Figures and Tables | References | Related Articles | Metrics

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Robot-assisted pedicle screw internal fixation in treatment of atlantoaxial dislocation Chen Wenchuang, Li Yong, Lu Yao, Zhang Meiren, Chen Haiyun, Yu Zhaoyu 2024, 28 (36):  5833-5838.  doi: 10.12307/2024.683 Abstract ( 53 )   PDF (1851KB) ( 7 )   Save BACKGROUND: Atlantoaxial dislocation, because of its high difficulty and high risk of surgery, has been regarded as the “surgical restricted area” by the international orthopedic community. However, with the rapid development of intelligent digitization in orthopedics, robot-assisted navigation screw placement technology has been widely used in clinical practice, which significantly reduces the difficulty and risk of surgery and improves the safety of surgery. However, there are few reports on the application of this technique in the treatment of atlantoaxial dislocation.  OBJECTIVE: To explore the application value of robot-assisted pedicle screw internal fixation in the treatment of atlantoaxial dislocation.  METHODS: The medical records of five patients with atlantoaxial dislocation treated with C1-C2 pedicle screw fixation under robot-assisted navigation in Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine from October 2021 to July 2022 were retrospectively analyzed. Operation time, length of neck incision, blood loss, postoperative drainage volume, and length of hospital stay were recorded. Attention should be paid to cerebrospinal fluid leakage, vertebral artery injury, nerve injury, operative area infection and other complications. The visual analog scale score of neck pain, the spinal cord injury grade of the American Spinal Injury Association, the cervical spine score of the Japanese Orthopaedic Association, and the imaging indicators were collected before surgery and at the last follow-up. Screw placement accuracy was assessed. RESULTS AND CONCLUSION: (1) Five patients were successfully completed surgery, without vascular, nerve injury or other complications, and were followed up for 12-20 months. (2) A total of 20 cervical pedicle screws were placed in 5 patients, including 9 type A screws, 10 type B screws, and 1 type C screw. The accuracy of screw placement was 95%. (3) At the last follow-up, the visual analog scale score was (0.80±0.71) points, which was significantly lower than that before operation (4.00±2.83) points; the Japanese Orthopaedic Association score was (14.80±0.84) points, which was significantly higher than that before operation (8.00±0.71) points. Anterior atlantodental interval decreased from (7.86±3.25) mm to (2.82±0.93) mm; space available of the spinal cord increased from (6.74±1.99) mm to (12.10±3.51) mm; cervicomedullary angle increased from (133.32±13.55)° to (153.44±9.53)°; clivus-canal angle increased from (128.02±9.92)° to (143.25±12.99)°. The results of the last follow-up indexes were improved compared with those before operation, and the differences were significant (all P < 0.05). (4) Postoperative imaging follow-up showed that all patients had bone fusion in the bone graft area, and no internal fixation loosening, fracture or pull-out occurred. (5) This method can avoid relying on the doctor’s experience and hand feeling, ensure the accuracy of upper cervical screw placement, reduce the risk of surgery, and obtain satisfactory results in mid-term follow-up.  Figures and Tables | References | Related Articles | Metrics

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Correlation of circumference and displacement of the third fracture fragment with the healing of femoral shaft fractures treated with intramedullary nailing Yang Shuo, Feng Tao, Chen Shuchang, Yu Jian, Zhang Yanyan, Huo Yongfeng, Gu Guangxue, Yin Zhaoyang 2024, 28 (36):  5839-5845.  doi: 10.12307/2024.696 Abstract ( 54 )   PDF (1242KB) ( 8 )   Save BACKGROUND: After the treatment of femoral shaft fracture with the intramedullary nail, the third fracture open reduction indications are controversial. Some scholars believe that limited open reduction can achieve anatomical reduction, conducive to fracture healing; but some scholars believe that no open reduction of the third fracture still has a high fracture healing rate. OBJECTIVE: To investigate the effect of the circumference and displacement of the third fragment on fracture healing after intramedullary nailing of femoral shaft fractures with the third fragment.  METHODS: A retrospective cohort study was conducted to analyze the clinical data of 142 patients suffered a femoral shaft fracture with a third fragment admitted to the Affiliated Lianyungang Hospital of Xuzhou Medical University from February 2016 to December 2021. The fracture were classified into three types according to the circumference of the third fracture with reference to the diaphyseal circumference at the fracture site: type 1 in 71 cases, type 2 in 52 cases, and type 3 in 19 cases. Referring to the diaphyseal diameter, the fractures were classified into three degrees according to the degree of the third fragment displacement: degree I in 95 cases, degree II in 31 cases, and degree III in 16 cases. All patients were treated with femoral interlocking intramedullary nails, and no intervention was performed for the displaced third fragment during the operation. Postoperative follow-up was performed to compare the fracture healing rate, healing time, and the modified Radiographic Union Scale for Tibia at month 9 after surgery in each group. The effect of third fracture fragment circumference and degree of displacement on fracture healing was assessed.  RESULTS AND CONCLUSION: (1) All 142 patients were followed up for at least 12 months, with a mean of (14.7±4.1) months, and the overall healing rate was 73.4%. (2) When the third fragment was displaced by degree I, the healing rate, healing time, and modified Radiographic Union Scale for Tibia score at month 9 were not statistically significant among the three sub-groups of circumference classification. (3) When the third fragments were displaced by degree II or III, the healing rate and healing time were not statistically significant among the three subgroups of circumference classification; the modified Radiographic Union Scale for Tibia score at month 9 in the type 1 group was higher than that in the type 2 and 3 groups (P = 0.017). (4) Logistic regression analysis showed that a greater third fragment displacement and circumference were associated with lower fracture healing rates (P < 0.05). (5) These findings indicate that in the treatment of femoral shaft fractures with third fragment by intramedullary nails, when the fracture fragment is displaced to degree I, the circumference size has little effect on fracture healing, and no intervention is required during surgery. When the third fragment is displaced to degree II or III and the circumference of which is type 1, a higher modified Radiographic Union Scale for Tibia score can still be obtained with no intervention of the third fragment. However, when the circumference is of type 2 or type 3, it significantly affects the fracture healing. Consequently, intraoperative intervention to reduce the distance of displacement of the fragment is required to lower the incidence of nonunion. The displacement of the third fracture fragments has a greater impact on fracture healing than their circumference. Figures and Tables | References | Related Articles | Metrics

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Reliability of photogrammetry for evaluating pelvic posture in healthy individuals Dong Miaomiao, Li Xiang, Xie Jiani, Zhang Lixin, Wang Yuexi 2024, 28 (36):  5846-5851.  doi: 10.12307/2024.678 Abstract ( 63 )   PDF (1089KB) ( 12 )   Save BACKGROUND: In clinical practice, the anterior superior iliac spine and posterior superior iliac spine are usually located by palpation, and the tilt of the pelvis is determined by visual observation method or photogrammetry. Among them, the visual observation method can only have qualitative conclusions, and its reliability is poor. The photogrammetry is not only more convenient and fast, but also can give more accurate quantitative data, which is one of the best clinical evaluation methods. However, there are no studies on the reliability of pelvic posture assessment using photogrammetry in China.  OBJECTIVE: To evaluate the pelvic posture by visual observation method and photogrammetry, and to compare the reliability level of the two methods to guide clinical application.  METHODS: Forty-five healthy subjects were selected and red marks were made at the bilateral anterior superior iliac spine and posterior superior iliac spine. Pelvic posture was photographed from the front, back (coronal plane), left, and right (sagittal plane). The left and right pelvic tilt angles (α, β angles) were selected from the front and back views, which represented the angle between the bilateral anterior superior iliac spine line or the bilateral posterior superior iliac spine line and the horizontal line. The anterior and posterior pelvic tilt angles (γ, θ angles) were selected from the side view, which represented the angle between the ipsilateral anterior superior iliac spine and posterior superior iliac spine line and the horizontal plane, indicating the sagittal plane pelvic tilt. Evaluation methods included visual observation method and photogrammetry. Two evaluators independently evaluated the pelvic α, β, γ, θ angles using the visual observation method first, and then recorded the pelvic α, β, γ, θ angles using the photogrammetry. After a one-month interval, the visual observation method and photogrammetry were performed again, and the pelvic α, β, γ, θ angles were recorded. The intraclass correlation coefficients were used to analyze the data obtained from the two evaluation methods and the before-and-after measurements: 0.90-0.99 as an excellent correlation, 0.80-0.89 as a good correlation, 0.70-0.79 as a moderate correlation, and ≤0.69 as a poor correlation. The standard error of measurement and the minimal detectable change with 95% confidence intervals were calculated to evaluate the inter-rater and intra-rater reliability.  RESULTS AND CONCLUSION: (1) The interrater intraclass correlation coefficients of the visual observation method and photogrammetry were as follows: anterior view: 0.682 and 0.718, posterior view: 0.513 and 0.867, left view: 0.739 and 0.960, and right view: 0.756 and 0.971. The visual observation method showed poor correlation between the anterior and posterior views and moderate correlation between the left and right views, while the photogrammetry showed moderate correlation for the anterior view, good correlation for the posterior view, and excellent correlation for the left and right views. The standard error values of measurement were as follows: anterior view: 3.266 and 1.625, posterior view: 4.278 and 1.763, left view: 5.935 and 1.787, and right view: 5.723 and 1.698. The minimal detectable change values with 95% confidence intervals were as follows: anterior view: 9.053 and 4.504, posterior view: 11.858 and 4.887, left view: 16.451 and 4.953, and right view: 15.863 and 4.707. (2) The interrater intraclass correlation coefficients of the visual observation method and photogrammetry were as follows: anterior view: 0.452 and 0.723, posterior view: 0.483 and 0.904, left view: 0.518 and 0.955, and right view: 0.657 and 0.968. The visual observation method showed poor correlation in all four directions, while the photogrammetry showed moderate correlation for the anterior view and excellent correlation for the other three directions. The standard error values of measurement were as follows: anterior view: 5.651 and 1.610, posterior view: 4.237 and 1.523, left view: 7.322 and 1.891, and right view: 6.509 and 1.781. The minimal detectable change values with 95% confidence intervals were as follows: anterior view: 15.664 and 4.463, posterior view: 11.744 and 4.222, left view: 20.296 and 5.242, and right view: 18.042 and 4.937. (3) These results confirm that the sagittal and coronal plane photogrammetries have good intrarater and interrater reliability for evaluating pelvic posture, especially with the use of the photogrammetry, which has good data stability. This method is simple, fast, efficient, accurate, low-cost, and does not cause X-ray damage, and can qualitatively and quantitatively reflect the actual situation of the patient’s pelvis, making it suitable for clinical use.  Figures and Tables | References | Related Articles | Metrics

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A randomized controlled trial of acupuncture at Jiaji points for treatment of lumbar disc herniation under ultrasonic guidance Zhu Xi, Tao Yuhong, Huang Peng, Li Dan 2024, 28 (36):  5852-5857.  doi: 10.12307/2024.685 Abstract ( 48 )   PDF (1061KB) ( 6 )   Save BACKGROUND: In the research on acupuncture treatment for lumbar disc herniation, most acupuncture treatments are performed under CT guidance or without guidance. The precise control of the target site and the effective acupuncture location are not clear.  OBJECTIVE: To observe the clinical effects of acupuncture at Jiaji points under ultrasonic guidance in treating lumbar disc herniation. METHODS: A total of 70 cases of lumbar disc herniation, 36 males and 34 females aged 18-65 years old, were selected from Chinese PLA General Hospital and Third Affiliated Hospital of Beijing University of Chinese Medicine. They were divided into trial group and control group by random number table method, with 35 cases in each group. The control group received acupuncture at Jiaji points. The trial group received acupuncture at Jiaji points under ultrasonic guidance. The patients were treated once on the day of treatment and 4, 7 days after treatment. Visual analog scale score, Oswestry disability index, Japanese Orthopaedic Association score, and MOS 36-Item Short-Form Health Survey (SF-36) were evaluated before and after treatment. RESULTS AND CONCLUSION: (1) Compared with before treatment, the visual analog scale scores of both groups were decreased after treatment (P < 0.01). Compared with the control group, the visual analog scale scores of the trial group were decreased on days 2, 3, 6, 7 of treatment and 1, 2 weeks after the end of treatment (P < 0.05, P < 0.01). (2) Compared with before treatment, Oswestry disability index after treatment was decreased in both groups (P < 0.01). Compared with the control group, Oswestry disability index of the trial group was decreased from days 1 to 7 of treatment and 1, 2 weeks after treatment (P < 0.01). (3) Compared with before treatment, the Japanese Orthopaedic Association scores of both groups were increased after treatment (P < 0.01). Compared with the control group, the Japanese Orthopaedic Association scores of the trial group were increased on days 3, 7 of treatment and 1, 2 weeks after treatment (P < 0.05, P < 0.01). (4) Compared with before treatment, SF-36 scores in both groups were increased after treatment (P < 0.01). There was no significant difference in SF-36 scores between the two groups after treatment (P > 0.05). (5) These results show that acupuncture at Jiaji points has curative effect on lumbar disc herniation, and ultrasonic guidance could improve the clinical curative effect of acupuncture at Jiaji points for lumbar disc herniation.   Figures and Tables | References | Related Articles | Metrics

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Prolonging use of tranexamic acid is helpful to reduce perioperative hidden blood loss in senile patients with intertrochanteric fractures Zhao Yan, Wu Fan, Li Hong, Wan Shengyu, He Jin, Zhu Binren, Jiang Congbing 2024, 28 (36):  5858-5864.  doi: 10.12307/2024.689 Abstract ( 50 )   PDF (1040KB) ( 7 )   Save BACKGROUND: Intertrochanteric fracture of femur often occurs in the elderly, and there will be a large amount of hidden blood loss after surgery. Reducing hidden blood loss can decrease complications and hospital stay. OBJECTIVE: To evaluate the effect of prolonged use of tranexamic acid on hidden blood loss after proximal femoral nail antirotation implantation in senile intertrochanteric fractures. METHODS: From January 2022 to May 2023, 62 elderly admitted patients with intertrochanteric fracture of femur were selected from Zigong Fourth People’s Hospital. All of them were treated with proximal femoral nail antirotation implantation after closed reduction on the traction bed. According to the use time of tranexamic acid, they were divided into two groups. In the control group (n=38), 1 g tranexamic acid was given intravenically 15-30 minutes before incision, and 1 g was added 3 hours later. Based on the control group, the trial group (n=24) was given 1 g tranexamic acid intravenously once for 12 hours on the first day after surgery. Blood routine examinations were performed before surgery, on the day after surgery, and on the first, third and fifth days after surgery. Hemoglobin and hematocrit were counted. The theoretical total blood loss was calculated by Cross equation, and the incidence of complications in the two groups was recorded. RESULTS AND CONCLUSION: (1) Through statistical analysis, there was no significant difference in the amount of dominant blood loss between the two groups (P > 0.05). (2) The number of grams of hemoglobin decreased, total blood loss and hidden blood loss in the trial group during perioperative period were lower than those in the control group, and the differences were statistically significant (P < 0.05). (3) The hemoglobin values of the trial group on day 3 after surgery, and the hematocrit values on days 1 and 3 after surgery were higher than those of the control group, with statistical significance (P < 0.05). (4) The hemoglobin and platelet count showed a downward trend after surgery, and the hemoglobin value was the lowest value on day 3, and the platelet value was the lowest value on day 1 after surgery, and then began to rise in both groups. (5) There was no significant difference in postoperative complications between the two groups (P > 0.05). (6) The results show that prolonging use of tranatemic acid can effectively reduce the hidden blood loss in the treatment of femoral intertrochanteric fracture with proximal anti-rotation intramedullary nail, and does not increase the risk of complications. Figures and Tables | References | Related Articles | Metrics

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Relationship between blood indicators and course of nontraumatic osteonecrosis of femoral head in different stages: multiple logistic regression analysis Wu Zixuan, Sun Shiyi, Zhang Cheng, Zhang Guangyi, Yang Tongjie, He Haijun 2024, 28 (36):  5865-5871.  doi: 10.12307/2024.695 Abstract ( 51 )   PDF (918KB) ( 6 )   Save BACKGROUND: Up to now, there is no literature on the relationship between blood laboratory tests and the course of nontraumatic osteonecrosis of femoral head in different stages. It is necessary to further explore and analyze so as to better clarify the influencing factors of nontraumatic osteonecrosis of femoral head. OBJECTIVE: To analyze the relationship between blood laboratory indicators and the course of nontraumatic osteonecrosis of the femoral head by the Association Research Circulation Osseous (ARCO), thus exploring the influencing factors of blood laboratory indicators on the course of nontraumatic osteonecrosis of the femoral head. METHODS: This study used a retrospective study design. A total of 2 103 patients with osteonecrosis of the femoral head were retrieved from Wangjing Hospital of China Academy of Chinese Medical Sciences database, and 1 075 patients with nontraumatic osteonecrosis of the femoral head were ultimately included based on inclusion and exclusion criteria. Patient age, gender, body mass index, and blood laboratory test results were collected. Blood laboratory tests included low-density lipoprotein, total cholesterol, triglycerides, high-density lipoprotein, apolipoprotein β, apolipoprotein α1, uric acid, total protein quantitative, alkaline phosphatase, activated partial thromboplastin time, prothrombin time, prothrombin time International Normalized Ratio, prothrombin time activity, fibrinogen quantitative, coagulation time of thrombin, D-dimer, total iron binding capacity, and platelet count. The indicators of patients with different age groups and different ARCO stages were compared, and multiple Logistic regression analysis was applied to explore the influencing factors of ARCO stages in osteonecrosis of the femoral head. RESULTS AND CONCLUSION: (1) There were statistical differences in total cholesterol, uric acid, prothrombin time, prothrombin time International Normalized Ratio, and D-dimer among ARCO stages in the young group (P < 0.05). Among young patients in ARCO stage II, total cholesterol levels were higher than those in ARCO stage III (P < 0.05). Uric acid levels in ARCO stage IV were higher than those in ARCO stage II and III (P < 0.05). Prothrombin time and prothrombin time International Normalized Ratio were shorter in ARCO stage IV and II than in ARCO stage III (P < 0.05). D-dimer levels were higher in ARCO stage III and IV than in ARCO stage II (P < 0.05). (2) There were statistically significant differences in high-density lipoprotein, coagulation time of thrombin, and D-dimer among ARCO stages in the middle-aged group (P < 0.05). Among middle-aged patients in ARCO stage IV, high-density lipoprotein levels were higher than those in ARCO stages II and III (P < 0.05). Coagulation time of thrombin was shorter in ARCO stage IV than in ARCO stage III (P < 0.05). D-dimer levels were higher in ARCO stages IV than in ARCO stages II and III (P < 0.05). (3) The uric acid, activated partial thromboplastin time, D-dimer, and platelet count in the elderly group showed statistically significant differences (P < 0.05). The uric acid level in ARCO stage IV was higher than that in ARCO stage II and III patients in the elderly group (P < 0.05), while the activated prothrombin time in ARCO stage II patients was shorter than that in ARCO stage III patients in the elderly group (P < 0.05). The D-dimer level in ARCO stage III and IV patients was higher than that in ARCO stage II patients in the elderly group (P < 0.05). The platelet count in ARCO stage IV was lower than that in ARCO stage III patients in the elderly group (P < 0.05). (4) Multiple logistic regression analysis showed that total cholesterol and platelet count may be protective factors for course of nontraumatic osteonecrosis of the femoral head, while D-dimer, uric acid, overweight, and young and middle age may be risk factors for course of nontraumatic osteonecrosis of the femoral head. (5) It is indicated that total cholesterol, high-density lipoprotein, uric acid, prothrombin time, prothrombin time International Normalized Ratio, and D-dimer are statistically significant among patients with different ARCO stages. Total cholesterol and platelet count may be protective factors for the course of nontraumatic osteonecrosis of the femoral head, while D-dimer, uric acid, overweight, and middle-aged and young age groups may be hazard factors for the course of nontraumatic osteonecrosis of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Mitophagy and intervertebral disc degeneration Pan Shihong, Liu Ruiduan 2024, 28 (36):  5872-5876.  doi: 10.12307/2024.672 Abstract ( 90 )   PDF (966KB) ( 19 )   Save BACKGROUND: During intervertebral disc degeneration, mitophagy plays an extremely important role in preventing the progression of intervertebral disc degeneration. Regulating the level of mitophagy may be a new strategy for the treatment of intervertebral disc degeneration.  OBJECTIVE: To review the relationship between mitophagy and intervertebral disc, in order to provide a reference for the treatment of intervertebral disc degeneration by regulating the level of mitophagy. METHODS: A literature search was performed in CNKI, Wanfang, VIP, and PubMed using “intervertebral disc degeneration, mitophagy, targeted therapy, inflammation, signaling pathways” as Chinese and English search terms. Finally, 54 articles were included and summarized. RESULTS AND CONCLUSION: (1) At present, the specific mechanism of intervertebral disc degeneration is not clear. A large number of studies have shown that intervertebral disc degeneration is closely related to mitophagy, which involves a relatively complex mechanism and pathway. Among various pathways, PINK1/Parkin is the most widely studied signaling pathway for mitophagy regulation. (2) Some drugs, such as Salidroside, Urolithin A, Honokiol, MitoQ, have been found to have the potential to treat intervertebral disc degeneration by regulating the level of mitophagy. These drugs have shown positive preclinical results. (3) At present, the targeted therapy of mitophagy is mainly preclinical research and has achieved positive results. Further clinical research is needed to explore its clinical efficacy and safety. Figures and Tables | References | Related Articles | Metrics

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Impact of measurement of joint space width on effectiveness and prognosis of medial unicondylar knee arthroplasty Xu Gengbin, Ru Jiangying 2024, 28 (36):  5877-5883.  doi: 10.12307/2024.747 Abstract ( 62 )   PDF (1133KB) ( 9 )   Save BACKGROUND: Compared with total knee arthroplasty, unicondylar knee arthroplasty has such advantages as quick recovery, low cost and good proprioception, but its high revision rate after operation is also a problem that cannot be ignored. At present, the reasons for the high revision rate after unicondylar knee arthroplasty are not completely clear. Therefore, preoperative strict control of surgical indication may be crucial to improve postoperative outcome and reduce revision rate after unicondylar knee arthroplasty. As an index commonly used in the measurement of imaging, the evaluation of joint space width may have important clinical reference value in the selection of indications for unicondylar knee arthroplasty.  OBJECTIVE: To review the measurement of joint space width and its effect on the curative effect and outcome of medial unicondylar knee arthroplasty.   METHODS: WanFang and PubMed were used to search the relevant literature published from January 1, 1950 to June 1, 2023 on the evaluation factors of curative effect of unicondylar knee arthroplasty and the influence of joint space width on the curative effect of unicondylar knee arthroplasty. By summarizing and analyzing the literature, the measurement methods of joint space width, the influence of preoperative medial compartment joint space width on the curative effect of medial compartment joint space width, and the influence of postoperative lateral compartment joint space width on the outcome were reviewed.  RESULTS AND CONCLUSION: (1) Although many methods have been used to study and measure knee joint space width, X-ray measurement of joint space width under weight-bearing position is still a common method in daily orthopedic practice to assess the progression of osteoarthritis, and it can moderately reflect the thickness of cartilage. (2) Preoperative medial compartment joint space width of knee joint can affect the efficacy of medial movable platform after unicondylar knee arthroplasty. Patients with knee osteoarthritis whose medial joint space width/lateral joint space width ratio is < 40% or medial joint space width ≤2 mm may be more suitable for medial movable platform unicondylar knee arthroplasty. (3) Changes in lateral compartment joint space width after medial unicondylar knee arthroplasty also have a certain impact on outcome. Improving the joint matching degree of lateral compartment after surgery can delay the progression of lateral compartment joint degeneration and reduce the prosthesis revision rate. However, relevant clinical studies are still lacking. In conclusion, the imaging measurement of joint space width has important clinical reference value for evaluating the postoperative efficacy and prognosis of medial unicondylar knee arthroplasty.  Figures and Tables | References | Related Articles | Metrics

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Risk factors for adjacent vertebral compression fractures after percutaneous vertebroplasty Liu Dongyuan, Guan Haishan, Shi Haoran, Liu Xiaoliang, Zhou Haosheng 2024, 28 (36):  5884-5891.  doi: 10.12307/2024.693 Abstract ( 47 )   PDF (1263KB) ( 11 )   Save BACKGROUND: Percutaneous vertebroplasty is the most widely used method for the treatment of osteoporotic vertebral compression fractures, and most studies have concluded that percutaneous vertebroplasty increases the probability of adjacent vertebral secondary compression fractures in patients with osteoporotic vertebral compression fractures. However, controversy remains regarding the risk factors associated with adjacent vertebral re-fracture caused after percutaneous vertebroplasty. OBJECTIVE: To summarize the influencing factors of adjacent vertebral compression fractures after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures, in order to provide a certain reference for reducing the risk of its occurrence as well as formulating the corresponding treatment plan. METHODS: Using “osteoporosis, fracture, percutaneous vertebroplasty, adjacent vertebral compression fractures, risk factors” as the Chinese search terms, “osteoporosis, osteoporotic vertebral compression fractures, percutaneous vertebroplasty, adjacent vertebral compression fractures, risk factors” as English search terms, computerized searches were conducted on CNKI, Wanfang Medical Network, VIP, PubMed, Springer, ScienceDirect, and Elsevier databases. The search timeframe focuses on January 2018 through September 2023, with the inclusion of a few classic forward literature. The literature was screened by reading the titles and abstracts, and 83 papers were finally included in the review. RESULTS AND CONCLUSION: (1) Osteoporotic vertebral compression fractures are one of the most common complications of osteoporosis, placing elderly patients at a significant risk of disability and death. Percutaneous vertebroplasty is a practical and effective treatment for osteoporotic vertebral compression fractures. (2) With the popularity of percutaneous vertebroplasty, its secondary vertebral compression fractures have gradually increased, with adjacent vertebral compression fractures being the most common. (3) Previous studies have only discussed the effects of factors such as bone mineral density, multiple vertebral fractures, body mass index, age, sex, amount of bone cement, cement leakage, and anti-osteoporosis treatment on secondary compression fractures of adjacent vertebrae after percutaneous vertebroplasty, and summarized the number of vertebral fractures, timing of the operation, surgical approach, cement material, diffuse distribution of bone cement, recovery height of the injured vertebrae, and wearing of a support after surgery, which is not yet comprehensive. The analysis of the specific mechanisms of risk factor-induced adjacent vertebral fractures is relatively rare. (4) The results of the article showed that low bone mineral density, advanced age, perimenopausal women, multiple vertebral fractures, excessive recovery of the height of the injured vertebrae, cement leakage, comorbid underlying diseases, and poor lifestyle habits were the risk factors for secondary adjacent vertebral compression fractures after percutaneous vertebroplasty, and that maintaining a normal body mass index, early surgery, bilateral percutaneous vertebroplasty, use of a new type of cement material, an appropriate volume of bone cement injection and uniform cement dispersion, regular anti-osteoporosis treatment, and postoperative brace wearing are protective factors for secondary adjacent vertebral compression fractures after percutaneous vertebroplasty. Figures and Tables | References | Related Articles | Metrics

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Albumin/globulin ratio in diagnosis of periprosthetic joint infection: a system evaluation and meta-analysis Geng Qidi, Jiang Yongdong, Wu Yufeng 2024, 28 (36):  5892-5898.  doi: 10.12307/2024.673 Abstract ( 43 )   PDF (1302KB) ( 7 )   Save OBJECTIVE: As one of the serious complications after total hip arthroplasty or total knee arthroplasty, periprosthetic joint infection has always been the focus of joint surgeons. Albumin/globulin ratio is emerging as a promising biomarker for the diagnosis of periprosthetic joint infection. This study aimed to investigate the diagnostic value of albumin/globulin ratio in diagnosing periprosthetic joint infection. METHODS: A systematic search was conducted in PubMed, Embase, and Cochrane Library databases on July 29, 2023. The literature was screened according to the inclusion and exclusion criteria, and the literature related to diagnostic trials of albumin/globulin ratio was included in this study. QUADAS-2 method was used to evaluate the quality of the included articles. Bivariate mixed-effect model was applied to combine the sensitivity, specificity, likelihood ratio, and diagnostic odds ratio of the included articles, and the receiver operating characteristic curve and area under the curve were integrated to specifically evaluate the accuracy of D-dimer in the diagnosis of periprosthetic joint infection. Subgroup analysis was used to explore the sources of heterogeneity. RESULTS: We included eight eligible diagnostic studies, all of which were of medium to high quality. The sensitivity and specificity of the combined diagnosis were 0.78 (95%CI: 0.66-0.86) and 0.83 (95%CI: 0.78-0.88), respectively. The combined positive and negative likelihood ratios were 4.63 (95%CI: 3.43-6.22) and 0.27 (95%CI: 0.17-0.42), respectively. The combined diagnostic scores and diagnostic odds ratio were 2.85 (95%CI: 2.23-3.48) and 17.35 (95%CI: 9.29-32.45), respectively. The area under the summary receiver operating characteristic curve was 0.88 (95%CI: 0.85-0.90). CONCLUSION: The albumin/globulin ratio is of guiding significance in the diagnosis of periprosthetic joint infection. However, it is not universal in clinical practice, so it should be combined with specific clinical practice. In addition, there are relatively few studies on the threshold of albumin/globulin ratio, different sampling types, different laboratory detection methods, and different races, so more prospective clinical trials with large samples, multi-centers, and scientific design should be carried out for verification in the future. Figures and Tables | References | Related Articles | Metrics

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Effectiveness of different specific exercise therapies in treatment of adolescent idiopathic scoliosis: a network meta-analysis Chang Ying, Xia Yuan, Sun Yundi, Cheng Lulu, Xiong Wenjuan, Zhao Xianghu 2024, 28 (36):  5899-5904.  doi: 10.12307/2024.692 Abstract ( 83 )   PDF (1565KB) ( 25 )   Save OBJECTIVE: At present, there are a variety of treatment methods for scoliosis using specific exercise therapy, but there is a lack of comparison of efficacy between different specific exercise therapy. This article compared the effectiveness of different specific exercise therapies to treat adolescent idiopathic scoliosis through a network meta-analysis. METHODS: Domestic and foreign electronic databases of relevant studies were searched for randomized controlled trials of specific exercise therapy for adolescent idiopathic scoliosis. Search time was from January 2000 to July 2023. The literature was screened by two reviewers using RevMan 5.4 and Stata 16.0 software to extract data and assess the bias risk of of inclusion studies. RESULTS: (1) This article includes 20 randomized controlled trials with 1 377 patients. Of them, 12 studies involved Schroth therapy; 2 studies involved BSPTS therapy, and 6 studies involved SEAS therapy. (2) The network meta-analysis indicated that in terms of improving Cobb angle and reducing trunk rotation angle in scoliosis patients, the BSPTS therapy group and Schroth therapy group were better than the conventional control group [WMD=-4.60, 95%CI(-8.37, -0.82), P < 0.05; WMD=-3.37, 95%CI(-4.98, -1.75), P < 0.05; WMD=-3.20, 95%CI(-5.50, -0.90), P < 0.05; WMD=-2.13, 95%CI(-3.16, -1.09), P < 0.05]. The Schroth therapy group performed better than the conventional control group effective in improving the International Society for Scoliosis Research-22 Questionnaire quality of life score [WMD=1.41, 95%CI(0.07, 2.75), P < 0.05]. CONCLUSION: Given the current evidence, BSPTS therapy group and Schroth therapy group were better than the conventional control group in improving Cobb angle and reducing trunk rotation angle. In the comparison of different specific exercise therapies, BSPTS therapy can be preferred to improve Cobb angle and reduce trunk rotation angle in adolescent idiopathic scoliosis patients. In addition, Schroth therapy may be the best treatment to improve the quality of life of adolescent idiopathic scoliosis patients. Limited by the quantity and quality of the included studies, the above conclusions should be interpreted with caution and need more high-quality studies to further validation. Figures and Tables | References | Related Articles | Metrics