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28 May 2025, Volume 29 Issue 15 Previous Issue    Next Issue

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Finite element analysis of a novel lumbar facet joint fusion device Sun Feilong, Qiu Haiyang, Ji Yufei, Yang Yipeng, Liu Daming, Wang Longchao, Wang Fei, Lei Wei, Zhang Yang 2025, 29 (15):  3081-3088.  doi: 10.12307/2025.176 Abstract ( 81 )   PDF (1572KB) ( 86 )   Save BACKGROUND: Facet joint osteoarthritis is acknowledged as a significant contributor to lower back pain in the geriatric population. The advent of an innovative spinal facet joint fusion device presents a therapeutic option for intervening during the initial stages of facet joint osteoarthritis, and significantly reduces the incidence of a series of complications caused by poor early conservative treatment and late surgical treatment. However, its effect on the biomechanics of the lumbar spine is unknown.  OBJECTIVE: To investigate the biomechanical disparities between the novel lumbar zygapophyseal joint fusion device and traditional fusion devices. METHODS: A comprehensive three-dimensional finite element model of the L3-S1 lumbar spine was established and validated. Based on this intact model, three groups of surgical models were constructed: a bilateral pedicle screw fixation model, a bilateral novel facet joint fusion fixation model, and a bilateral facet screw fixation model, with the surgical segment designated as L4-5. Under a load of 500 N, a torque of 7.5 Nm was applied to all lumbar models to calculate the range of motion, displacement values, and intervertebral disc stress values at the L4-5 segment; stress values at the L3-4 and L5-S1 segments were also measured. RESULTS AND CONCLUSION: (1) Compared with the intact model, the range of motion at the L4-5 segment was reduced in all surgical models. (2) The novel device exhibited the smallest range of motion at the L4-5 segment under left and right rotational conditions; the greatest range of motion at the L4-5 segment under extension conditions; and a greater range of motion under other conditions than the bilateral pedicle screw fixation model. (3) The novel device demonstrated the smallest displacement values at the L4-5 segment under left and right rotational conditions; under other conditions, the displacement values at the L4-5 segment were greater than those in the bilateral pedicle screw fixation model. (4) In terms of stress distribution at the L4-5 segment, the novel device consistently exhibited the smallest values across all conditions. (5) For the L3-4 segment, the novel device showed the greatest stress values under extension and left and right rotational conditions, while under other conditions, the values were lower than those in the bilateral pedicle screw fixation model. (6) Compared with pedicle screw fixation, the novel device produced smaller stress values at the L5-S1 segment. (7) This study indicates that, compared with pedicle screw fixation, the novel device impacts the biomechanics of the lumbar spine by fusing the facet joints. It provides stability while preserving the range of motion at the surgical segment and reduces stress on the intervertebral discs of the surgical and adjacent segments, thereby potentially delaying disc degeneration. This suggests that the novel device can achieve biomechanical effects similar to those of pedicle screw fixation in theory. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of percutaneous vertebroplasty combined with pedicle augmentation in treatment of severe osteoporotic vertebral fractures Li Hongtao, Pan Hongyu, Lei Yang, Xiao Changming 2025, 29 (15):  3089-3094.  doi: 10.12307/2025.109 Abstract ( 60 )   PDF (1182KB) ( 73 )   Save BACKGROUND: Pedicle internal bone cement augmentation combined with vertebroplasty has been used to treat diseases such as Kummell’s disease and osteolytic metastases of the pedicle. However, the impact of this surgical method on adjacent vertebrae and intervertebral discs remains unclear. OBJECTIVE: A three-dimensional finite element model was used to explore the impact of percutaneous vertebroplasty combined with pedicles augmentation in the treatment of severe osteoporotic vertebral fractures on the biomechanics of adjacent segmental vertebral bodies and intervertebral discs. METHODS: A female patient who had undergone percutaneous vertebroplasty combined with pedicles augmentation for a severe osteoporotic vertebral fracture (L1) was selected. Preoperative and postoperative CT files were extracted. The study range was T12 to L2, including the injured vertebra, adjacent vertebrae, and intervertebral discs. Software like Mimics, SolidWorks, and Geomagic was used to establish finite element models of the spinal functional unit before and after surgery. A 500 N force and a 10 N·m rotational torque were applied in the vertical direction of the T12 upper endplate to simulate movements such as flexion, extension, lateral bending, and rotation, analyzing the stress changes in the vertebral endplates and intervertebral discs of adjacent segments before and after surgery. RESULTS AND CONCLUSION: (1) Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established. (2) We calculated and analyzed that under simulated load, the stress distribution of the inferior endplate of T12 was more uniform and the maximum stress value was reduced after surgery, with no significant difference compared with before surgery (P > 0.05). The stress distribution of the superior endplate of L2 after surgery was more uniform and the maximum stress was not significantly different from that before surgery (P > 0.05). Similarly, the stress distribution of T12/L1 and L1/L2 intervertebral discs after surgery was also more uniform and the maximum stress value was significantly reduced (P < 0.05). (3) Therefore, percutaneous vertebroplasty combined with pedicles augmentation can effectively improve the stress distribution of adjacent vertebral endplates and intervertebral discs after surgery and reduce stress, ultimately reducing the risk of postoperative re-fractures and significantly delaying intervertebral disc degeneration. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of Pauwels II type middle-aged and young femoral neck fracture fixed by dynamic cross screw system combined with cannulated screw Alimujiang·Yusufu, Abuduwupuer·Haibier, Abudula·Abulaiti, Ran Jian 2025, 29 (15):  3095-3100.  doi: 10.12307/2025.112 Abstract ( 60 )   PDF (1431KB) ( 84 )   Save BACKGROUND: Femoral neck fracture is a kind of unsolved fracture. Although cannulated screw, dynamic hip screw, and femoral neck dynamic cross screw have emerged, the best internal fixation scheme for femoral neck fracture with large Pauwels angle and shear force has not been unified. OBJECTIVE: To investigate biomechanical properties of femoral neck dynamic cross screw combined with cannulated screw in the treatment of Pauwels II type middle-aged and young femoral neck fractures using finite element analysis.  METHODS: According to the extracted CT data of volunteers’ femur, the model of femoral neck fracture with Pauwels angle of 50° was established, and the femoral neck was divided into three equal parts. Four groups of models were constructed: In group A, main nail of femoral neck dynamic cross screw was located in the middle 1/3. In group B, main nail of femoral neck dynamic cross screw was located in the lower 1/3. In group C, main nail of femoral neck dynamic cross screw was located at the lower 1/3 + cannulated screw at the upper 1/3. In group D, main nail of femoral neck dynamic cross screw was located in the anterior medial part of the middle 1/3 + cannulated screw was located in the medial posterior medial part of the middle 1/3. The stress distribution, peak value, maximum deformation, and stress distribution of fracture section of four groups of femur and internal fixation models were measured under 1 200 N load. RESULTS AND CONCLUSION: (1) The finite element analysis showed that the stress distribution and peak value, the maximum deformation and the stress of the fracture section of the femur and internal fixation model in group C were less than those in the other three groups. (2) Compared with group A, group B had smaller stress and displacement of femoral bone, internal fixation, and fracture section, indicating that the placement of head nail of femoral neck dynamic cross screw at the lower 1/3 of the femoral neck was more stable than that of middle 1/3. (3) The results show that the head nail of femoral neck dynamic cross screw located at the lower 1/3 of the femoral neck and 1/3 parallel screws on the femoral neck is more stable for Pauwels II femoral neck fracture in young adults, and it is a good choice for the treatment of this type of fracture. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of mechanical differences between different internal fixation modalities for proximal humerus fractures Wang Lei, Wang Qing, Zhang Shenshen 2025, 29 (15):  3101-3109.  doi: 10.12307/2025.165 Abstract ( 57 )   PDF (1452KB) ( 82 )   Save BACKGROUND: There is currently still no absolute standard for internal fixation of plates in the treatment of proximal humerus fractures in clinical practice, but reconstruction of the medial humeral distance and effective resistance to inversion displacement of the humeral head are the key points in achieving strong fixation of proximal humerus fractures. OBJECTIVE: Finite element analysis techniques were used to obtain the mechanical differences between these three internal fixation modalities acting on proximal humerus fractures and to compare which internal fixation method provides more stable fixation support. METHODS: A healthy female volunteer was selected to undergo CT scanning of the left shoulder joint, and finite element analysis software was used to construct a model of proximal humerus fracture with medial column support defect. The model was categorized into three groups based on different internal fixation methods. In group A, Philos plate fixation was applied only on the lateral side. In group B, Philos plate fixation was applied on the lateral side combined with miniature straight-locking compression plate fixation on the medial side. In group C, Philos plate fixation was applied on the lateral side combined with miniature straight-locking compression plate fixation on the anterior medial side. The biomechanical stability of these three groups of internal fixation models was evaluated using ANSYS analysis software under the same fixation support and constraint conditions. RESULTS AND CONCLUSION: (1) The stress of the internal fixation in the three groups of internal fixation models did not exceed 450 MPa. (2) The stress of the humerus and internal fixation in group A was higher than that in groups B and C under different loading conditions, whereas the stress of the humerus and internal fixation in group C was the minimum. (3) Under the flexion loading condition, the relative displacement in group C had a smaller value than that in groups A and B. (4) The relative displacement of the fracture end in group B was the smallest under all the loading conditions. The relative displacement of group B was about half of that of group A under the loading conditions of internal retraction, abduction, and axial compression. (5) The relative displacements between group C and group B were not significantly different, and all of the relative displacements in group C were smaller than those in group A as well. (6) It was found that the combination of the lateral Philos plate and the medial miniature in-line locking compression plate, as well as the combination of the lateral Philos plate and the anterior medial miniature in-line locking compression plate, demonstrated significant stability of the internal fixation system compared with the application of the lateral Philos plate alone. However, when comparing the combination of the lateral Philos plate with the medial miniature in-line locking compression plate and the combination of the lateral Philos plate with the anterior medial miniature in-line locking compression plate, no significant difference in internal fixation system stability was observed. Considering the difficulty of operation in clinical practice, the combination of lateral Philos plate and anterior medial miniature in-line locking compression plate may bring better treatment results in the treatment of proximal humerus fractures.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of three internal fixation plates for treating C1 type fractures of distal radius Nuerbiyanmu · Kuerban, Wurikaixi ·Aiyiti, Maihemuti · Yakufu 2025, 29 (15):  3110-3115.  doi: 10.12307/2025.126 Abstract ( 60 )   PDF (1469KB) ( 12 )   Save BACKGROUND: The C1 type fracture of the distal radius is an intraarticular unstable fracture, which is difficult to treat. At present, there are few clinical studies about the comparison of the biomechanical differences of different internal fixation plates for distal radius fractures under different loading conditions, and there are still controversies in the selection of internal fixation plates. OBJECTIVE: To compare the biomechanical properties of different internal fixation plates for C1 type fractures of distal radius using a finite element analysis method. METHODS: The distal radius model of a healthy female volunteer was used, and the files were sequentially imported into Mimics 21.0, Geomagic Wrap 2017, and Solid Works 2021 for processing. The C1 type fracture of the distal radius was modeled. According to the plate data provided by the manufacturer, the volar oblique T-locking plate, volar fixed-angle anatomical plate, volar variable-angle locking plate and screws three-dimensional model were created and assembled with the fracture model. The material properties were given in ANSYS 19.0 to set up the relationship of interaction between the contact surfaces, and to define the loads and boundary conditions. Four load cases, including compression, dorsal flexion, palmar flexion and torsion, were applied to compare the biomechanical properties. RESULTS AND CONCLUSION: (1) In the three groups of internal fixation models, the overall displacement of the internal fixation model was mainly concentrated on the articular surface of the distal radius under four load conditions. The maximum displacement of the model under the dorsal, palmar and torsion load conditions was 2-6 times that of the displacement under the axial load, indicating that the internal fixation system was the most stable under the axial load condition. (2) The stress on the internal fixation was much greater than the stress on the bone fracture fragments. The stress of the internal fixation was mainly concentrated in the area that near to the fracture end of the bone plate, among which the stress distribution of the volar fixed-angle anatomical plate, volar variable-angle locking plate was relatively uniform, and the stress concentration of the oblique T-locking plate was the most obvious. (3) Under compressive and torsional loads, the stress of the fracture fragments was mainly concentrated in the area that around the screw holes. Under dorsal and palmar flexion, it gradually expanded from the distal end to the proximal radius. Under the same load condition, the stress of the fracture block in the oblique T-locking plate fixation state was the highest, and the peak stress of the fracture fragments in the volar variable-angle locking plate fixation system was the lowest. The difference between the peak stress of the bone fracture fragments in the fixed state of the volar fixed-angle anatomical plate and the volar variable-angle locking plate was only in the range of 0.2-6.0 MPa. (4) It is indicated that compared with the oblique T-locking plate and the volar fixed-angle anatomical plate, the volar variable-angle locking plate has more uniform stress distribution, less displacement of articular surface, and the best stability in the internal fixation in the C1 type fracture of the distal radius. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Biomechanical test of reduction ability of axis pivot screw in atlantoaxial screw-rod fixation Chen Shujin, Ma Xiangyang, Zou Xiaobao, Liao Yingqiang, Qi Hairu, Liu Bao, Zeng Xianming 2025, 29 (15):  3116-3120.  doi: 10.12307/2024.691 Abstract ( 102 )   PDF (1167KB) ( 92 )   Save BACKGROUND: At present, the surgical treatment of atlantoaxial dislocation mainly adopts the posterior atlantoaxial screw-rod internal fixation system for lifting and reduction. During the operation, the curvature of the connecting rod is often increased to increase the drop between the atlantoaxial vertebrae to improve the reduction effect, but it increases the difficulty and risk of surgery. The axis pivot screw directly increases the reduction drop between the atlantoaxial vertebrae, but the extent to which it increases the reduction capacity is unclear. OBJECTIVE: To test the reduction ability of axis pivot screw and compare it with ordinary screw. METHODS: Six fresh human craniocervical specimens were used in study. The joint capsules of two lateral mass joints and atlanto-odontoid joint and transverse ligament were removed to make an atlantoaxial instability model. Three kinds of internal fixation were performed successively on both sides of the axis of each specimen: uniaxial axis pivot screws (group A), multi-axial axis pivot screws (group B) and ordinary screws (group C). Flexible ultra-thin film pressure sensors were placed in the anterior atlanto-odontoid space. Two connecting rods with the same curvature were placed to simulate the lifting and reduction, and the pressure of the anterior atlanto-odontoid space was obtained. Comparative analysis was conducted among the three groups.   RESULTS AND CONCLUSION: (1) The anterior atlanto-odontoid space pressure of groups A-C was (97.59±8.58), (60.43±5.09), and (22.74±0.81) N, respectively. There were significant differences among the three groups (F=251.603, P=0.000). The pairwise comparison among the three groups showed significant differences (P=0.000). (2) The axis pivot screw applied to the posterior atlantoaxial screw-rod internal fixation system can improve the reduction capacity compared with the common cervical posterior screw, and the uniaxial axis pivot screw has more reduction capacity than the multi-axis uniaxial axis pivot screw to improve the posterior atlantoaxial screw-rod internal fixation system. Figures and Tables | References | Related Articles | Metrics

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Stress characteristics of the main joints of femur and lower limb bones of Tai Chi with different steps based on Anybody simulation Du Zhihao, Zhu Yutong, Li Haojie, Zhai Feng, Li Feiyu 2025, 29 (15):  3121-3128.  doi: 10.12307/2025.173 Abstract ( 102 )   PDF (1312KB) ( 148 )   Save BACKGROUND: Anybody musculoskeletal modeling system uses mathematical modeling techniques to simulate the relationship between human bones, muscles, and the environment, allowing for the study of inverse dynamics of the human body and obtaining indicators such as lower limb joint forces. OBJECTIVE: To analyze the stress distribution patterns of lower limb joints during the practice of Tai Chi movements, thereby exploring the scientific training and exercise value of Tai Chi. METHODS: Eight Tai Chi master-level athletes were selected from the Wushu College of Beijing Sport University for data collection, including seven sets of stepping movements and CT scans of the right femur. The BTS infrared capture system and Kistler three-dimensional force platform were used to collect kinematic and mechanical data of the seven sets of stepping movements in Tai Chi (Eight Methods and Five Steps). The Anybody 7.2 musculoskeletal model’s multi-body dynamics simulation technology was utilized to calculate lower limb joint dynamic parameters, and Workbench 19.2 was used to perform stress analysis on the femur. RESULTS AND CONCLUSION: (1) Using Workbench software, the stress results of the femur for seven sets of movements were obtained. The peak stress values of the seven sets of movements in descending order were: Retreat and Rollback (22.00 MPa), Retreat and Pluck (19.379 MPa), Left and Right Shift Step Squeeze and Press (9.35 MPa), Left and Right Shift Step Elbow Lean (6.30 MPa), Forward Step and Expand (4.68 MPa), Forward Step and Pull (2.57 MPa), and Middle Fixed Standalone Position (0.31 MPa). (2) In the seven sets of stepping movements, the two backward stepping movements resulted in the greatest stress on the femur (P < 0.05), and the maximum stress positions on the femur were different during the movement of the seven sets of actions. (3) It is concluded that during the seven sets of stepping movements in Tai Chi (Eight Methods and Five Steps), stress threshold and maximum stress position of the femur will vary with different movements in five directions (seven sets of movements). Continuous training can comprehensively stimulate the femoral body. Forward stepping movements have a greater impact on the front and upper lateral side of the femoral body, while backward stepping movements have a greater impact on the back and inner side of the femoral body. Left and right lateral stepping movements mainly involve symmetrical stress on both sides of the femoral body. (4) Beginners should train targeted according to the stress characteristics of different stepping movements. During forward and backward stepping movements, attention should be paid to the rotational force of Tai Chi, and during left and right lateral stepping movements, attention should be paid to the medial counterforce. Beginners should focus on the Tai Chi training steps that correspond to their own weaknesses to achieve better exercise outcomes. Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of different orthopedic modalities for adolescent idiopathic scoliosis based on finite element simulation analysis Yue Bo, Cao Zhenhua, Zhang Yunfeng, Xu Yangyang, Jin Feng, Su Baoke, Wang Lidong, Wang Xing, Tong Ling, Liu Qinghua, Fang Yuan, Sha Lirong, Wang Haiyan, Li Xiaohe, Li Zhijun 2025, 29 (15):  3129-3137.  doi: 10.12307/2025.198 Abstract ( 114 )   PDF (3157KB) ( 234 )   Save BACKGROUND: The asymmetrical biomechanical environment of adolescent idiopathic scoliosis can lead to further wedge deformation of the vertebral body, which may affect cardiopulmonary function and compress nerves in severe cases. Adolescent idiopathic scoliosis with different degrees of scoliosis should be treated with exercise, bracing, and surgery. However, the mechanical mechanism of selecting an orthopedic approach remains unclear due to the individual variability of patients.  OBJECTIVE: To investigate the biomechanical mechanism of different orthopedic modalities for the treatment of adolescent idiopathic scoliosis to provide a basis for clinical selection of treatment modalities based on the spine model of adolescent idiopathic scoliosis patients.  METHODS: Based on the CT images of an adolescent idiopathic scoliosis patient, a scoliosis model (C7-L5) was reconstructed in Mimics software in three dimensions, and lateral thrust force was applied at the T8/T9 thorax and vertical distraction force was applied over the C7 vertebra with the magnitude of 20, 40, 60, 80, 100, and 120 N. The intervertebral disc stress and vertebral displacement in concave and convex sides, and Cobb angle of the spine were analyzed under two orthopedic modalities.   RESULTS AND CONCLUSION: (1) With lateral thrust, there was no significant change in the C7T1-T7T8 intervertebral disc. The concave and convex stress of T7T8-L4L5 segment decreased first and then increased with the increase of lateral thrust force. The correction effect of lateral thrust on the segment near T8T9 was obvious and weakened with the extension of the segment to the cephalic and caudal ends. At 120 N of lateral thrust, the thoracic Cobb angle changed from 53.2° to 32.5° and the lumbar Cobb angle changed from 50.2° to 43.9°. (2) With the vertical distraction, the thoracic intervertebral disc stresses first decreased and then increased, and all the lumbar disc stresses decreased. The C7 displacement was the most obvious, and the correction effect gradually diminished with the segment extended to the caudal end. At a vertical distraction force of 120 N, the thoracic Cobb angle changed from 53.2° to 39.4° and the lumbar Cobb angle changed from 50.2° to 47.6°. (3) It is concluded that both orthopedic modalities provide improvement in the degree of scoliosis, with the thoracic correction being greater than the lumbar correction. Also, the asymmetric stress distribution on the concave and convex sides is improved, which contributes to normal bone growth. A vertical distraction approach is appropriate for larger Cobb angles, and a lateral thrust approach is appropriate for smaller Cobb angles. The results of this study help to understand the mechanism of spinal orthosis and provide a theoretical basis for the choice of orthopedic approach. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Digital anatomical characteristics of morphological development of neurocentral synchondrosis of cervical vertebra in children Yi Yuying, Sun Ruifen, Yin Zhaozheng, Li Lei, Zhang Fengzhen, Li Ziyu, Li Kun, Ren Xiaoyan, Wang Xing, Zhang Shaojie 2025, 29 (15):  3138-3146.  doi: 10.12307/2025.197 Abstract ( 78 )   PDF (4179KB) ( 44 )   Save BACKGROUND: With the increasing attention of scholars at home and abroad to children’s cervical spine-related diseases, the demand for exploring the anatomical indicators and changes of cervical spine morphology and development in children of different ages is increasing. OBJECTIVE: To explore and analyze the morphological changes of children with different ages and vertebral sequences by measuring the anatomical position indexes of C2-C7 neurocentral synchondrosis in children aged 1-6 years. METHODS: Normal cervical spine CT images were retrospectively collected from 160 children aged 1-6 years at provincial tertiary hospitals. They were divided into six groups according to an age group of 1 year. The raw data of consecutively scanned cervical spine tomography images were imported into Mimics 16.0 software. The positional anatomical indexes of cervical spine segments C2-C7 in coronal and transverse planes were measured and analyzed under the two-dimensional image window by choosing the measurement tools under the toolbar of Measurements. RESULTS AND CONCLUSION: (1) The distance between the two sides of C2-C7 neurocentral synchondrosis and the distance between the left and right sides of neurocentral synchondrosis and the transverse process gradually increased with age. The overall development of vertebrae in each cervical vertebral segment was faster than the ossification of the neurocentral synchondrosis. (2) The cross-sectional angles on both sides of C2-C7 neurocentral synchondrosis gradually increased with age, and the angles between the left and right sides of neurocentral synchondrosis and the anterior and posterior edges of the vertebral body gradually decreased. Both sides of the neurocentral synchondrosis in cervical vertebral segments tended to grow toward the arch site, which mainly promoted the growth and development of the arch. (3) Except for C7, the angle between the coronal planes on both sides of the cervical spine changed little with the descending neurocentral synchondrosis of the cervical spine, and the neurocentral synchondrosis of the cervical spine was more inclined to longitudinal growth and ossification. (4) The neurocentral synchondrosis position changes in C7 were significantly different from those in the rest of the cervical vertebrae. (5) The anatomical indexes of C2-C7 neurocentral synchondrosis position in children have obvious development rules among different ages and vertebral bodies, and these rules are helpful for the clinical diagnosis and treatment of cervical spine diseases in children. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Hypoproteinemia after total hip arthroplasty: risk factors and nomogram prediction model establishment Zheng Zewei, Ye Kaijing, Zhang Kuo, Zhao Qinghua, Chen Xiutian, Jiang Yulai, Yi Yanzi, Zhang Qingwen 2025, 29 (15):  3147-3152.  doi: 10.12307/2025.150 Abstract ( 104 )   PDF (1044KB) ( 125 )   Save BACKGROUND: The patient underwent multiple hypoproteinemia after total hip arthroplasty, which affected postoperative healing and rehabilitation. OBJECTIVE: To investigate and screen the risk factors for hypoproteinemia after total hip arthroplasty, and to establish a nomogram prediction model so as to provide guidance for judging whether hypoproteinemia occurs after total hip arthroplasty. METHODS: A total of 355 patients who underwent total hip arthroplasty were included, and according to whether hypoproteinemia occurred on the first day after surgery, they were divided into 238 cases in the hypoproteinemia group and 117 cases in the normal group, with a hypoproteinemia rate of 67%. Data were collected, including age, gender, diabetes mellitus, hypertension, hyperuricemia, hyperlipidemia, anesthesia method, preoperative leukocytes, preoperative erythrocytes, preoperative hemoglobin, preoperative platelets, preoperative plasma prothrombin time, preoperative activated partial prothrombin time, preoperative international normalized ratio, preoperative thrombin time, preoperative fibrinogen, preoperative erythrocyte sedimentation rate, preoperative C-reactive protein, preoperative D-dimer,  preoperative mean corpuscular hemoglobin content,  preoperative mean corpuscular volume, operation time, body mass index,  preoperative procalcitonin, and preoperative hematocrit. SPSS 27.0 software was used for univariate analysis, followed by R language (4.3.1) to perform least absolute shrinkage and selection operator regression and 10-fold cross-validation of the observation indicators to obtain the intersection of the two risk factors. SPSS 27.0 software was used to perform multivariate binary logistic regression to obtain the final risk factors. The prediction model of hypoproteinemia after total hip arthroplasty was constructed by R language. The receiver operating characteristic curve, calibration curve, and clinical decision curve were constructed to assess the predictive model predictive ability. RESULTS AND CONCLUSION: (1) Univariate analysis, least absolute shrinkage and selection operator regression, and multivariate logistic regression were used to screen out significant differences in age (OR=1.024, P=0.023), preoperative platelets (OR=0.995, P=0.028), and preoperative erythrocyte sedimentation rate (OR=1.031, P=0.045) in judging whether hypoproteinemia would occur after surgery (P < 0.05). (2) The nomogram prediction model was constructed based on the final risk factors screened by multivariate Logistic regression, and the prediction ability of the model was evaluated by constructing the receiver operating characteristic curve, and the area under the calculated receiver operating characteristic curve reached 0.835 (95%CI=0.779-0.891), C-index=0.835. A threshold of 0-0.83 could bring better clinical efficacy calculated by the decision curve analysis. The model has good sensitivity and accuracy, which can better identify the risk of postoperative hypoproteinemia for medical staff and patients before total hip arthroplasty. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Stress effect of femoral prosthesis misalignment on structure of lateral compartment during medial unicompartmental knee arthroplasty in patients with osteoporosis Liu Mengfei, Sun Rongxin, Jiang Kan 2025, 29 (15):  3153-3158.  doi: 10.12307/2025.108 Abstract ( 72 )   PDF (1431KB) ( 104 )   Save BACKGROUND: Prosthesis misalignment and patient bone condition are important factors affecting the prognosis of unicompartmental knee arthroplasty, and postoperative osteoarthritic progression of the lateral compartment is a major complication leading to its high revision rate. Therefore, this will become a hot research topic in the future. OBJECTIVE: To analyze the effect of different femoral prosthesis tilt angles on the stress on the structure of the lateral compartment after unicompartmental knee arthroplasty in patients with normal bone and osteoporosis, and to investigate the correlation between osteoporosis and osteoarthritis of the lateral compartment in the postoperative period. METHODS: Using a validated finite element model of the knee, normal bone (M1) and osteoporotic (M2) unicompartmental knee arthroplasty were modeled. The femoral prosthesis tilt models (normal bone group: varus angles of 3°, 6°, 9°, 12°, and 0°, valgus angles of 3°, 6°, 9°, 12°; osteoporosis group: varus angles of 3°, 6°, 9°, 12°, 0°, valgus angles of 3°, 6°, 9°, 12°) were established respectively, totaling 18 working conditions. The effects of different femoral prosthesis tilt angles on stress magnitude and distribution in the meniscus, tibial cartilage, and femoral cartilage of interstitial compartment were evaluated.  RESULTS AND CONCLUSION: (1) The high stress values on the meniscus surface and tibial cartilage surface of the healthy lateral compartment of the two models increased with the increase of the prosthesis varus angle, and decreased with the increase of the prosthesis valgus angle. Under the same working conditions, the peak stress on the meniscus surface of the osteoporotic group was greater than that of the normal bone group, but that of the tibial cartilage surface of the osteoporotic group was less than that of the normal bone group. (2) The high stress values on the femoral cartilage of the lateral compartment of the two models increased with the increase of the prosthesis varus and valgus angles. Under the same working conditions, the peak stress on the femoral cartilage of the osteoporotic group was greater than that of the normal bone group. (3) It is indicated that when the fixed-bearing femoral prosthesis is varus, the stresses on the lateral compartment structures after medial unicompartmental knee arthroplasty in normal bone and osteoporotic knees will increase, and the increase in the stresses on the lateral intercondylar structures in osteoporotic knees will be more pronounced. Therefore, special attention should be paid to the placement of the prosthesis during unicompartmental knee arthroplasty to avoid varus and valgus of the prosthesis as much as possible. At the same time, the findings confirm that osteoporosis may exacerbate the progression of lateral compartment osteoarthritis after medial unicompartmental knee arthroplasty. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Timing of total knee arthroplasty with tourniquet under navigation system: a single-center, retrospective analysis Pan Hao, Yang Meng, Liu Guoqiang 2025, 29 (15):  3159-3164.  doi: 10.12307/2025.119 Abstract ( 69 )   PDF (808KB) ( 97 )   Save BACKGROUND: The timing of tourniquet application in traditional total knee arthroplasty has been clearly reported. With the continuous refinement of joint-related techniques, the timing of tourniquet application in total knee arthroplasty under navigation system has rarely been reported.  OBJECTIVE: To evaluate the effect of total knee arthroplasty with Brainlab navigation system using full-course and half-course tourniquets.  METHODS: From January to December 2022, data of 145 eligible patients who underwent total knee arthroplasty under navigation system in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were retrospectively analyzed and they were divided into the full course group (n=71) and the half course group (n=74) according to the timing of tourniquet release. General data, perioperative conditions, postoperative swelling around the knee joint, postoperative lower extremity deep venous thrombosis, visual analog scale score, Hospital for Special Surgery knee score, and forgotten joint score were collected to assess knee joint function and statistically compared.  RESULTS AND CONCLUSION: (1) The operation time of the full course group was shorter than that of the half course group, the incidence of lower extremity deep venous thrombosis was higher, and the postoperative knee joint swelling was more severe (P < 0.001, P = 0.027, P < 0.001). The intraoperative blood loss of the full course group was less than that of the half course group (P < 0.001), and the occult blood loss of the full course group was more than that of the half course group (P < 0.001), with statistically significant differences. (2) At 1 week after surgery, the visual analog scale score in the full course group was significantly higher than that in the half course group (P < 0.001). (3) There was no significant difference in forgotten joint score between the two groups at 3, 6 months and 1 year after surgery (P > 0.05). (4) It is indicated that in patients undergoing total knee arthroplasty using a navigation system, the half-course group has less occult blood loss, lower postoperative swelling and incidence of postoperative lower extremity deep venous thrombosis, and faster recovery of knee joint function. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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L5 osteoporotic vertebral compression fractures treated through “O” point approach and traditional unilateral puncture approach Xu Yuguo, Huang Jiahu, Wang Qing, Xu Shuang, Wang Song 2025, 29 (15):  3165-3170.  doi: 10.12307/2025.110 Abstract ( 50 )   PDF (1046KB) ( 97 )   Save BACKGROUND: Percutaneous kyphoplasty through a unilateral puncture approach is considered more effective than a bilateral puncture approach for the treatment of osteoporotic vertebral compression fractures. However, due to the unique anatomical shape and location of the L5 vertebral body, the traditional unilateral puncture approach has limited applicability in treating L5 osteoporotic vertebral compression fractures. To address this issue, we propose the use of the “O” point puncture approach. OBJECTIVE: To compare the effectiveness of percutaneous kyphoplasty via basal transversal process-posterior superior pedicle-lateral articular process intersection (“O” point) with conventional approach percutaneous kyphoplasty in treating the L5 osteoporotic vertebral compression fractures. METHODS: A retrospective analysis was conducted on 54 patients with L5 osteoporotic vertebral compression fractures treated with traditional percutaneous kyphoplasty or percutaneous kyphoplasty via the “O” point approach between January 2020 and December 2022 at Affiliated Hospital of Southwest Medical University. According to the surgical method, the patients were divided into the “O” point approach group (group A, n=29) and the traditional approach group (group B, n=25). The position of the “O” point and iliac spine and puncture angle were measured by orthography before operation in group A. Cobb angle, anterior vertebral margin, middle height, and bone cement distribution were compared between the two groups prior to and 2 days after surgery, and during final follow-up. Pain relief and daily living ability were assessed using the visual analog scale and Oswestry disability index prior to and 2 days after surgery, and during final follow-up. Complications related to the surgery were recorded. RESULTS AND CONCLUSION: (1) Operative time and intraoperative fluoroscopy times were significantly shorter in group A than in group B (P < 0.05). However, no significant differences were observed in intraoperative blood loss or bone cement injection amounts between the two groups. (2) Both groups demonstrated significantly lower visual analog scale scores and Oswestry disability index on day 2 after surgery and at the last follow-up in comparison to before surgery. However, group A experienced a more noticeable decrease than group B (P < 0.05). (3) On both sides, the “O” point was located on average 1.23 cm below the highest point of the iliac spine line. The mean transverse distance between the “O” point and the iliac spine was 2.89 cm. (4) During the final follow-up, the Cobb angle of both groups exhibited significant improvements compared to their respective preoperative values (P < 0.05). However, there was no significant difference between the two groups (P > 0.05). (5) After operation, the distribution of bone cement was good in group A, accounting for 97% (28/29), and good in group B, accounting for 88% (22/25). Group A was significantly better than group B (P < 0.05). (6) The efficacy of percutaneous kyphoplasty utilizing the “O” point puncture technique on osteoporotic vertebral compression fractures of the L5 vertebra was superior to that of the traditional percutaneous kyphoplasty approach. However, the bone cement distribution achieved with percutaneous kyphoplasty via “O” point puncture was more satisfactory, and the puncture approach was able to circumvent the influence of a high iliac spine on the L5 vertebra. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Relationship between anterior convex angle and fusion cage settlement after oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation Zhou Youzhi, Gao Peng, Yuan Qingsen, Tan Ying, Xu Shitao, Chen Guanglin, Wang Jinqiang, Zhang Liang 2025, 29 (15):  3171-3178.  doi: 10.12307/2025.170 Abstract ( 78 )   PDF (1403KB) ( 116 )   Save BACKGROUND: With the continuous advancement of medical technology, the combination of oblique lumbar interbody fusion and percutaneous pedicle screw fixation has become a common method for treating lumbar degenerative diseases; however, there is still a lack of in-depth research on the relationship between changes in anterior convexity angles at different postoperative segments and fusion device settlement.  OBJECTIVE: To explore the relationship between changes in anterior convexity angle of different segments and Cage subsidence after oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation surgery.   METHODS: Patients (93 cases) with lumbar degenerative diseases who underwent oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation surgery in Weifang Hospital of Traditional Chinese Medicine from February 2019 to April 2023 were selected as the research subjects. According to the postoperative disc height loss value, they were divided into Cage subsidence group (25 cases, ≥ 2 mm) and non-Cage subsidence group (68 cases, < 2 mm). Multiple Logistic regression analysis was used to analyze the risk factors for cage subsidence. Stepwise regression was utilized to evaluate the relationship of each risk factor and Cage subsidence. Risk prediction model was built and evaluated.  RESULTS AND CONCLUSION: (1) After adjusting for confounding factors, there was still independent correlation between lumbar lordosis loss value and segmental lordosis improvement value and Cage subsidence risk (P < 0.05). (2) Age, oswestry disability index, disc height improvement value, segmental lordosis improvement value, and lumbar lordosis loss value were all independent influencing factors for the occurrence of Cage subsidence (P < 0.05). Among them, age, lumbar lordosis loss value, disc height improvement value, and segmental lordosis improvement value were most closely related to Cage subsidence. (3) The results of multivariate Logistic regression model analysis showed that when P=0.80, the Jordan index was the highest and the prediction effect was the best, with accuracy of 89.27%, sensitivity of 86.67%, and specificity of 89.89%. The model evaluation results showed that it had good discrimination and high accuracy. (4) As the lumbar lordosis loss value and segmental lordosis improvement value increase, the risk of Cage subsidence increases, which affects clinical efficacy. (5) It is indicated that age, lumbar lordosis loss value, disc height improvement value, and segmental lordosis improvement value are most closely related to Cage subsidence, and clinical doctors should pay more attention.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Machine learning prediction of the risk of secondary screw perforation after plate internal fixation for proximal humerus fractures Xu Daxing, Tu Zesong, Ji Muqiang, Xu Weipeng, Niu Wei 2025, 29 (15):  3179-3187.  doi: 10.12307/2025.169 Abstract ( 88 )   PDF (1710KB) ( 192 )   Save BACKGROUND: Secondary screw perforation of the articular surface is one of the major complications after locking plate internal fixation of proximal humerus fracture, and cut-out screws can damage shoulder function by abrading the glenoid and causing impingement of the acromion. Therefore, accurate risk prediction has positive clinical significance. OBJECTIVE: To screen risk factors for secondary screw perforation after proximal humerus fracture plating by machine learning methods, and to develop and validate a risk prediction model that facilitates clinicians to identify and intervene in high-risk patients at an early stage. METHODS: Clinical data of 214 patients with proximal humerus fractures who underwent locking plate internal fixation from June 2013 to June 2022 were collected as a training group to establish the model, and 61 similar patients from another hospital in the same period were included in the external validation group. The patients were divided into secondary screw perforation and screw maintenance groups according to whether they developed secondary screw perforation after surgery. The training group used three machine learning algorithms, namely, random forest, support vector machine, and logistic regression, to construct the prediction model. The recursive feature elimination method was used, and 10-fold cross-validation resampling was used as the screening method for the variables, and the intersection of the variables that were included when the accuracy of the three models was the highest was taken as the highly correlated with the secondary screw perforation reliable risk variables. The dynamic predictive model was constructed by R language software and presented as a web calculator, and the model was internally and externally validated. The internal test of the model was conducted by the Bootstrap method with 1 000 resamples, and the area under the receiver operating characteristic curve, the calibration curve, and the clinical decision curve were used to evaluate the differentiation, calibration ability, and clinical application value of the model. The Youden index was used to determine the optimal risk threshold of the prediction model, according to which the patients in the external validation group were divided into high- and low-risk groups, and the stability and extensibility of the model were evaluated according to the accuracy of its risk prediction ability.  RESULTS AND CONCLUSION: (1) The machine learning algorithm identified four risk variables that were highly correlated with secondary screw perforation, namely cortical support of the proximal medial humeral column, deltoid tuberosity index, fracture type, and postoperative reduction. (2) The constructed risk prediction model showed good discrimination and accuracy [area under the curve=0.874, 95% confidence interval (0.827, 0.922)], and the calibration curve showed good agreement between the model predicted risk and the actual occurrence risk. (3) The clinical decision curve suggested that the model had good clinical applicability when the probability of the risk threshold was in the 0.1-0.75 range. (4) A risk probability of 26% was the optimal threshold for model risk stratification, and the external validation group used model risk stratification to predict secondary screw perforation with an overall accuracy rate of 84%. (5) The risk prediction model has good accuracy and extrapolation, and may provide a basis for guiding clinical treatment. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Arthroscopic single-row fixation and knotless suture bridge fixation for rotator cuff injuries combined with osteoporosis Zhang Haoliang, Xia Sijia, Zhan Bingzhen, Feng Shuo, Zha Guochun, Li Cheng 2025, 29 (15):  3188-3192.  doi: 10.12307/2025.142 Abstract ( 76 )   PDF (918KB) ( 108 )   Save BACKGROUND: Arthroscopic single-row fixation with knotless suture bridge fixation techniques have been commonly used in the treatment of rotator cuff injuries, but the clinical efficacy in rotator cuff injuries combined with osteoporosis is unclear. OBJECTIVE: To investigate the clinical efficacy of arthroscopic single-row fixation versus knotless suture bridge fixation in the treatment of rotator cuff injuries combined with osteoporosis. METHODS: One hundred and twenty-two patients with rotator cuff injuries combined with osteoporosis who underwent arthroscopic treatment admitted to Affiliated Hospital of Xuzhou Medical University between January 2018 and August 2022 were retrospectively analyzed. They were divided into two groups according to the treatment plan. There were 63 patients with single-row fixation (single-row group) and 59 patients with knotless suture-bridge fixation (suture-bridge group). The visual analog scale scores for pain, University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons Score, Constant-Murley score, and shoulder range of motion were compared between the two groups at the preoperative and 1 year postoperative periods. Rotator cuff re-tears were evaluated at 1 year postoperatively using the Sugaya staging criteria. The occurrence of complications was recorded in both groups. RESULTS AND CONCLUSION: (1) All patients received more than 1-year follow-up. No complications such as incision infection and nerve injury occurred in both groups after surgery. (2) Postoperative visual analog scale scores, University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons Score, Constant-Murley scores, and shoulder range of motion were significantly improved 1 year postoperatively in both groups compared with the preoperative period (P < 0.05). Visual analog scale scores, University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons Score, Constant-Murley scores, and shoulder range of motion were better in the suture-bridge group than in the single-row group 1 year postoperatively (P < 0.05). (3) At 1 year postoperatively, the re-tear rate in the single-row group [22% (14/63)] was significantly higher than that in the suture-bridge group [7% (4/59)], and the difference between the two groups was statistically significant (χ2=5.777, P=0.016). (4) It is indicated that arthroscopic single-row fixation and knotless suture bridge fixation for rotator cuff injuries combined with osteoporosis both yielded satisfactory clinical outcomes, but knotless suture bridge fixation was more clinically effective, with a lower rate of postoperative retear. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Suture anchor and medial malleolus repair in treatment of injury in the deep layer of deltoid ligament Kong Changgeng, Guo Xiang, Wu Duoqing, Huang Youhua, Wang Congren, Fu Huisi, Fan Zhongcheng, Chen Bo, Shen Hui 2025, 29 (15):  3193-3198.  doi: 10.12307/2025.143 Abstract ( 71 )   PDF (1180KB) ( 213 )   Save BACKGROUND: Ankle fracture complicated with deltoid ligament injury is clinically common, and one stage repair of deltoid ligament with internal fracture fixation has gradually become a main therapeutic method, which can significantly reduce the long-term complications of ankle joint. In recent years, new progress has been made in anatomical structure characteristics and dynamic biomechanical research of deltoid ligament, thus greatly improving repairing techniques for injury in the deep layer of deltoid ligament, but there are still some controversies. OBJECTIVE: To explore the clinical efficacy of suture anchor and medial malleolus repair in the treatment of ankle joint fractures with the deep layer of deltoid ligament. METHODS: A total of 56 patients with ankle joint fractures and complete fracture of the deep and superficial layer of deltoid ligament treated in Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University from January 2017 to January 2022 were selected, and they were divided into two groups according to different treatment methods in repairing the deep layer of deltoid ligament with suture anchor: suture anchor repair group (n=32) and medial malleolus repair group (n=24). The medial clear space of ankle joint and American Orthopedic Foot and Ankle Society Score of patients in the two groups were evaluated before and after operative treatment. RESULTS AND CONCLUSION: (1) All the 56 patients finished the surgery smoothly and were followed up for more than 12 months after operation. Their ankle fracture healed, and the time for fracture healing was 8-12 weeks, with a mean of 10.5 weeks. (2) The medial clear space of ankle joint in the two groups 12 months after operation was remarkably narrower than that before operation, and the difference was statistically significant (P < 0.001). The medial clear space of ankle joint in the two groups maintained a normal range 12 months after operation, and there was no statistically significant difference between the two groups (P > 0.05). (3) The AOFAS scale of patients in the two groups 6 and 12 months after operation was obviously bigger than that before operation (P < 0.001), but there was no statistically significant difference in the American Orthopedic Foot and Ankle Society Score of patients between the two groups at corresponding time points (P > 0.05). (4) It is concluded that both suture anchor and medial malleolus repair in the treatment of injury in the deep layer of deltoid ligament can recover the medial clear space of ankle joint, effectively keep the stability of ankle, and thus achieve good clinical efficacy.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Risk factors related to intradural lumbar disc herniation analyzed by propensity score matching Gao Haoran, Zhang Heling, Jia Fanglin, Guo Di, Jing Li, Shi Yaozhou, Song Hanlin, Gao Xiao, Feng Hu 2025, 29 (15):  3199-3205.  doi: 10.12307/2025.166 Abstract ( 92 )   PDF (1259KB) ( 108 )   Save BACKGROUND: According to different locations of lumbar disc herniation, it can be classified into many types. Among them, patients with intradural sac type lumbar disc herniation have severe clinical symptoms, which greatly affect their quality of life. Therefore, this article studies the risk factors for its onset, and improving the preoperative diagnostic rate is of great significance for the treatment and prevention of this disease.  OBJECTIVE: To explore the risk factors for intradural lumbar disc herniation.  METHODS: A retrospective analysis was conducted on 15 patients with intradural lumbar disc herniation (herniation group) admitted to three hospitals in Xuzhou city from May 2014 to November 2022. Propensity score matching was used to match patients with lumbar disc herniation who did not protrude into the dura mater in a ratio of 1:4. A total of 59 patients were selected and included in the non-herniation group. Clinical data were observed in the two groups. Univariate and binary logistic regression analysis, multiple linear regression, and PROBIT regression analysis were utilized to identify the relevant risk factors for intradural lumbar disc herniation. RESULTS AND CONCLUSION: (1) The results of univariate analysis showed that the average disease course, proportion of segments, modified Pfiirmann grading, sacral tilt angle, proportion of previous lumbar spine surgery history, and proportion of heavy manual workers, proportion of lumbar spinal stenosis, redundancy of the cauda equina, and ossification of the posterior longitudinal ligament all showed statistical differences in the herniation and non-herniation groups (P < 0.05). (2) Multivariate regression analysis showed that duration of disease, protruding segment, history of lumbar surgery, modified Pfiirmann grading, cauda equina redundancy, and lumbar spinal stenosis were independent risk factors for intradural lumbar disc herniation. (3) Based on the influencing factors, an receiver operating characteristic curve was constructed, with an area under curve of 0.956 (95% CI: 0.913-0.998), indicating good discrimination. (4) There was a significant correlation between the duration of the disease, the protruded segment, the history of lumbar spine surgery, the modified Pfirmann classification, cauda equina redundancy, lumbar spinal canal stenosis, and the incidence rate of intradural lumbar disc herniation.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Analysis of degeneration degree in the main curvature region of degenerative scoliosis Wang Minglang, Jiang Lin, Song Bin, Zhang Li, Zhang Qiang, Feng Daxiong 2025, 29 (15):  3206-3214.  doi: 10.12307/2025.181 Abstract ( 57 )   PDF (1176KB) ( 92 )   Save BACKGROUND: The pathogenesis of degenerative scoliosis is unclear, and asymmetric degeneration of the main curvature region may be strongly associated with the onset and progression of scoliosis. Fully recognizing the degeneration of the main curvature region can help to inform more clinical treatment strategies.  OBJECTIVE: To explore the relationship between the degree of degeneration in the main curvature region and the parameters of the spinal pelvis in patients with degenerative scoliosis and to understand its pathogenesis.  METHODS: The medical records and imaging data of patients with degenerative scoliosis admitted to Department of Spine Surgery, Affiliated Hospital of Southwest Medical University from July 2018 to November 2023 were collected. The difference in the facet joint osteoarthritis between concave and convex sides of the superior and inferior facet joints of the apical vertebra was compared to analyze the correlation between parameters such as the severity of scoliosis, spinopelvic parameters, and facet joint osteoarthritis and to explore the influencing effect between parameters such as the severity of scoliosis, spinopelvic parameters, and facet joint osteoarthritis.  RESULTS AND CONCLUSION: (1) Among the facet joint of the apical vertebra, concave side was more severe than convex side with facet joint osteoarthritis, with a statistically significant difference (P < 0.001). On the same side (concave or convex side) of the apical vertebra superior facet joint osteoarthritis was more severe than inferior facet joint osteoarthritis, with a statistically significant difference (P < 0.001). (2) The pelvic incidence decreased with decreasing lumbar lordosis (rs=0.509, P < 0.001). The lateral osteophyte difference increased with decreasing lumbar lordosis (rs=-0.285, P=0.033). The facet joint tropism increased with decreasing pelvic incidence (rs=-0.379, P=0.004). (3) The L5 tilt angle and disc angle were risk factors for increased main curve Cobb angle (B=1.012, P < 0.001; B=0.620, P=0.016). Pelvic incidence was a protective factor against the increase of the main curve Cobb angle (B=-0.264, P=0.003). (4) It is concluded that in cases of degenerative scoliosis, the degree of degeneration on the concave side was significantly heavier than that on the convex side at the apical vertebra. There was no significant correlation between the severity of facet joint tropism and facet joint osteoarthritis and the severity of scoliosis. Lumbar lordosis and pelvic incidence played key roles in maintaining the normal spinal sequence. Pelvic incidence was a protective factor against the increase of the main curve Cobb angle. L5 tilt angle and disc angle were the risk factors for the increase of the main curve Cobb angle.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Establishment and validation of a Nomogram prediction model for risk factors of osteonecrosis of the femoral head in systemic lupus erythematosus Xu Wenbo, Wang Lihe, Li Songwei, Shi Pengbo 2025, 29 (15):  3215-3226.  doi: 10.12307/2025.802 Abstract ( 79 )   PDF (1381KB) ( 206 )   Save BACKGROUND: Osteonecrosis of the femoral head is a common complication in patients with systemic lupus erythematosus. The prediction and validation of the risk in advance will help to avoid or delay the progression of osteonecrosis of the femoral head. OBJECTIVE: To analyze risk factors for the occurrence of osteonecrosis of the femoral head in systemic lupus erythematosus patients and to construct and validate a nomogram prediction model of systemic lupus erythematosus patients with osteonecrosis of the femoral head.  METHODS: A retrospective study was conducted to analyze the medical records of 914 systemic lupus erythematosus patients who first visited First Affiliated Hospital of Henan University of Chinese Medicine between January 2013 and December 2022. All patients were divided into osteonecrosis of the femoral head (n=100) and non-osteonecrosis of the femoral head (n=814) groups according to whether they had suffered from osteonecrosis of the femoral head or not. Univariate, LASSO regression, and multifactorial logistic regression analyses were used to screen and identify the risk factors for systemic lupus erythematosus complicating osteonecrosis of the femoral head. The dataset was also randomly divided into training and test sets in a ratio of 7:3. A nomogram prediction model of the risk of systemic lupus erythematosus complicating osteonecrosis of the femoral head was constructed based on the results of the multifactorial logistic regression analysis. The performance of the nomogram was evaluated using the receiver operating characteristic curve, Hosmer-Lemeshow calibration curve, and decision curve analysis. RESULTS AND CONCLUSION: (1) There were significant differences in disease duration of systemic lupus erythematosus, systemic lupus erythematosus disease activity, lupus nephritis, respiratory involvement, gastrointestinal involvement, Sjögren's syndrome, osteoporosis, anti-ribonucleoprotein, complement C3 decrease, cyclophosphamide, mycophenolate mofetil, biologics, maximum daily dose of glucocorticosteroids, and pulses of intravenous methylprednisolone between the osteonecrosis of the femoral head and non-osteonecrosis of the femoral head groups (P < 0.05). (2) Ten predictor variables related to the risk of osteonecrosis of the femoral head in patients with systemic lupus erythematosus were screened using LASSO regression analysis. Multivariate logistic regression analysis further confirmed disease duration of systemic lupus erythematosus, respiratory involvement, Sjögren's syndrome, osteoporosis, anti-ribonucleoprotein, cyclophosphamide, mycophenolate mofetil, biologics, and maximum daily dose of glucocorticosteroids were independent risk factors for osteonecrosis of the femoral head in systemic lupus erythematosus patients (P < 0.05). (3) The area under the receiver operating characteristic curve for predicting the risk of occurrence of osteonecrosis of the femoral head in systemic lupus erythematosus patients was 0.802 (95%CI=0.742-0.862) in the training set and 0.811 (95%CI=0.745-0.876) in the testing set. The Hosmer-Lemeshow calibration curve fit was well (P=0.447 in raining set; P=0.870 in testing set). Decision curve analysis showed that it was beneficial in predicting the risk of osteonecrosis of the femoral head in systemic lupus erythematosus patients using the nomogram prediction model. (4) Menstrual abnormalities were one of the risk factors for osteonecrosis of the femoral head in female systemic lupus erythematosus patients. (5) The results suggest that the risk factors for systemic lupus erythematosus complicating osteonecrosis of the femoral head are multi-factorial, and a nomogram prediction model containing nine risk factors was also developed, which could be used to predict the risk of osteonecrosis of the femoral head in systemic lupus erythematosus patients. In addition, we reported for the first time that menstrual abnormalities were one of the risk factors for systemic lupus erythematosus complicating osteonecrosis of the femoral head in female. Figures and Tables | References | Related Articles | Metrics

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Applications and prospects of tissue clearing technology in field of orthopedics Gao Yang, Gao Yuan, Ma Bingjiang, Yue Hui, Shi Yongxin 2025, 29 (15):  3227-3234.  doi: 10.12307/2025.177 Abstract ( 145 )   PDF (921KB) ( 251 )   Save BACKGROUND: Bone tissue, as a highly mineralized and structurally complex connective tissue, plays a pivotal role in maintaining the form and function of living organisms. Traditional imaging techniques have been insufficient to meet the demands for in-depth observation of bone. The advent of tissue clearing technology has enabled researchers to more clearly observe the intricate structures within bones, such as trabecular bone, bone marrow cavities, and neural and vascular networks interacting with bone tissue. This has opened new perspectives for research and clinical applications in orthopedics. OBJECTIVE: To comprehensively summarize the applications of tissue clearing technology in the field of orthopedics and to explore its potential in the study of bone tissue structure and function, elucidation of disease mechanisms, and innovation in treatment strategies. Additionally, it provides an outlook on innovative directions. METHODS: The review encompassed a search of the CNKI and PubMed databases using search terms “tissue clearing, tissue optical, bone” in English and “tissue clearing, bone, bone defect” in Chinese, combined with Boolean logic to optimize the search strategy. The inclusion criteria were scholarly articles and dissertations directly related to tissue clearing technology and orthopedic research, excluding literature with weak relevance, duplication, or incomplete data. A total of 82 articles were finally analyzed, focusing on the efficacy of clearing techniques, their scope of application, and their contributions to orthopedic research.  RESULTS AND CONCLUSION: (1) Tissue clearing technology has demonstrated unique advantages in various domains, including the analysis of bone structure, the study of bone metabolism, the pathological characteristics of bone tumors, the process of fracture healing, the mechanisms of bone infection, and the evaluation of biocompatibility of bone grafts and implant materials. (2) The application of this technology has not only accelerated the progress of basic research in the field of orthopedics but also provides new strategies and methods for clinical treatment, indicating a broad application prospect in orthopedic research. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Role of neutrophils in fracture healing and the promoting effect on healing after intervention Gu Xinbo, Liu Zemin, Sun Haiyu 2025, 29 (15):  3235-3243.  doi: 10.12307/2025.174 Abstract ( 105 )   PDF (980KB) ( 141 )   Save BACKGROUND: Macrophages exhibit distinct pro-inflammatory and anti-inflammatory phenotypes. Through tissue engineering techniques, their phenotype transition has made them one of the most studied immune cells in bone injury repair. Recent studies have found that neutrophils also play a significant role in bone injury repair processes, but there is currently no such review available. OBJECTIVE: To summarize the current role of neutrophils in fracture healing and interventions targeting neutrophils to promote fracture healing. METHODS: We searched the Web of Science, PubMed, WanFang Data, and CNKI databases from January 2000 to February 2024 with the key words of “neutrophil, fracture healing, bone damage, bone repair, bone remodeling” in Chinese and English. Literature screening was conducted based on inclusion and exclusion criteria, resulting in a final selection of 72 articles for review. RESULTS AND CONCLUSION: (1) The history of neutrophils has been long, with their importance initially overlooked due to a lack of staining techniques. In 1900, Paul Ehrlich’s invention of triacid staining distinguished neutrophils, marking the beginning of research in this field. (2) Under normal conditions, neutrophils migrate to various organs to assist in their physiological functions. In pathological states, neutrophils exert their antimicrobial effects through phagocytosis, degranulation, and the formation of neutrophil extracellular traps. (3) Neutrophils primarily participate in the early hematoma inflammation stage of fracture healing by releasing cytokines to recruit other immune cells and mesenchymal stem cells. They also produce fibrinogen to promote hematoma formation and establish a local microenvironment. (4) Neutrophils transform into two distinct subtypes, N1 and N2, at different stages of fracture healing, coordinating with each other to promote bone repair. (5) Neutrophils recruited to the fracture site participate in the healing process by secreting cytokines such as tumor necrosis factor-alpha, interleukin-6, interleukin-10, fibroblast growth factor-2, monocyte chemoattractant protein-1, and platelet-derived growth factor. (6) Neutrophils regulate osteogenesis/osteolysis balance through interactions with the main cellular components involved in different stages of fracture healing. (7) Similar to the widespread research and application of tissue engineering techniques in modulating macrophage polarization in fracture healing, interventions targeting neutrophils to promote fracture healing hold promising prospects for the future. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application and development direction of finite element method in biomechanical analysis of thoracolumbar fractures of the spine He Kai, Xing Wenhua, Li Feng, Liu Shengxiang, Bai Xianming, Zhou Chen, Gao Xu, Qiao Yu, He Qiang, Gao Zhiyu, Guo Zhen, Bao Aruhan, Li Chade 2025, 29 (15):  3244-3252.  doi: 10.12307/2025.178 Abstract ( 93 )   PDF (914KB) ( 191 )   Save BACKGROUND: The highest incidence of spinal fracture is in the thoracolumbar segment, and its symptoms are back pain, posterior convexity deformity, activity limitation, or with spinal cord nerve injury causing lower limb pain, numbness, and even paraplegia and other complications. The finite element method is a digital computer modeling technique, which can simulate the physical model and carry out force analysis realistically. OBJECTIVE: To review the application of finite element method in thoracolumbar spine fractures. METHODS: We searched the Chinese and English literature databases PubMed, Web of Science, and CNKI for relevant literature on the application of the finite element analysis method in spinal thoracolumbar fracture published before March 2024. The search terms in Chinese and English were: finite element analysis methods, biomechanical phenomena, stress analysis, thoracolumbar fractures, spinal fractures. Finally, 55 papers were included. RESULTS AND CONCLUSION: (1) The exploration of thoracolumbar fractures caused by different etiologies (osteoporotic, traumatic, and pathological) through the finite element method is conducive to a deeper understanding of the biomechanics of various types of thoracolumbar fractures, and to improve the individualized and fine-tuned treatment of thoracolumbar fractures. (2) The finite element analysis of a single sample or a small number of samples has the chance, and a larger number of samples are required for the future finite element analysis to reduce the chance caused by the sample. (3) The rigid structure of bones alone cannot meet the biomechanical working conditions of the integrity of the physical object, and future finite element models need to incorporate all the structures of the physical object (e.g., soft tissues, such as muscles and ligaments) as far as possible. (4) The finite element method has been used in more studies on osteoporotic and traumatic thoracolumbar spine fractures, which will need to be more in-depth in the future, and less in the field of pathologic thoracolumbar fractures, which has a wider scope for future research.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Characteristics and advantages in finite element analysis techniques in knee biomechanics Guo Huanxuan, Kang Zhijie, Bai Xiaolong, Tian Xiaoyan, Jin Feng 2025, 29 (15):  3253-3261.  doi: 10.12307/2025.807 Abstract ( 178 )   PDF (894KB) ( 368 )   Save BACKGROUND: Finite element analysis is an advanced computer-based engineering technique that uses mathematical approximations to simulate the human body. This method accurately reflects the biomechanical characteristics within the knee, providing a powerful tool for understanding knee disease pathogenesis, optimizing surgical protocols, and developing new implant materials. OBJECTIVE: To review the establishment of finite element modelling of the knee joint and its application in the study of knee joint diseases, and look forward to the future development trend. METHODS: The first author searched the PubMed and EI databases in April 2024 by applying a computer with English search terms “finite element analysis, FEA, knee joint, finite element model, knee biomechanics, knee osteoarthritis, knee prosthesis, knee ligaments, meniscus” and searched CNKI and WanFang databases with Chinese search terms “finite element analysis, finite element model, knee joint, biomechanics, osteoarthritis, computational model, knee prosthesis, knee ligament, meniscus.” Finally, 75 papers were included in the analysis. RESULTS AND CONCLUSION: (1) Finite element analysis method uses medical imaging data to obtain a three-dimensional human model, simplifies the complex human joint structure into finite and interconnected units, and visually displays the internal stress distribution of the knee joint by applying external loads to the model. (2) The researchers deeply study the internal stress and strain distribution of the knee joint under different working conditions by means of finite element analysis, revealing the overloading of the articular cartilage and the decrease of load in some areas when the balance of the internal load distribution of the knee joint is changed, and that such long-term abnormal stresses cause deformation, wear and tear, and eventual loss of cartilage, which is crucial for understanding how biomechanical factors cause degenerative changes of the knee joint. (3) The effect of physical therapy methods such as Tai Chi and gait adjustment in patients with osteoarthritis of the knee joint was evaluated by finite element analysis, and the results showed that these treatments reduced the overloading of the cartilage, which provided a scientific theoretical basis for clinical treatment. (4) Clinicians are able to optimize surgical treatment strategies by performing three-dimensional reconstruction, data measurement, and simulation of surgery before surgery through finite element analysis. Furthermore, the mechanical characteristics of different prostheses can be simulated to improve the shape, material, and fixation of the prostheses, reduce patient complications, and improve patient outcomes. (5) The combination of artificial intelligence and finite element analysis makes the construction of finite element models more accurate and easy to operate, greatly contributing to the efficiency of clinicians’ medical practice and patient outcomes. (6) Finite element analysis is only a digital simulation, which is still somewhat different from the real physical state. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application and value of acoustic emission technique in joint surgery Xu Zhen, Zhang Mengru, Lyu Ke, Xia Zhongyu, Zhang Caiwei, Xu Jianda 2025, 29 (15):  3262-3270.  doi: 10.12307/2025.194 Abstract ( 91 )   PDF (1097KB) ( 191 )   Save BACKGROUND: Acoustic emission technology is one of the most reliable and perfect technologies in nondestructive testing, and is widely used in many fields such as mechanical, civil and underwater acoustics. In recent years, acoustic emission technology is initially applied in the field of biomedical engineering due to its great progress, especially in the friction evaluation of human joints and implant monitoring. OBJECTIVE: To summarize the application status, existing challenges, and potential directions of acoustic emission technology in joint surgery. METHODS: PubMed database, Web of Science database, CNKI database, and WanFang database were searched from January 1989 to March 2024 with the Chinese and English search terms “acoustics, hip replacement arthroplasties, hip prosthesis, prosthesis failure, knee osteoarthritides, knee joint, monitoring, artificial joint.” A total of 2 991 articles were initially examined, and 80 articles were finally included for review analysis according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) In the field of joint surgery, acoustic emission technology is mainly used for earlier detection and diagnosis of joint-related diseases, as well as the detection of bone cracks during joint replacement surgery and postoperative prosthesis sinking, implant wear, aseptic loosening, and bone cracks. (2) The advantages of acoustic emission technology can make up for the shortcomings of traditional detection methods. It can detect arthritis early, diminish the risk of injury during surgery, monitor and reduce postoperative complications, and improve surgical safety and clinical prognosis. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Classification and advantages and disadvantages of orthopedic robots in clinical applications Sun Chengjie, Zhang Deqiang 2025, 29 (15):  3271-3279.  doi: 10.12307/2025.175 Abstract ( 178 )   PDF (1263KB) ( 246 )   Save BACKGROUND: Since entering the intelligent age, there has been a growing enthusiasm for research on artificial intelligence technologies applied to healthcare. In the field of orthopedics, robot-assisted technology is one of the most attractive artificial intelligence technologies. After nearly 40 years of development, robot-assisted technology has gradually matured, and the types of orthopaedic surgeries in which it can be involved have gradually increased and played a crucial role.  OBJECTIVE: To summarize the application of orthopedic robots in the clinic and analyze their advantages and disadvantages.  METHODS: The PubMed and CNKI databases were searched for relevant literature. The search terms were “robot-assisted technology, surgical robots, orthopaedic robots, robotic arm, orthopaedic, orthopaedic surgery, joint, spine, trauma, bone tumor” in English and Chinese. A total of 82 articles with high relevance were screened according to the inclusion criteria. RESULTS AND CONCLUSION: (1) Robot-assisted technology is now more mature in clinical practice and can be used in most orthopedic surgeries with good clinical performance. (2) The main advantages of orthopedic robots include relieving clinicians’ work pressure, reducing intraoperative side injuries, and shortening radiation exposure time. However, there may also be a prolongation of surgical operation time and an increase in postoperative complications. (3) The future development of orthopedic robots will be along the direction of high intelligence, low cost, and faster. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Visual analysis of hotspots and frontiers in knee osteoarthritis pain field Zhao Dun, Qi Lingchen, Xu Jinfan, Shao Min 2025, 29 (15):  3280-3289.  doi: 10.12307/2025.179 Abstract ( 125 )   PDF (2524KB) ( 292 )   Save BACKGROUND: Pain is the main symptom of knee osteoarthritis, which seriously affects the quality of life of elderly patients. The pain mechanism of knee osteoarthritis is complex and involves multi-tissue and multi-discipline. Visual analysis is needed to understand its cutting-edge content and research hotspots. OBJECTIVE: To analyze and summarize the cutting-edge content and research hotspot in knee osteoarthritis pain field using bibliometrics visualization software. METHODS: Literatures related to knee osteoarthritis pain from 2014 to 2024 were retrieved from Web of Science Core Collection (WoSCC). Three visualization software, Citespace, VOSviewer, and Bibliometrix R-Package were used for bibliometric and visual analysis.  RESULTS AND CONCLUSION: (1) The number of articles on knee osteoarthritis pain research is increasing year by year. (2) The United States, China, and Australia were the top three countries in the number of publications in this field in 10 years. Boston University, University of Sydney, and University of Florida are the top three research institutions. OSTEOARTHRITIS AND CARTILAGE has published the most research articles in this field, and PAIN has been the most cited journal in this field. The author with the most published articles is Fillingim Roger B. The active authors in this field have formed a number of stable research teams among themselves, but there is a lack of international cooperation. (3) Daily management (motor, psychological, and intelligent management), inflammatory mechanism of pain, proteomics, combination medication, central sensitization, and pain regulation of knee osteoarthritis pain patients are the key contents of knee osteoarthritis pain research. Artificial intelligence assistance, extracorporeal shock wave therapy, radiofrequency ablation, nerve cryotherapy, intra-articular injection of blood or cell preparations may be the research frontiers in this field. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Visual analysis of research trends in pigmented villonodular synovitis Xiong Binglang, Cao Xuhan, Zhang Cheng, Guo Ziyan, Sun Xudong, Bai Zixing, Sun Weidong 2025, 29 (15):  3290-3300.  doi: 10.12307/2025.182 Abstract ( 72 )   PDF (5022KB) ( 131 )   Save BACKGROUND: There are still great controversies in the etiology, clinical manifestations, diagnosis and treatment of pigmented villonodular synovitis. Bibliometric and visualization studies on pigmented villonodular synovitis can clarify the research development context and point out the direction for future research.  OBJECTIVE: To analyze the global research status, hotspot, and trend of pigmented villonodular synovitis.  METHODS: All publications related to pigmented villonodular synovitis from 1995 to 2023 were retrieved from Web of Science and CNKI. Citespace and bibliometrics were used to analyze the clustering, co-occurrence, and emergent words of all articles. The Web of Science database adopts subject headings plus free words for retrieval, while the CNKI database retrieves through subject headings. Finally, 986 English articles and 599 Chinese articles were included. RESULTS AND CONCLUSION: (1) The United States has an absolute leading position in research in this field, ranking first in the number of published papers, H index, and cited times. China ranks the 4th in the total volume of published articles and 12th in the H index. The quality of published articles and international cooperation still need to be improved. (2) Cluster analysis of pigmented villonodular synovitis studies showed that the top five clusters were radiotherapy, soft tissue sarcoma, rheumatoid arthritis, magnetic resonance imaging, and diagnosis. (3) The key words that continued to emerge until 2023 were colony-stimulating factor 1, giant cell tumor of tendon sheath, case report, chromosome translocation, radiotherapy, expression, and kinase. (4) Based on keyword analysis and co-citation analysis, it is found that the research on the clinical characteristics of pigmented villonodular synovitis, the development of new colony-stimulating factor 1 inhibitors, and the application of colony-stimulating factor 1 inhibitors in the treatment process are current research hotspots. (5) Combining thematic evolution with the analysis of current research hotspots, based on clarifying the etiology, pathogenesis, and clinical characteristics of pigmented villonodular synovitis, improving the diagnostic accuracy of pigmented villonodular synovitis, enhancing the precision of treatment, and reducing the recurrence rate after treatment will be key issues that require focus in the future. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics