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28 July 2025, Volume 29 Issue 21 Previous Issue    Next Issue

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Finite element analysis of four different internal fixation methods for treatment of Pauwels type III femoral neck fractures Lu Jianpeng, Chen Long, Le Jiadi, Zhang Jianxiong 2025, 29 (21):  4401-4406.  doi: 10.12307/2025.153 Abstract ( 75 )   PDF (1331KB) ( 102 )   Save BACKGROUND: Pauwels type III femoral neck fractures may be subjected to more shear and bending forces, and may be prone to complications such as internal fixation failure, bone nonunion, or femoral head necrosis. There is no consensus on the optimal selection of internal fixation devices. OBJECTIVE: To compare the biomechanical properties of four types of internal fixation methods for Pauwels type III femoral neck fracture by finite element analysis METHODS: Femur CT data of a healthy young volunteer were imported into Mimics software to construct a three-dimensional model of normal femur. Pauwels type III femoral neck fracture was simulated based on 70° fracture line. Four types of fracture internal fixation models were optimized and constructed using Geomagic and UG software: conventional inverted triangle hollow screw, femoral neck fixation system, femoral neck fixation system plus anterior or posterior hollow screw treatment. Finally, Ansys software was used to analyze the stress distribution, peak stress, and peak displacement of proximal femur fracture block in four types of different internal fixation models. The displacement distribution and peak displacement of internal fixation device and femoral neck fracture were observed.  RESULTS AND CONCLUSION: (1) The peak stress of proximal fracture fragments in the four groups was concentrated near the fracture line. The peak stress in the femoral neck fixation system group was the largest, and that in the conventional inverted triangle hollow screw group was the smallest. (2) The peak displacement of fracture fragments was located at the top of the femoral head. The peak displacement of the conventional inverted triangle hollow screw group was the largest, and that in the femoral neck fixation system + hollow screw (posterior) group was the smallest. (3) The peak displacement of the internal fixation model was located at the top of the model. The peak displacement was maximum in the conventional inverted triangle hollow screw group and minimum in the femoral neck fixation system + hollow screw (posterior) group. (4) The displacement of the fracture surface in the femoral neck fixation system + hollow screw (posterior) group was at the upper part of the fracture end. The peak displacement was the largest in the conventional inverted triangle hollow screw group and the smallest in the femoral neck fixation system + hollow screw (posterior) group. (5) It is indicated that compared with the other three internal fixation methods, femoral neck fixation system + hollow screw (posterior) group showed good biomechanical stability. When Pauwels type III femoral neck fracture occurs in a young person, from the point of view of finite element analysis, it may be a more favorable choice to treat the Pauwels type III femoral neck 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 intramedullary and extramedullary fixation of femoral neck base fractures: proximal femoral nail antirotation and femoral neck system Qin Qi, Alimujiang·Yusufu, Liu Yuzhe, Liu Xiuxin, Ren Zheng, Ran Jian 2025, 29 (21):  4407-4412.  doi: 10.12307/2025.154 Abstract ( 71 )   PDF (1240KB) ( 87 )   Save BACKGROUND: The biomechanical stability of basal femoral neck fracture is poor, and the treatment plan is different from the traditional femoral neck fracture. At present, there is still no consensus on the surgical plan for the treatment of basal femoral neck fracture in young adults. OBJECTIVE: To compare the biomechanical characteristics of proximal femoral nail antirotation and femoral neck system in the treatment of basal femoral neck fractures by finite element analysis. METHODS: First, Mimics Medical 21.0 software was used to extract the right femur CT data of healthy young female volunteers to establish a preliminary model. Secondly, the model was imported into Geomagic Wrap 2021 software for further smoothing. SOLIDWORKS 2021 software was used to establish and assemble the femoral neck base fracture model, proximal femoral nail antirotation model, and femoral neck system model. Finally, the assembled model was imported into Workbench 2021 R1 software for biomechanical analysis.  RESULTS AND CONCLUSION: (1) Stress distribution: the stress distribution of the proximal femoral nail antirotation group was mainly near the fracture line and the medial side of the femur, and the peak stress was 151.90 MPa. In the femoral neck system group, the stress distribution of the femoral model was mainly near the fracture line, and the peak stress was 290.74 MPa. The proximal femoral nail antirotation internal fixation stress was mainly distributed at the proximal end of the helical blade and the main nail, and the peak stress was 102.95 MPa. The stress distribution of internal fixation in femoral neck system mainly extended to both sides of the support rod, and the peak stress was 184.69 MPa. (2) Total displacement: the maximum displacement of the femoral model in the proximal femoral nail antirotation group was 4.032 3 mm, and the maximum displacement of the femoral model in the femoral neck system group was 4.648 9 mm. The maximum displacement was located in the femoral head. The peak displacement of internal fixation in the proximal femoral nail antirotation group and the femoral neck system group was 2.709 4 mm and 3.130 3 mm, respectively. The displacement of internal fixation in the two groups was mainly concentrated in the proximal end of internal fixation, and gradually decreased to the distal end. (3) It is concluded that in the femoral neck base fracture model, whether it is the femoral model or the internal fixation model, the proximal femoral nail antirotation group has more dispersed stress distribution, lower stress peak, smaller femoral head displacement, and better biomechanical stability than the femoral neck system group. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of muscle loading effect on biomechanics of early healing of femoral stem fractures Cheng Chaoran, Zhang Junxia, Jia Jun 2025, 29 (21):  4413-4420.  doi: 10.12307/2025.814 Abstract ( 78 )   PDF (1415KB) ( 91 )   Save BACKGROUND: Previous studies have mostly performed biomechanical analysis of early fracture healing by ignoring muscle loading and using simplified femoral loading. Nevertheless, the biomechanical effects of muscle loading on early fracture healing are still uncertain. OBJECTIVE: To construct various femoral loading models allows for the study of the biomechanical effects of muscle loading on fracture healing, enabling clinicians to gain a deeper understanding of the biomechanical process of fracture healing and to optimize treatment protocols. METHODS: The AnyBody Modeling System software was employed to construct a personalized human musculoskeletal system, which was then analyzed by simulation in order to obtain the musculoskeletal loading model in vivo. This model, along with the femur loading model constructed using the improved simplified loading method and the simplified loading method, was utilized as boundary conditions for the finite element inputs, which were used to analyze the locking compression plate stress-strain and interfragmentary strain in the standing condition, respectively. RESULTS AND CONCLUSION: (1) The locking compression plate stresses and strains and interfragmentary strains obtained from the musculoskeletal method were, respectively, 31.9%, 38.9%, and 19.5% smaller than those obtained from the simplified loading method. (2) A comparison of the musculoskeletal method with the modified simplified loading method revealed that the neglect of muscle loading resulted in an overestimation of locking compression plate stress and strain, as well as interfragmentary strain, by 16.8%, 14.3%, and 19.5%, respectively. Muscle loading did not have a significant effect on the magnitude of the shear motion of the fracture block, whereas it did have a significant effect on the direction of motion. (3) The results indicated that the simplified femoral loading and the method of ignoring muscle loading exhibited some deviation from the musculoskeletal loading situation. Consequently, it is necessary to consider the biomechanical effects of muscle loading in the study of fracture healing. Figures and Tables | References | Related Articles | Metrics

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Effect of minimally invasive interbody fusion device height on lumbar biomechanics in patients with adolescent lumbar disc herniation Zhang Ruofan, Guan Huanhuan, He Zhuoqun, Zhang Yunfeng, Jin Feng, Wang Zhiqiang, Wang Jianzhong, Li Xiaohe, Zhu Yong, Wang Haiyan, Zhang Kai 2025, 29 (21):  4421-4429.  doi: 10.12307/2025.820 Abstract ( 55 )   PDF (2062KB) ( 39 )   Save BACKGROUND: Adolescent lumbar disc herniation is the main cause of low back pain in adolescents. At present, most of them are treated by conservative treatment. When long-term non-surgical treatment attempts, surgery may be necessary to prevent further injury when the patient’s symptoms are not sufficiently relieved or when the patient has symptoms of single nerve paralysis or compression of the cauda equina, it is very important to choose a suitable interbody fusion device for the surgical treatment of the patients. OBJECTIVE: To explore the effects of minimally invasive interbody fusion with different heights on lumbar biomechanics in patients with adolescent lumbar disc herniation.  METHODS: CT scans of a 17-year-old male patient with adolescent lumbar disc herniation (L4-5 segment herniation) were collected. After the three-dimensional reconstruction of MIMICS, the interbody fusion device equal to and 3 mm higher than the intervertebral space was selected for analysis, so two expandable mixed material interbody fusion devices were designed and reconstructed. Fusion device L: 11 mm high front, 9 mm high posterior, 9 mm wide, 28 mm long, and fusion device H: 14 mm high front, 11 mm high posterior, 11 mm wide, 28 mm long and the lumbar fusion device was modeled. The fusion device and lumbar spine model were optimized, inversely modeled, and then imported into ABAQUS, and finally the 3D model of lumbar fusion was obtained. The physiological activities of the human body were simulated, such as lumbar extension, forward bending, right bending, and left bending, to obtain the corresponding stress contours. The biomechanical characteristics of the L4-5 vertebra under seven different working conditions were observed.  RESULTS AND CONCLUSION: (1) The maximum stress of the two kinds of fuses was in the condition of forward bending and backward extension, the stress value of H fuses was (18.27±3.80) MPa and (15.02±3.24) MPa; the stress value of L fuses was (9.16±0.05) MPa and (9.17±1.83) MPa. The stress values of the end plate of the H-fusion in the extension station were (19.11±4.03) MPa and (16.32±3.72) MPa respectively. The stress values of the L-fusion end plate were (9.13±0.01) MPa and (4.92±1.01) MPa respectively. (2) The stress of H-type fusing end plate was higher than that of L-type fusing end plate except for L-5 end plate at neutral position (P < 0.05). (3) Choosing an interbody fusion device with a height of more than 3 mm in the same intervertebral space has a more stable biomechanics. 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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Effect of differences in vertebral cortical bone reinforcement on biomechanics of osteoporotic vertebral compression fractures Fang Wei, Huang Xinghua, Qu Bo, Yang Hongsheng 2025, 29 (21):  4430-4438.  doi: 10.12307/2025.824 Abstract ( 97 )   PDF (3440KB) ( 51 )   Save BACKGROUND: The cortical bone reinforcement area of bone cement in the vertebral body during percutaneous vertebroplasty for osteoporotic vertebral compression fractures has an important influence on spinal biomechanics and clinical efficacy, but previous studies were mostly limited to the two-dimensional level.  OBJECTIVE: To investigate the effect of the difference in cortical bone reinforcement of bone cement in the three-dimensional plane of the vertebral body on the biomechanical distribution of the vertebral body, adjacent intervertebral disc and endplate in osteoporotic vertebral compression fractures by finite element analysis during percutaneous vertebroplasty, so as to evaluate its effect. METHODS: The finite element model of percutaneous vertebroplasty for osteoporotic vertebral compression fractures of T12 vertebrae was established. The presence or absence of cortical reinforcement of bone cement was analyzed in groups from the transverse, sagittal and coronal planes. The effects of cortical reinforcement on the biomechanics of T12 vertebral cancellous bone, cortical bone, T11/T12 intervertebral disc, T12/L1 intervertebral disc, T11 lower endplate, and L1 upper endplate under different body position changes were studied.  RESULTS AND CONCLUSION: (1) Under the effect of vertical compression force, percutaneous vertebroplasty cortical reinforcement with or without bone cement had no significant changes in structural stress except for the injured vertebral cortical bone. (2) The Von Mises stress value of the injured cortical bone was significantly different in human forward flexion, left/right bend, and left/right axial rotation. The maximum Von Mises stress value in the best group of cortical reinforcement was significantly smaller than that in the non-cortical reinforcement group. The Von Mises stress value showed a downward trend with extensive cortical reinforcement in the same plane. (3) It is indicated that when percutaneous vertebroplasty is performed, bone cement should be distributed as broadly and symmetrically horizontally along the cortical edge of the vertebral body as far as possible in cross section. Bone cement in sagittal plane should be widely distributed longitudinally near the upper and lower endplates and the anterior and posterior walls. Bone cement in coronal plane should be widely distributed on both sides of the midline while symmetrically touching the upper and lower endplates and lateral walls. It can effectively avoid the risk of refracture of the injured vertebra and does not increase the risk of adjacent vertebral fracture and residual discogenic pain. 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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Mechanical properties of solid-liquid biphase fiber-reinforced cartilage in developmental dysplasia of hip patients Gao Yongchang, Chen Pengfei, Chen Zhenxian, Wei Jing, Dong Zhe, Li Hui, Zhang Zhifeng 2025, 29 (21):  4439-4444.  doi: 10.12307/2025.159 Abstract ( 55 )   PDF (1812KB) ( 62 )   Save BACKGROUND: Developmental dysplasia of hip causes groin pain in patients with prolonged activity or standing due to the presence of deformities of the acetabulum and femoral head in terms of structure, size and orientation, and if not effectively treated, patients’ normal activities will be severely limited.  OBJECTIVE: Finite element model of the hip joint of solid-liquid biphase fiber reinforced cartilage based on FEBio was established to explore the biomechanical properties of the cartilage for patients with developmental dysplasia of hip and the normal hip joint.   METHODS: A patient with developmental dysplasia of hip and a normal volunteer were chosen to build their left hip models including left pelvis, left femur, and cartilage attached thereto. The solid-liquid biphase fiber reinforced cartilage of normal hip was verified to be effective. The cartilage equal contact stress, fluid pressure, solid effective stress, and fluid support rate differences between the developmental dysplasia of hip patients hip and the normal one in the case of one leg of static load (2 130 N) were compared after establishing finite element models of developmental dysplasia of hip patients. RESULTS AND CONCLUSION: (1) Compared with the finite element results of the normal hip model, the cartilage contact position of developmental hip dysplasia patient hip showed obvious edge contact, the peak contact stress (3.86 MPa) and peak fluid pressure (3.76 MPa) were both higher than normal hip model. (2) After 1 500 s (stable load-bearing capacity), peak contact stress and peak fluid pressure in both models decreased, but the cartilage contact position of developmental hip dysplasia patient hip moved from the edge of cartilage to the center, and fluid support rate decreased from 97.41% to 91.08%. The fluid support rate in normal hip was decreased by 0.58% from 95.24% to 94.66%. (3) It is indicated that under the physiological load of standing on one leg, the cartilage of developmental dysplasia of hip patients showed obvious edge load, and the decrease of peak contact stress, fluid pressure, and fluid formation rate was greater than that of normal cartilage. Considering the solid-liquid biphasic fiber reinforcement characteristics of cartilage, it is of great clinical significance to evaluate the biomechanical properties of hip cartilage in developmental dysplasia of hip patients, to understand the pathophysiological mechanism of developmental dysplasia of hip, and make preoperative plan. 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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Influence of paravertebral muscles on spinopelvic sagittal plane in patients with isthmic spondylolisthesis: an evaluation of muscle quantity and quality Song Hanlin, Hu Tianyu, Gao Haoran, Shi Yaozhou, Gao Xiao, Feng Hu 2025, 29 (21):  4445-4451.  doi: 10.12307/2025.148 Abstract ( 48 )   PDF (1384KB) ( 33 )   Save BACKGROUND: Cross-sectional area and fat infiltration are the standard parameters for quantifying paravertebral muscle, but it is too cumbersome and time-consuming to introduce new quantifying indicators. OBJECTIVE: To investigate the relationship between paravertebral muscle and spinopelvic sagittal parameters and the predictive value of lumbar indentation value for sagittal balance in patients with isthmic spondylolisthesis. METHODS: The study included 87 patients diagnosed with spondylolisthesis, all of whom had grade II spondylolisthesis according to Meyerding classification, including 40 males and 47 females, with a mean age of (51.4±9.1) years. The sagittal vertical axis, pelvic incidence angle, pelvic inclination angle, sacral inclination angle, lumbar lordosis, thoracic kyphosis, and the difference between pelvic incidence and lumbar lordosis were measured. The total cross-sectional area, functional cross-sectional area, and fat infiltration of lumbar paracolateral muscles were measured. Pearson correlation analysis was used to investigate the correlation between sagittal parameters and paravertebral muscle measurements. Multiple linear regression was used to analyze the effects of lumbar indentation value, age, sex, and body mass index on spinopelvic sagittal balance. The receiver operating characteristic curve was used to find the best cut-off point of the indentation value of the lumbar spine, and the relationship of sagittal vertical axis and pelvic incidence with lumbar lordosis was evaluated.  RESULTS AND CONCLUSION: (1) According to Pearson correlation analysis, the total cross-sectional area of the multifidus muscle was significantly correlated with lumbar lordosis (r=0.464, P < 0.01) and the difference between pelvic incidence and lumbar lordosis (r=-0.306, P < 0.01). The functional cross-sectional area of multifidus muscle was significantly correlated with lumbar lordosis (r=0.367, P < 0.01) and the difference between pelvic incidence and lumbar lordosis (r=-0.228, P < 0.05). The indentation value of lumbar spine was significantly correlated with the sagittal vertical axis (r=-0.300, P < 0.01), lumbar lordosis (P=0.417, P < 0.01), thoracic kyphosis (r=0.351, P < 0.01), and the difference between pelvic incidence and lumbar lordosis (r=-0.319, P < 0.01). (2) According to multiple linear regression analysis, the indentation value of lumbar spine was independently correlated with the difference between pelvic incidence and lumbar lordosis and the sagittal vertical axis. 55% (11/20) of patients with lumbar indentation value ≤11.5 mm had sagittal vertical axis ≤ 50 mm, while 96% (64/67) of patients with lumbar indentation value > 11.5 mm had sagittal vertical axis ≤ 50 mm. 30% (6/20) of patients with the difference between pelvic incidence and lumbar lordosis ≤ 11.5 mm had the difference between pelvic incidence and lumbar lordosis ≤ 10°, while 66% (44/67) of patients with lumbar indentation value > 11.5 mm had the difference between pelvic incidence and lumbar lordosis ≤ 10°. (3) It is concluded that both total cross-sectional area and functional cross-sectional area were significantly correlated with lumbar lordosis and the difference between pelvic incidence and lumbar lordosis. Lumbar indentation value, as a new indicator for the evaluation of paravertebral degeneration, was independently correlated with the sagittal vertical axis and the difference between pelvic incidence and lumbar lordosis, and had certain predictive value for postoperative sagittal plane correction. It was a simple and practical method for the evaluation of spinopelvic sagittal plane and paravertebral muscle degeneration. The degeneration of the paravertebral muscle is related to spinopelvic sagittal balance.  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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Effect of periacetabular osteotomy on pelvic sagittal tilt in developmental dysplasia of hip Wang Lingcheng, Chen Xi, Yang Shuoyao, Huang Zhoulu, Yang Shunjie, You Mingke, Zhou Kai, , Chen Gang, , Li Jian 2025, 29 (21):  4452-4457.  doi: 10.12307/2025.155 Abstract ( 74 )   PDF (1087KB) ( 87 )   Save BACKGROUND: Developmental dysplasia of hip refers to the deformity of acetabulum and proximal femur, which can lead to hip instability and hip osteoarthritis. Periacetabular osteotomy is the main treatment for non-terminal developmental dysplasia of hip in adolescents and adults. Pelvic inclination plays an important role in biomechanics of hip joint, which determines the stress direction of hip joint. In hip joint diseases, pelvic compensatory tilt can occur to minimize the abnormal stress of hip joint. OBJECTIVE: To observe whether periacetabular osteotomy changes pelvic sagittal tilt in patients with developmental dysplasia of hip, and to investigate the effect of acetabular covering on pelvic sagittal tilt. METHODS: A retrospective analysis was performed on 29 patients who underwent periacetabular osteotomy due to developmental dysplasia of hip in West China Hospital of Sichuan University from August 2019 to June 2022. Anteroposterior X-rays of the standing pelvis were collected before and 6 months after surgery. The pelvic tilt parameters, including the lateral center-edge angle, pubic symphysis to sacroiliac joint distance, pubic symphysis to sacroiliac joint midline distance, sacrofemoral-pubic angle, and pelvic tilt, were measured. Hip functions of all patients were assessed by hip disability and osteoarthritis score and Harris score before and 6 months after surgery.   RESULTS AND CONCLUSION: (1) The lateral center-edge angle, pubic symphysis to sacroiliac joint midline distance, and sacrofemoral-pubic angle were significantly increased 6 months postoperatively compared to preoperative values (P < 0.05). Tonnis angle and pelvic tilt were significantly decreased (P < 0.05). There was no significant difference in pubic symphysis to sacroiliac joint distance between preoperative and postoperative measurements (P > 0.05). (2) The hip disability and osteoarthritis scores and Harris scores were significantly increased 6 months after operation (P < 0.01). (3) It is indicated that periacetabular osteotomy surgery can significantly improve acetabular coverage and the pelvis showed significant anteversion changes in patients with developmental dysplasia of hip. 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 characteristics of lower limbs in female patients with different types of patellofemoral pain syndrome Dong Youqing, Wei Zixuan, Wu Haiou, Chen Ruixiong, Duan Peng, Chen Nan, Lin Xikai 2025, 29 (21):  4458-4468.  doi: 10.12307/2025.822 Abstract ( 101 )   PDF (1156KB) ( 219 )   PDF（mobile） (1156KB) ( 4 )   Save BACKGROUND: Currently, research both domestically and internationally on patellofemoral pain syndrome has explored the kinematics and dynamics during daily activities such as stair ascent and descent, and walking. However, there is a lack of studies examining the lower limb biomechanical characteristics of young female patients with patellofemoral pain syndrome in different squatting conditions. OBJECTIVE: To investigate the lower limb biomechanical characteristics among young female patients with patellofemoral pain syndrome in different functional states of the subtalar joint, providing theoretical support for the clinical treatment of various types of patellofemoral pain syndrome.  METHODS: A total of 33 participants were included in this study. There were 10 subjects in the healthy control group (group C). The other 27 subjects with patellofemoral pain syndrome were divided into two groups according to the foot posture index: 14 subjects in the normal subtalar joint group (group A, foot posture index 0-6 points) and 13 subjects in the abnormal subtalar joint group (group B, foot posture index 7-12 points). The biomechanical indices of the subjects in each group were collected and compared when they walked on stairs at normal speed. The kinematic indices included the three-dimensional joint angles of the hip and knee and the sagittal plane joint angles of the ankle at the initial contact moment and the moment of maximum knee flexion angle during the stance period. The dynamic indices included the three-dimensional joint torques of the hip and knee and the sagittal plane joint torques of the ankle at the moment of maximum knee flexion angle during the stance period. The surface electromyography indices included the root mean square amplitudes of the vastus medialis, vastus lateralis, rectus femoris, semitendinosus and semimembranosus, biceps femoris, and gluteus medius in the pre-activation stage and the buffering stage.  RESULTS AND CONCLUSION: (1) At the initial ground contact moment, group A exhibited a greater knee flexion angle (P < 0.05), greater hip external rotation angle (P < 0.01), and smaller knee external rotation angle (P < 0.01) compared to group B. Compared to group C, group A showed a greater knee flexion angle and smaller hip flexion angle (both P < 0.01). Group B demonstrated a greater knee external rotation angle and smaller hip external rotation angle and hip flexion angle (all P < 0.01) compared to group C. (2) At the moment of maximum knee flexion, group A had a smaller knee valgus angle (P < 0.05), smaller knee external rotation angle (P < 0.05), and greater knee flexion angle (P < 0.01) compared to group B. Compared to group C, group A showed a smaller knee valgus angle (P < 0.05), smaller hip flexion angle (P < 0.01), and smaller hip external rotation angle (P < 0.05). Group B had a smaller knee flexion angle, hip flexion angle, hip external rotation angle, and greater knee external rotation angle (all P < 0.01) compared to group C. Additionally, group A exhibited a greater hip internal rotation moment (P < 0.05) and plantarflexion moment (P < 0.01) compared to group C. (3) At normal speed during the staircase buffering phase, group C showed higher activation levels than group A in the vastus lateralis (P < 0.05), vastus medialis (P < 0.01), gluteus medius (P < 0.01), and biceps femoris (P < 0.05). Group C also had higher activation levels than group B in the vastus medialis (P < 0.01), gluteus medius (P < 0.01), and biceps femoris (P < 0.05). Additionally, group A showed higher activation in the semitendinosus and semimembranosus muscles compared to group B (P < 0.05). (4) These findings indicate that young female patients with patellofemoral pain syndrome have stiffer hip and knee joint buffering while descending stairs, potentially compensated by the ankle joint. Low muscle activation levels contribute to patellofemoral pain, with those having normal subtalar joints but experiencing pain showing the lowest and most abnormal activation. ③ Abnormal biomechanics in the normal subtalar joint group are mainly due to insufficient hip and knee flexion. Abnormal biomechanics in the abnormal subtalar joint group are mainly due to excessive subtalar joint pronation. 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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Effect of foot position and chair height on lower limb kinematic and kinetic parameters during sit-to-stand tasks in children with cerebral palsy Li Wenjing, Gao Xiao, Li Aihua, Ni Yan, Sun Wei, Wang Jiangna 2025, 29 (21):  4469-4476.  doi: 10.12307/2025.806 Abstract ( 53 )   PDF (1135KB) ( 52 )   Save BACKGROUND: Foot position and seat height are important factors affecting “Sit-to-Stand”, but most of the current research on “Sit-to-Stand” focuses on healthy people and Parkinson’s disease patients. The kinematic and kinetic characteristics of the lower limbs of children with spastic cerebral palsy during the “Sit-to-Stand” task under different foot positions and seat heights are not known. OBJECTIVE: To investigate the effects of different foot positions and different seat height on lower limb kinematic and kinetic parameters during the “Sit-to-Stand” task in children with cerebral palsy. METHODS: Seven children with spastic cerebral palsy were selected as the research subjects. All subjects received the “Sit-to-Stand” test of six tasks, namely three seat heights (high, medium, and low stools) × two foot positions (front and back foot positions). The kinematic and dynamic data of children with cerebral palsy were collected under different foot positions and seat heights. RESULTS AND CONCLUSION: (1) The time characteristics results showed that the total time required for the children with cerebral palsy to perform the sit-to-stand transfer task was significantly smaller in the high stool condition compared to the low stool condition (P=0.046). (2) The kinetic results showed that at the moment of lifting, the knee flexion moment was significantly larger in the bipedal posterior condition than the bipedal anterior condition (P=0.049). The knee flexion moment was significantly smaller in the high stool condition compared to the medium stool condition (P < 0.001). (3) It is concluded that raising the seat height and changing the foot position had an effect on the sit-to-stand transfer in children with spastic cerebral palsy. The children were able to perform the sit-to-stand maneuver with less motor compensation in the high-stool bipedal-rear position condition. Meanwhile, the high chair can be used as an aid to enhance the performance of sit-to-stand transfer in children with spastic cerebral palsy. The high stool bipedal hindfoot condition was the most effective in improving the sit-to-stand transfer in children with spastic cerebral palsy. Figures and Tables | References | Related Articles | Metrics

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Correlation of gait parameters and muscle parameters with imaging in adolescent idiopathic scoliosis patients Liu Jing, Xu Chunxin, Lu Yangyang, Qu Qinquan, Zhu Qi, Guo Yulan, Shen Min 2025, 29 (21):  4477-4485.  doi: 10.12307/2025.819 Abstract ( 241 )   PDF (1067KB) ( 146 )   Save BACKGROUND: Gait analysis, as a radiation-free dynamic assessment method, may be able to assist imaging to evaluate patients with scoliosis, thereby reducing radiation exposure. OBJECTIVE: To analyze the correlation between gait parameters and imaging parameters in adolescent idiopathic scoliosis patients, and preliminarily explore the potential mechanism through OpenSim simulation modeling. METHODS: Twenty adolescent idiopathic scoliosis patients aged 10-18 years with Cobb angle of 10°-45° were selected as adolescent idiopathic scoliosis group. The control group was normal children of the same age and the same body mass index range, and a total of 40 subjects were included. The differences in spatiotemporal parameter, kinematic parameters, dynamic parameters, and gait deviation index of the two groups were compared to explore the correlation between pathological gait and coronal balance. The related mechanisms were preliminarily studied. RESULTS AND CONCLUSION: (1) The comparison of gait parameters between groups showed that the percentage of bilateral support phase and double support phase increased in adolescent idiopathic scoliosis patients, and the percentage of bilateral swing phase decreased (P < 0.05). The maximum adduction angle of the left hip joint of patients in the adolescent idiopathic scoliosis group was greater than that of the control group, and the maximum abduction angle of the bilateral hip joints was significantly less than that of the control group (P < 0.05). The ankle joints of the two groups when the bilateral heels initially touched the ground; the difference between angles was significant (P < 0.05). The peak power of right hip flexor muscle group in adolescent idiopathic scoliosis patients was significantly decreased when they pushed off the ground (P < 0.05). (2) The results of the correlation study showed that the maximum abductive angle of the right hip joint was significantly positively correlated with the Cobb angle (r=0.552, P=0.012), and the right peak power of right hip flexor muscle and C7 lateral offset were significantly negatively correlated (r=-0.475, P=0.034). There was a significant positive correlation between ankle angle and lateral pelvic tilt when left foot followed the ground (r=0.476, P=0.034). (3) The simulation results of muscle length showed that the change of muscle fiber length of gluteal medium muscle in adolescent idiopathic scoliosis patients was significantly reduced (P < 0.05). The change of muscle fiber length of the bilateral internal oblique muscle was significantly reduced in adolescent idiopathic scoliosis patients (P < 0.05). Comparing the muscle fiber length of the two groups when foot followed the ground, it was found that the muscle fiber length of the calf triceps of the adolescent idiopathic scoliosis patients was significantly shorter when foot followed the ground (P < 0.05). (4) The results showed that the postural stability control of the trunk of adolescent idiopathic scoliosis patients was decreased, which was manifested as slow step frequency, increased percentage of double support phase and decreased percentage of swing phase. The common pattern of low foot striking pattern is caused by bilateral Achilles tendon tension. In adolescent idiopathic scoliosis patients, the ability of hip flexor muscle to do work is decreased, which may be related to joint angular velocity and main bend direction.  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 three-dimensional morphological analysis of developmental characteristics of cervical facet joints in adolescents aged 13-18 years Li Guihua, He Yujie, Shi Jun, Li Kun, Zhang Shaojie, Liu Lu, Li Zhijun, Wang Xing 2025, 29 (21):  4486-4491.  doi: 10.12307/2025.102 Abstract ( 50 )   PDF (1162KB) ( 68 )   Save BACKGROUND: The cervical facet joint, as an important anatomical structure of the posterior column of the cervical spine, plays an important role in neck activity, stress transmission, and maintaining cervical stability. In recent years, anatomical and biomechanical studies have shown that asymmetry of cervical facet joints can cause degeneration of facet joints, which may be the main cause of cervical spine degeneration in young people. Existing research is mostly focused on adults, and there are also reports on preschool and school-age children in China, while there are few reports on the morphological parameters of cervical facet joints in adolescents. OBJECTIVE: Through three-dimensional reconstruction of the cervical facet joints in adolescents, measuring their relevant morphological parameters, and comparing them with those in children and adults, we explored the age-related changes in the morphological development of cervical facet joints, providing a theoretical basis for the diagnosis, treatment, and prevention of cervical spondylosis arising from cervical facet joints. METHODS: A total of 62 adolescents aged 13-18 years were selected to undergo spiral CT scan of cervical vertebrae and 3D reconstruction, requiring no bone destruction, tumor, deformity, or fracture, no changes in vertebrae morphology and structure, no previous spinal operations. The guardian’s informed consent to the experimental protocol was obtained. By age group, group A was 13-14 years old; group B was 15-16 years old; group C was 17-18 years old. The correlation morphometry and statistical analysis of C2-C7 facet joints were performed in adolescents of each group. RESULTS AND CONCLUSION: (1) In three groups of subjects, the facet joint surface heights and widths displayed decreasing and increasing trends in relation to the change of vertebra order. The facet joint surfaces on the inferior surface showed larger height and width compared to the corresponding indicators on the superior surface. (2) The intra-articular height of the articular process was lowest in C5 among the three groups of ages, and it showed a positive correlation with age. (3) Among the three groups, the gaps between the articular surfaces of the joints in C4-5 of group A, C3-4 of group B, and C4-5 of group C were significantly larger than the rest of the gaps in each group. Except for C4-5, there were no significant differences between the two groups. Except for C2-3,  the remaining gaps between the vertebrae in group C were significantly larger than those in the two groups. (4) It is indicated that the morphology of the cervical facet joint surface gradually transitions from circular to elliptical as the vertebral order increases. In inter-group comparison, facet joint surface height is significantly affected by age compared to facet joint surface width. The area of the lower facet joint surface of each segment is greater than that of the upper facet joint surface, with only significant differences in the shape and area of C4-5 and C5-6. In addition, the minimum height of the facet joint is located at C5, and the significantly widened gap between the facet joint surfaces is mainly located at C3-4 and C4-5. Therefore, cervical instability often occurs at the mid-level.  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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Mechanical performance of a novel press-fit lumbar intervertebral fusion device Li Shiwen, Yu Changshui, Liu Qi, Wang Zhibo, Liu Yuliang, Qi Quan 2025, 29 (21):  4492-4498.  doi: 10.12307/2025.167 Abstract ( 55 )   PDF (1480KB) ( 77 )   Save BACKGROUND: When performing percutaneous minimally invasive transforaminal lumbar interbody fusion to implant an intervertebral cage, due to the narrow operating range of the approach, there is a risk of nerve root injury or poor position of cage. To solve the above problems, a novel mechanical deformable press-fit cage (YP-cage) was invented. OBJECTIVE: To preliminarily evaluate the mechanical strength characteristics of this new lumbar fusion device YP-cage. METHODS: Static axial compression and torsion tests were conducted on 9, 11, and 13 mm YP-cages (n=9) and poly (ether ether ketone) (PEEK)-cages (n=9). The force-displacement curves were collected to calculate yield displacement and load, ultimate load displacement and stiffness, yield angular displacement and torque, ultimate load and angle displacement torque and stiffness for comparative analysis.  RESULTS AND CONCLUSION: (1) In the static axial compression test, YP-cage was superior to PEEK-cage in terms of stiffness, yield load, ultimate displacement, and load limit in three groups of tests (9, 11, 13 mm) (P < 0.01), but the yield displacement of YP-cage was smaller than that of PEEK-cage (P < 0.05). (2) In the static torsion test, there was no significant difference in the ultimate torsion angle between YP-cage and PEEK-cage in 9 mm group. YP-cage was lower than PEEK-cage in yield torque, yield torsion angle, and ultimate torque (P < 0.01), while YP-cage torsional stiffness was greater than PEEK-cage in 9 mm group and 11 mm group (P < 0.01). (3) The results show that the novel press-fit mechanical lumbar cage has higher compressive strength than PEEK cage, but the torsional strength is not as good as PEEK-cage. 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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Debridement, antibiotics, and implant retention combined with replacement of assembled components in treatment of acute prosthetic joint infection after total hip arthroplasty Pan Xian, Zhang Yuanjin, Zhang Guofu, Li Jun, Liu Bingxia, Zhou Dingkang, Sun Farui 2025, 29 (21):  4499-4505.  doi: 10.12307/2025.163 Abstract ( 51 )   PDF (1546KB) ( 98 )   Save BACKGROUND: Lifespan of prosthetic joint was being influenced by periprosthetic infection after total hip arthroplasty. Combination of debridement, antibiotics, and implant retention with the replacement of assembled components represents a novel approach in the management of acute prosthetic joint infection after total hip arthroplasty. OBJECTIVE: To observe the efficacy of debridement, antibiotics, and implant retention combined with the replacement of assembled components in the treatment of acute prosthetic joint infection after total hip arthroplasty. METHODS: Twenty-two patients with acute prosthetic joint infection after initial total hip arthroplasty at the Department of Orthopedics, Huangshi Central Hospital, China, between July 2018 and February 2022 were enrolled. The infection time of all patients was less than 3 weeks after the initial arthroplasty. Intraoperative joint fluid extraction and bacterial culture of infected synovium proved to be acute stage infection. They were treated using debridement, antibiotics, and implant retention combined with the replacement of assembled components. Infections were assessed using leukocyte count, erythrocyte sedimentation rate, and C-reactive protein levels before, 3 and 6 months after surgery. Improvements in hip joint function were evaluated using Harris hip score. Pain relief was assessed using visual analog scale score. Paired sample t-test was used to analyze the improvement of each index before and after operation.  RESULTS AND CONCLUSION: (1) One patient died of non-periprosthesis infection and was subsequently lost to follow-up, which was excluded. The remaining 21 patients received clinical follow-up, and the follow-up time was more than 1 year, with a mean follow-up time of (19.52±3.88) months. Among them, 20 patients were successfully treated with surgery and 1 patient failed, and the infection control rate was 95%. (2) The levels of leukocyte count, erythrocyte sedimentation rate, and C-reactive protein were lower in 3 and 6 months after surgery (P < 0.05); Harris hip function scores were higher than those before surgery (P < 0.05); pain visual analog scale scores were lower than those before surgery (P < 0.05), and the differences were significant (P < 0.05). (3) It is indicated that debridement, antibiotics, and implant retention combined with the replacement of assembled components after total hip arthroplasty in patients with acute prosthetic joint infection can effectively control prosthetic joint infection, improve hip function, and relieve hip pain caused by infection. 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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Total hip arthroplasty after failure of internal fixation for intertrochanteric fractures: model prediction of occult blood loss Lyu Xiaodong, Gu Jinrui, Gao Jingyu, Ge Jianzhong 2025, 29 (21):  4506-4513.  doi: 10.12307/2025.187 Abstract ( 65 )   PDF (1371KB) ( 92 )   Save BACKGROUND: Intertrochanteric fractures of the femur are particularly common in elderly and osteoporosis patients, and treatment often requires internal fixation surgery to stabilize the fracture and promote healing. However, internal fixation surgery may occasionally fail, leading to serious problems such as nonunion of fractures, malunion, or re-fracture. OBJECTIVE: To explore the effect of artificial total hip arthroplasty on postoperative failure of internal fixation for intertrochanteric fractures of the femur and the influencing factors of postoperative occult blood loss. METHODS: Totally 86 patients with failed internal fixation of intertrochanteric fractures of the femur who were treated in First People’s Hospital of Yangquan City from May 2019 to September 2022 and had complete follow-up data were collected. Using artificial total hip arthroplasty for treatment, relevant clinical indicators of the patient were recorded, and Harris score, visual analog scale score, and SF-36 score were compared and analyzed before and after surgery. Univariate and multivariate logistic regression analysis was conducted on the factors affecting occult blood loss after total hip arthroplasty. Logistic regression models and neural network models were established to predict occult blood loss. The predictive performance and accuracy of the two models were compared by drawing receiver operating characteristic curves. RESULTS AND CONCLUSION: (1) Totally 86 patients with intertrochanteric fractures of the femur were successfully treated with artificial total hip arthroplasty after internal fixation failure. (2) There were statistically significant differences in Harris score, visual analog scale score, SF-36 score, and hip active range of motion between patients before and 3, 6, and 12 months after surgery (P < 0.05). (3) The age, hypertension ratio, diabetes ratio, osteoporosis ratio, operation time, total blood loss, intraoperative blood loss, postoperative drainage volume, and hemoglobin decrease in the high occult blood loss group were significantly higher than those in the low occult blood loss group (P < 0.05). The proportion of bone cement type prostheses, anterior approach, and 2-3 grade hip joint space in the low occult blood loss group were higher than those in the high occult blood loss group (P < 0.05). There was no statistically significant difference between the two groups in terms of gender ratio, body mass index, proportion of chronic bronchitis, proportion of sides, anesthesia method, and acetabular cup diameter (P > 0.05). (4) Through multivariate logistic regression analysis, age, diabetes, osteoporosis, prosthesis type, surgical approach, hip joint space, total blood loss, intraoperative blood loss, postoperative drainage volume, and hemoglobin decrease were the risk factors for high occult blood loss after total hip arthroplasty (P < 0.05). (5) After incorporating influencing factors into the logistic regression model and neural network model for predicting occult blood loss, the receiver operating characteristic curves of the two models were plotted with area under curve values of 0.882 and 0.923, sensitivity values of 0.879 and 0.886, specificity values of 0.854 and 0.908, Youden index values of 0.733 and 0.794, and accuracy values of 0.867 and 0.897, respectively. The area under curve, Youden index, and accuracy of both models were higher than those of neural network models. (6) It is concluded that total hip arthroplasty has a significant clinical effect on treating postoperative failure of internal fixation for intertrochanteric fractures of the femur, with good recovery of hip joint range of motion. Age, diabetes, osteoporosis, prosthesis type, surgical approach, hip joint space, total blood loss, intraoperative blood loss, postoperative drainage volume, and hemoglobin decrease are important factors for the high risk of occult blood loss after total hip arthroplasty. Logistic regression model and neural network model based on risk factors have little difference in the prediction results of occult blood loss, and neural network model is higher.   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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Dose-effect relationship between dexmedetomidine and ropivacaine during pericapsular nerve group block in elderly patients undergoing total hip arthroplasty Li Yuanfeng, Ye Pufeng, Pan Guifeng, Mai Zhenjiang 2025, 29 (21):  4514-4520.  doi: 10.12307/2025.168 Abstract ( 78 )   PDF (898KB) ( 175 )   Save BACKGROUND: Ropivacaine and dexmedetomidine are two commonly used local anesthetic agents and adjuvants in elderly total hip arthroplasty. They provide sedation and analgesic effects during peripheral hip nerve blocks. OBJECTIVE: To explore the dose-effect relationship between dexmedetomidine and ropivacaine in continuous sedation during pericapsular nerve group block in elderly patients undergoing total hip arthroplasty.   METHODS: A total of 120 elderly patients who received total hip arthroplasty in Dongguan Hospital, Guangzhou University of Chinese Medicine from January 2021 to January 2023 were selected as study subjects and randomly divided into two groups 1:1 matching according to propensity matching method. The observation group (n=60) received pericapsular nerve group block by giving 20 mL mixture of ropivacaine and 1 μg/kg dexmedetomidine. The control group (n=60) received received pericapsular nerve group block by giving 20 mL of ropivacaine. The general data, perioperative indexes, postoperative analgesia, hemodynamic indexes, inflammatory factors, stress indexes, postoperative adverse reactions, length of hospital stay, and the occurrence of postoperative complications were compared and analyzed between the two groups. The median effective dose and 95% effective dose concentrations of ropivacaine pericapsular nerve group block were calculated by the Probit method.   RESULTS AND CONCLUSION: (1) The postoperative analgesia of the observation group was better than that of the control group, and the visual analog scale score at 6-hour dynamic, 12-hour static, 12-hour dynamic, 24-hour static, 24-hour dynamic, 48-hour static, 48-hour dynamic, as well as the time of first patient-controlled analgesia compression and the number of patient-controlled analgesia compression at 24 and 48 hours postoperatively were statistically different (P < 0.05). (2) There were significant differences between the two groups in mean arterial pressure and heart rate at extubation and 12 hours after extubation (P < 0.01). (3) The levels of interleukin-6, tumor necrosis factor-α, epinephrine, and noradrenaline in the observation group were significantly lower than those in the control group at 24 and 48 hours after surgery (P < 0.01). (4) There was significant difference in the length of hospital stay between the two groups (P < 0.01), and no difference was detected in the occurrence of postoperative complications (P > 0.05). (5) The median effective dose and 95% effective dose values of dexmedetomidine combined with ropivacaine were 0.164% and 0.188%, respectively, while the median effective dose and 95% effective dose values of ropivacaine alone were 0.194% and 0.276%, respectively. (6) It is concluded that using dexmedetomidine combined with ropivacaine in pericapsular nerve group block can effectively alleviate postoperative analgesia in elderly patients with total hip arthroplasty, help maintain the hemodynamic stability of patients, reduce postoperative inflammation and stress response, and shorten the length of hospital stay. In addition, dexmedetomidine can reduce the dosage of ropivacaine under the condition of effective pericapsular nerve group block reaction. 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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Comparison of short-term therapeutic effects between digital precision total knee arthroplasty and traditional methods Wang Yuning, Zhu Haotian, Liu Kang, Ding Huanwen, Yan Han 2025, 29 (21):  4521-4528.  doi: 10.12307/2025.188 Abstract ( 63 )   PDF (2379KB) ( 28 )   Save BACKGROUND: Traditional total knee arthroplasty has limited preoperative preparation. We propose a digital precision total knee arthroplasty based on computer simulation and 3D printing technology, aiming to enhance surgical outcomes through comprehensive preoperative planning. OBJECTIVE: To establish a digital precision total knee arthroplasty using computer simulation and personalized surgical guides, and to compare the clinical outcomes between the new and traditional approaches. METHODS: A retrospective analysis was conducted on 97 patients who underwent total knee arthroplasty. Patients were divided into two groups based on the surgical method they received. The control group (n=48) underwent total knee arthroplasty using traditional methods and used conventional film templates. The observation group (n=49) underwent surgery using the digital precision total knee arthroplasty and utilized computer-assisted technology to select prosthetic sizes. Surgical time, intraoperative blood loss, preoperative and postoperative Hospital for Special Surgery knee joint function scores, as well as the differences in femoral alignment, knee joint line angle and tibial slope, and hip-knee-ankle angle compared to standard angles were compared between the two groups.  RESULTS AND CONCLUSION: (1) There were no significant differences in gender, age, body mass index, Hospital for Special Surgery knee scores, as well as the differences in tibial slope, femoral alignment, knee joint line angle, hip-knee-ankle angle compared to standard angles between the two groups (P > 0.05). (2) Compared to the control group, the observation group showed shorter surgical time, reduced blood loss, and significant increases in knee joint Hospital for Special Surgery knee scores at 3 months postoperatively compared to preoperative scores (P > 0.05). Additionally, the postoperative Hospital for Special Surgery knee scores were higher in the observation group than in the control group (P > 0.05). (3) The differences in tibial slope, femoral alignment, knee joint line angle, and hip-knee-ankle angle compared to standard angles were significantly different between the two groups; the observation group was better than the control group (P < 0.05). (4) The accuracy of predicting femoral implant size was 94% in the observation group and 58% in the control group, while the accuracy of predicting tibial implant size was 96% in the observation group and 62% in the control group. (5) It is indicated that digital precision total knee arthroplasty results in shorter surgical time, reduced blood loss, and better postoperative knee joint function scores and alignment compared to traditional total knee arthroplasty. It demonstrates favorable clinical outcomes. 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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Opposing needling acupuncture combined with preemptive analgesia in treatment of pain after initial unilateral total knee arthroplasty Xu Minglan, Hu Xiaoxue, Shen Jun, Xiang Zheng, Zhang Chengbo, Xiao Lianbo 2025, 29 (21):  4529-4536.  doi: 10.12307/2025.199 Abstract ( 74 )   PDF (1040KB) ( 47 )   Save BACKGROUND: With the continuous improvement of artificial biological materials and surgical techniques, total knee arthroplasty has become the preferred way to improve the quality of life of patients with knee osteoarthritis. However, patients with knee osteoarthritis have severe pain after knee arthroplasty, and there is no good treatment at present. Electroacupuncture therapy is a low-cost option for pain relief and has wide application prospects in combination with preemptive analgesia.  OBJECTIVE: To investigate the effect of opposing needling acupuncture with preemptive analgesia on postoperative analgesia after initial unilateral total knee arthroplasty in patients with knee osteoarthritis.  METHODS: Using a randomized controlled design, 120 participants were selected from Shanghai Guanghua Hospital of Integrative Medicine. All of them received the initial unilateral total knee arthroplasty. The patients were divided into three groups by using the statistical software SPSS 25: pre-electroacupuncture group, post-electroacupuncture group, and sham group, with 40 patients in each group. In pre-electroacupuncture group, opposing needling acupuncture was performed 1 day before operation, 30 minutes before anesthesia induction, and 1-3 days after operation. In post-electroacupuncture group, opposing needling acupuncture was performed with the same acupoints and parameters 1-3 days after operation, thus the sham electroacupuncture was performed 1 day before operation and 30 minutes before anesthesia induction. The sham group was treated with the same acupuncture point parameters with five times of sham electroacupuncture. The improvement of numerical rating scale after operation, the consumption of remifentanil and propofol used during operation, the time when patient first used the patient-controlled analgesia, the number of postoperative nausea and vomiting, the increase rate of thigh circumference, and the success rate of blind method were compared among the three groups.  RESULTS AND CONCLUSION: (1) Compared with the pre-electroacupuncture group, the improvement of numerical rating scale at rest between post-electroacupuncture group and sham group on day 4 after operation was significantly reduced; the improvement of numerical rating scale at rest in sham group on day 7 after operation was significantly reduced (P < 0.05). (2) Compared with the pre-electroacupuncture group, the improvement of numerical rating scale score between post-electroacupuncture group and sham group on day 4 after operation was significantly reduced (P < 0.05), and the improvement of numerical rating scale with movement on day 7 after operation was not significant among the three groups (P > 0.05). (3) Compared with the pre-electroacupuncture group, the remifentanil consumption was significantly increased in post-electroacupuncture group and sham group (P < 0.05). (4) Compared with the pre-electroacupuncture group, the first time used the patient-controlled analgesia pump was significantly shortened in post-electroacupuncture group and sham group (P < 0.05). (5) Compared with the pre-electroacupuncture group, the number of postoperative nausea was increased in post-electroacupuncture group and sham group (P < 0.05). (6) Compared with the pre-electroacupuncture group, the increase rate of thigh circumference in post-electroacupuncture group and sham group was significantly increased on day 3 and day 7 after operation (P < 0.05). Compared with the post-electroacupuncture group, the increase rate of thigh circumference in sham group was significantly increased on day 3 and day 7 after operation (P < 0.05). (7) There was no significant difference in the success rate of blind method among the three groups (P > 0.05). (8) The artificial knee prosthesis has good biocompatibility. To conclude, opposing needling acupuncture with preemptive analgesia can relieve acute pain after total knee arthroplasty, reduce the consumption of intraoperative anesthesia, prolong the time of postoperative analgesia, alleviate postoperative adverse reactions, and reduce the increase rate of thigh circumference.  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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Correlation between body mass index and efficacy after medial unicompartmental knee arthroplasty in postmenopausal women Mou Limin, Li Chao, Zhang Wenhao, Shi Zhengyu, Deng Yingjie, Fang Rui 2025, 29 (21):  4537-4544.  doi: 10.12307/2025.186 Abstract ( 64 )   PDF (928KB) ( 95 )   Save BACKGROUND: In the follow-up after unicompartmental knee arthroplasty, some patients have knee pain, among which postmenopausal obese women are the most common. As an important index to measure the degree of body obesity, whether body mass index is related to the curative effect after unicompartmental knee arthroplasty and whether obesity will affect the function of knee joint after operation are worthy of further study. OBJECTIVE: To evaluate the clinical efficacy of postmenopausal obese women undergoing medial unicompartmental knee arthroplasty, and to determine the influence of body mass index on the quality of life after unicompartmental knee arthroplasty.   METHODS: Female postmenopausal patients who underwent medial unicompartmental knee arthroplasty for the first time due to medial knee pain from January 2017 to January 2019 in the Fourth Clinical Medical College of Xinjiang Medical University were enrolled. A total of 270 cases were included according to inclusion and exclusion criteria, and were divided into 4 groups according to preoperative body mass index: There were 42 cases in normal group (body mass index 18.5-22.9 kg/m2), 58 cases in overweight group (body mass index 23.0-24.9 kg/m2), 122 cases in obese group (body mass index 25.0-29.9 kg/m2), and 48 cases in severely obese group (body mass index ≥30 kg/m2). Hospital for Special Surgery score, Western Ontario and McMaster Universities Osteoarthritis Index score, knee range of motion, visual analog scale score, and hip-knee-ankle angle were compared before, after and at the last time in each group. Patients were followed up to record the time of use of prostheses after surgery and reasons for failure or revision. The effective utilization rate of prostheses was calculated and compared in each group. Survival curve was used for statistical analysis of the effective utilization rate of prostheses.  RESULTS AND CONCLUSION: (1) There was no significant difference in postoperative follow-up time, knee joint range of motion, visual analog scale score, and hip-knee-ankle angle between the groups (P > 0.05). (2) The Hospital for Special Surgery score and Western Ontario and McMaster Universities Osteoarthritis Index score of each group in final follow-up were significantly improved compared with those before surgery (P < 0.05), and the postoperative effect was obvious in each group (P < 0.05).  Regarding Hospital for Special Surgery score, the improvement effect was worse in the severely obese group. (3) The comparison of hip-knee-ankle angle between all groups immediately after surgery and the last follow-up showed that there were significant differences between the other groups at two time points (P < 0.05) except the normal group (P > 0.05). (4) The effective utilization rate of prosthesis in normal, overweight, obesity, and severely obese groups was 100%, 95%, 94%, and 94%, respectively, and there was no significant difference between the groups (χ2=2.532, P=0.469). (5) It is indicated that body mass index of postmenopausal obese women had no significant effect on the effective utilization rate of medial unicompartmental prosthesis. Obesity is an important factor affecting the postoperative knee function score and the effective utilization rate of prosthesis. Weight should be properly controlled before and after unicompartmental knee arthroplasty. At the same time, female body mass index ≥ 30 kg/m2 is not the best indication for unicompartmental knee arthroplasty. It is suggested that female patients undergoing unicompartmental knee arthroplasty should control body mass index below 30 kg/m2. 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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Anatomical characteristics of normal development and variation of axis in children based on CT images Lyu Shaomao, Lan Zuozhen, Wu Wenxue, Chi Jincheng, Duan Shaoyin 2025, 29 (21):  4545-4551.  doi: 10.12307/2025.171 Abstract ( 85 )   PDF (1156KB) ( 76 )   Save BACKGROUND: The development and evolution of atlas are complex, and there are a few research reports. CT imaging can show the normal development process, anatomical structure, developmental variation and deformity of the axis. It has important clinical value to clarify the time of occurrence of ossification center of axis and closure of epiphyseal plate and its evolution process and law.  OBJECTIVE: To present the anatomical structure of the normal development and variation of children’s axis based on CT images. METHODS: CT images obtained from 732 children aged 0 to 15 years who underwent neck scans between June 2016 and November 2019 were retrospectively analyzed. The observation indicators encompassed the axis odontoid, bilateral pedicle, vertebral ossification center, secondary ossification center at the tip of odontoid, pedicle, base of odontoid, and posterior median epiphyseal plate, as well as any variations or deformities in axis development. The changes in these indicators were analyzed and compared across different age groups. SPSS 17.0 statistical software package was utilized for data classification and statistical analysis.  RESULTS AND CONCLUSION: (1) A total of 732 subjects were examined, comprising 718 cases (98.1%) with normal development of the axis and 14 cases (1.9%) exhibiting deformity or dysplasia. (2) The axis demonstrated the presence of five ossification centers, including those of the bilateral pedicles, odontoid process, and vertebral body, which were observed at birth. The median age for the secondary ossification center located at the tip of the odontoid process was determined to be 5.7 years, with an interquartile range of 4.1 to 7 years. The earliest recorded occurrence was observed at 8 months and 22 days, while the latest occurrence was noted at 12 years and 10 months. (3) The median age at which fusion took place was 6 years, with an interquartile range of 5-8 years. The maximum age at which non-fusion was observed was 8 years and 9 months, while the minimum age at which fusion occurred was 4 years and 3 months. (4) The median age at which bilateral epiphyseal plate closure occurred was approximately 3.8 years, with an interquartile range of about 2.9-4.6 years. The earliest observed closure was at 2 years and 3 months, while the latest observed unclosure was at 6 years old. (5) The median age at which odontoid base epiphyseal plate closure occurred was 5.2 years, with an interquartile range of 3.5-6.8 years. The minimum age for closure was 2 years and 6 months, and the latest age for non-closure was 9 years and 6 months. (6) The posterior median epiphyseal plate typically closed at a median age of 1.5 years, with an interquartile range of 1.0-2.1 years. However, two cases exhibited delayed closure, occurring at ages 2 years and 5 months, and 14 years, respectively. The earliest closure observed was at 6 months and 20 days. (7) Axis malformation or developmental abnormalities, including 7 cases of accessory ossification center and accessory epiphyseal plate, 3 cases of free ossified small bones in the axis, 2 cases of posterior median epiphyseal plate failure, 2 cases of secondary ossification centers in the absence of the apex of odontosis, and 1 case of absence at ossification center in the odontoid of the armature vertebrae. (8) It is concluded that the utilization of multi-slice spiral CT scanning in conjunction with the multi-plane reconstruction technique enables comprehensive visualization of the anatomical structure of the axis, facilitating precise assessment of both its typical developmental variations and deformities. 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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Short-term effect of manipulation therapy for lumbar disc herniation quantitatively evaluated by three-dimensional scoliosis angle Gu Jiangpeng, Chen Xujing, Liu Yikang, Guo Wei, Liu Xiaomin, Wang Fei, Feng Wei 2025, 29 (21):  4552-4559.  doi: 10.12307/2025.813 Abstract ( 69 )   PDF (1593KB) ( 163 )   Save BACKGROUND: Patients with lumbar disc herniation have different physical deformities due to nucleus pulposus compression and mechanical imbalance. On this basis, Professor Feng Tianyou proposed the “four-step waist type.” Professor Feng Wei proposed the objective quantification of three-dimensional scoliosis angle “four-step waist type.”  OBJECTIVE: To explore the application value of three-dimensional scoliosis angle in evaluating the efficacy of Feng’s spinal manipulation in the treatment of patients with lumbar disc herniation. METHODS: A total of 149 hospitalized patients with lumbar disc herniation were enrolled sequentially, including 96 cases of type-I/II and 55 cases of type-III/IV. The patients were treated with manual therapy for 2 weeks, and 10 healthy volunteers were included as healthy controls. The three-dimensional scoliosis angle was measured using surface topography technology. The difference of three scoliosis angles between patients with type-I/II and type-III/IV was compared before and after treatment. The difference between patients after treatment and healthy subjects was compered. The difference of three-dimensional scoliosis angles between type-I / II and type-III / IV after treatment was compared. The intrinsic correlation of each projection plane of three-dimensional scoliosis angle and its correlation with commonly used clinical efficacy scores were explored.   RESULTS AND CONCLUSION: (1) The three-dimensional scoliosis angle was significantly different in patients with type-I/II and type-III/IV before and after treatment (P < 0.05). (2) There were significant differences in coronal curve angle and transverse curve angle between patients with type-I/II, type-III/IV and healthy subjects (P < 0.05), but there was no significant difference in sagittal curve angle (P > 0.05). (3) There was a correlation between the angles of each section of the three-dimensional angle, and there was a correlation between the three-dimensional angle and the subjective scale. (4) It is indicated that the three-dimensional scoliosis angle can quantitatively evaluate the changes of body deformity before and after treatment. Quantitative indicators can reveal the changes in the patient’s condition before and after treatment. The three-dimensional scoliosis angle can reflect the severity of the impact on the patient’s living conditions, but the evaluation of scoliosis by a single plane parameter has certain limitations.  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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Modeling methods and evaluation criteria in animal models of steroid-induced osteonecrosis of the femoral head Wu Xiuli, Yan Xiaoxia, Ren Zhiqiang, Sun Nan, Li Jinju 2025, 29 (21):  4560-4567.  doi: 10.12307/2025.190 Abstract ( 143 )   PDF (935KB) ( 117 )   Save BACKGROUND: Steroid-induced osteonecrosis of the femoral head is a key risk factor for non-traumatic femoral head necrosis, and the incidence of it has gradually increased in recent years, but its specific pathogenesis is still unclear, and finding a reasonable animal model is essential for disease research and treatment.  OBJECTIVE: To review the commonly used animal models of steroid-induced osteonecrosis of the femoral head in recent years, and to analyze the advantages and disadvantages of different modeling methods and evaluation criteria, so as to provide a reference for follow-up research.  METHODS: The articles published from 2013 to 2023 were searched in CNKI, WanFang Data, and PubMed with the keywords “femoral head necrosis, osteonecrosis of the femoral head, steroid-induced osteonecrosis of the femoral head, animal model.” Finally, 61 articles were involved for comprehensive analysis according to the inclusion criteria, including 38 English articles and 23 Chinese articles.  RESULTS AND CONCLUSION: (1) Rabbits, rats, and chickens are the animals that are widely used in the study of steroid-induced osteonecrosis of the femoral head models. (2) Hormone combined with lipopolysaccharide or horse serum modeling has low mortality, high success rate, and strong stability. (3) Histopathology is the gold standard for the evaluation model, but the experiment needs to be terminated, which is not conducive to subsequent experimental research, so finding a non-invasive alternative method is still the direction of future efforts. (4) An ideal model of steroid-induced osteonecrosis of the femoral head has not yet been explored, and future researchers need to continue to strive to achieve breakthroughs in this field as soon as possible.  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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Inflammatory signaling pathways in traditional Chinese medicine for treating fever after lumbar interbody fusion surgery Fang Yuting, Peng Hong, Pang Yujie 2025, 29 (21):  4568-4575.  doi: 10.12307/2025.200 Abstract ( 105 )   PDF (901KB) ( 43 )   Save BACKGROUND: Postoperative fever is one of the common clinical symptoms after posterior lumbar interbody fusion. There is no clear etiology or pathogenesis. The postoperative body temperature of patients is easy to repeat, the course of the disease is long, and the therapeutic effect of western medicine is poor, which affects the postoperative recovery of patients.  OBJECTIVE: To review the relationship between inflammatory signaling pathways and postoperative fever and the mechanism of Chinese medicine in preventing and treating fever after posterior lumbar interbody fusion, and to explore new therapeutic drugs for postoperative fever. METHODS: The CNKI Chinese Journal full-text database, WanFang database, and PubMed database were searched for articles published from June 2006 to December 2023. Chinese search terms were “Chinese medicine, postoperative fever, inflammation, interleukin-1, interleukin-6, interleukin-8, interferon gamma, tumor necrosis factor, prostaglandin E2, p38 mitogen-activated protein kinase, nuclear factor-κB, Toll-like receptor, Janus kinases/signal transduction and transcriptional activator, Notch signaling pathway.” English search terms were “medicinal herb, postoperative fever, inflammation, interleukin-1, interleukin-6, interleukin-8, γ-interferon, tumor necrosis factor, prostaglandin E2, p38 mitogen-activated protein kinase, nuclear factor-κB, toll-like receptor, janus kinases/signal transducer and activator of transcription, notch signaling pathway.” Articles with irrelevant research content and poor quality were excluded, and 100 articles were included and summarized. RESULTS AND CONCLUSION: (1) The operation induced the release of inflammatory factors, and the pro-inflammatory factors acted on the thermoregulatory center in the anterior hypothalamus to promote fever. (2) The absorption of bleeding and oozing fluid in the incision after surgery, and the phagocytosis of the egg white decomposition products of the necrotic cells, produce endogenous pyrogen (interleukin, tumor necrosis factor, interferon, etc.), leading to fever. (3) Cytokines pass through inflammatory signals, play an inflammatory role, and promote fever. (4) Chinese herbs or Chinese herbal compounds can regulate inflammatory signaling pathways and play an anti-inflammatory and antipyretic role in preventing and treating postoperative fever. Due to the lack of the mechanism of action of traditional Chinese medicine, it is necessary to further study and clarify the signaling pathways related to the prevention and treatment of postoperative fever by traditional Chinese medicine, and use modern technology to link cellular and molecular technology with the pharmacological mechanism of traditional Chinese medicine, so as to guide clinicians to use medicine and promote postoperative recovery of patients. (5) Chinese medicine combined with Western medicine in the treatment of postoperative fever is a future research hotspot. We should give full play to the advantages of Chinese medicine, and clarify the target mechanism of action of different syndrome types of Chinese medicine monomer or active ingredient extracts and Chinese medicine decoction.  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 neuropilin 1 in promoting angiogenesis-osteogenesis coupling during fracture healing Zheng Li, Ding Yiheng, Li Xinhao, Wen Zekai, Jiang Bingzheng, Lin Xuexia 2025, 29 (21):  4576-4583.  doi: 10.12307/2025.809 Abstract ( 125 )   PDF (1030KB) ( 98 )   Save BACKGROUND: Neuropilin 1 plays a critical role in fracture healing, especially in osteogenesis-angiogenesis coupling. Osteogenesis-coupled angiogenesis is vital for fracture healing, including angiogenesis and bone formation (especially H-type vessel formation) and their association.  OBJECTIVE: To review the research progress of neuropilin 1 in promoting osteogenesis-coupled angiogenesis during fracture healing. METHODS: The literature search was performed in the PubMed and Chinese National Knowledge Infrastructure databases for articles published from January 1982 to April 2024 using the search terms “Neuropilin-1, neuropilin 1, NRP1, neuropilin-1, NRP-1, Neuropilin 1, Nrp1, Nrp-1.” We identified 43 articles associated with fracture healing, H-type vessels, arteries, bone cells, and angiogenesis-osteogenesis coupling. Moreover, 24 articles were searched manually. Finally, 67 papers were included.  RESULTS AND CONCLUSION: (1) Angiogenesis, osteoblastogenesis, and their association were critical for angiogenesis-osteogenesis coupling during fracture healing. Especially H-type vessel formation was critical during fracture healing. H-type vessels consisted of endothelial cells and pericytes. Osteoblasts, osteoclasts, chondrocytes, and other skeletal cells were critical contributors to new bone formation. (2) Neuropilin 1 enhanced endothelial cell migration and stabilization, increased stability of endothelial cells and pericytes, and strengthened the link of endothelial cells and pericytes to initiate angiogenesis by vascular endothelial growth factor and platelet-derived growth factor. (3) Neuropilin 1 promoted bone regeneration by suppressing osteoclastogenesis and enhancing osteoclasts and chondrocyte formation. (4) Neuropilin 1 was a key factor in angiogenesis-osteogenesis coupling. (5) Topical application of neuropilin 1 and relative biologics, and combination neuropilin 1, nano drug-loading systems, and polymerized smart materials provided a new idea for treatment of fractures and hold great promise for extensive applications. 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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Personalized combination of treatment options for osteochondral lesions of the talus Chen Xueming, She Chang 2025, 29 (21):  4584-4592.  doi: 10.12307/2025.818 Abstract ( 148 )   PDF (895KB) ( 180 )   Save BACKGROUND: For the treatment of osteochondral lesions of the talus, different treatment methods are adopted according to different types or clinical symptoms, including rehabilitation treatment, surgical treatment and biological agent treatment. Most of the rehabilitation treatment relieved the symptoms and delayed the disease in a short time. In recent years, arthroscopic microfractures, kirschner wire drilling, talus cartilage transplantation, autologous osteochondrocyte transplantation, stem cell transplantation, and biological preparation platelet-rich plasma can achieve good results. OBJECTIVE: To summarize the progress in the treatment of osteochondral lesions of the talus and provide a reference for their clinical treatment.  METHODS: Using English search terms “talus, osteochondral lesions of the talus” and Chinese search terms “microfracture, transplantation, platelet-rich plasma, stem cell,” we searched the PubMed and CNKI databases for related articles published from January 2019 to January 2024. A total of 67 articles were included for comprehensive analysis.  RESULTS AND CONCLUSION: (1) There are many ways to treat osteochondral lesions of the talus. Conservative rehabilitation and biological agents can alleviate the condition for Hepple type I and II lesions. Microfracture or Kirschner wire drilling bone marrow stimulation treatment is used for Hepple type III and above and lesion diameter < 15 mm, but the long-term efficacy is poor. Replacement and regeneration strategies are used for larger lesions, and transplant failure is the main risk. (2) Biological agent treatment is a new treatment method and is often used in combination therapy. (3) In view of the treatment of osteochondral lesions of the talus, many factors such as the area and location of cartilage injury should be taken into account. The selection of the treatment plan should also take into account the level of medical technology, patient acceptance, economic status and other factor. Personalized combination treatment of various schemes is recommended to achieve good results. 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 of virtual reality technology in functional recovery of peripheral nerve injury Zhang Shuyang, Du Xinyu, Zhao Donglin, Xing Zheng, Chu Xiaolei, Li Qi 2025, 29 (21):  4593-4601.  doi: 10.12307/2025.810 Abstract ( 82 )   PDF (1048KB) ( 161 )   Save BACKGROUND: Virtual reality technology is a popular human-computer intelligent interaction technology in recent years, and has been widely used in leisure and entertainment, vocational training, medical rehabilitation and other fields. OBJECTIVE: To explore the potential of virtual reality technology combined with different therapies in functional recovery of patients with peripheral nerve injury, summarize its mechanism of action, evaluate its application effects and prospects, and discuss its advantages and disadvantages, so as to provide new ideas and methods for rehabilitation practice after peripheral nerve injury. METHODS: The relevant literature of CNKI and PubMed database from inception to May 2024 was retrieved by computer. Chinese and English search terms were “peripheral nerves injury, virtual reality, endoplasmic reticulum stress, muscle atrophy, cerebral cortex, mirror therapy, tendon vibration, treadmill training.” Finally, 68 articles were included for analysis. RESULTS AND CONCLUSION: (1) Virtual reality technology, as a new auxiliary means, simulates the real environment to provide immersive multi-sensory experiences for patients, greatly enriching the dimensions of rehabilitation training and significantly accelerating the recovery process of patients with peripheral nerve injury. Its mechanism of action is to promote cortical plasticity through multi-sensory stimulation, invading the dormant areas adjacent to the cortex, and these areas responding to other inputs or generating new muscle activation, thereby promoting functional recovery. (2) Virtual reality technology has been widely combined with traditional therapies, showcasing its unique advantages. When combined with mirror therapy, the advantage of virtual reality is breaking the limitation of body position and advancing the time point of rehabilitation intervention. When combined with tendon vibration, virtual reality technology enhances the dual stimulation of visual and tactile perception to enhance the illusion of movement, significantly improving the perception and motor ability of patients, but also raises the issue of increased perception of limb weight. In running machine training, virtual reality technology further leverages its advantages by simulating real-life environments through multi-sensory stimulation to enhance balance and walking function, but problems such as motion sickness still exist. (3) Therefore, in actual applications, due to the fact that virtual reality combined with mirror therapy and tendon vibration will enhance the illusion of movement for patients, it is more suitable for early stages of rehabilitation. Meanwhile, the combination of virtual reality and treadmill training is suitable for the later stage of rehabilitation, helping patients to better return to their daily lives. (4) Although virtual reality technology has shown great potential in peripheral nerve injury rehabilitation, there are still some problems and challenges, such as motion sickness, the design and application of virtual reality rehabilitation games, and ethical considerations. Future research should focus on solving these problems to further promote the development of virtual reality technology in the field of rehabilitation. 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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Meta-analysis of external stent fixation and internal plate fixation for treatment of comminuted distal radius fractures Lin Qing, Liu Huan, Cheng Yongzhong, Jiang Junjie, Li Yongyao, Li Guangyao 2025, 29 (21):  4602-4611.  doi: 10.12307/2025.812 Abstract ( 59 )   PDF (2273KB) ( 58 )   Save OBJECTIVE: External fixators and plate internal fixation are commonly used treatments for comminuted distal radius fractures, each with its own advantages and disadvantages in clinical practice. To systematically evaluate the clinical efficacy and safety of external fixator and plate internal fixation in the treatment of comminuted distal radius fractures, and to provide a basis for the development of guidelines for the diagnosis and treatment of distal radius fractures with integrated traditional Chinese and Western medicine.  METHODS: PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biomedical Literature Database, VIP, and WanFang databases were systematically searched to include randomized controlled trials on external fixators and internal plate fixation for the treatment of comminuted distal radial fractures published from October 2013 to October 2023. The literature was screened according to the inclusion and exclusion criteria. Review Manager was used for literature quality evaluation and meta-analysis. RESULTS: (1) Eight articles were included, including 4 in Chinese and 4 in English, with a total sample size of 648 cases, including 328 cases in the external fixation stent group and 320 cases in the internal fixation plate group. (2) At 3 months after operation, the internal fixation plate group was superior to the external fixation stent group in the range of dorsal extension, palmar flexion and supination. At 12 months after operation, the grip strength, palmar inclination, palmar flexion, pronation and supination in the internal fixation plate group were better than those in the external fixation stent group. The postoperative infection in the internal fixation plate group was better than that in the external fixation stent group, and there was no statistical difference in other outcome indicators. CONCLUSION: Eight evidences showed that in the choice of treatment for comminuted distal radius fracture, both external fixation stent and incision plate internal fixation had good therapeutic effect, and plate internal fixation was better than other factors. However, for some special patients with highly severe comminuted distal radius fractures, poor bone quality, severely contaminated open fractures, and soft tissue swelling that did not allow incision surgery, external fixation was the first choice. The results of this study have limitations, and more high-quality, large-sample, multi-center randomized controlled trials are needed in the future, emphasizing the observation of long-term efficacy and other secondary indicators, and supplementing and optimizing the current research results.  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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Research and development trends and hot spots of spinal surgical robots for treatment of spinal diseases Niu Yanyan, Zhang Qi, Fan Mingxing 2025, 29 (21):  4612-4620.  doi: 10.12307/2025.828 Abstract ( 126 )   PDF (1491KB) ( 187 )   Save BACKGROUND: In recent years, the application of surgical robots has become a research hotspot in the field of spinal surgery, but there is still a lack of literature visualization analysis of spinal surgical robots in China. OBJECTIVE: To conduct literature visualization analysis on the research hotspots of spinal surgical robots for the treatment of spinal diseases to provide a useful reference for the research and development of spinal surgical robots in China.  METHODS: The Web of Science core set database was applied to search for relevant literature on spinal surgical robots for the treatment of spinal diseases, and 900 articles were finally included. Visualization analysis was conducted on number of publications, journals, institutions, countries, keywords, co-cited documents and highly cited documents of the included literature using VOSviewer 1.6.19 software.  RESULTS AND CONCLUSION: (1) The literature in the field of spinal surgical robots for the treatment of spinal diseases has been increasing year by year, especially in 2023, when the number of publications reached a peak. United States, China, and Germany are the research hotspots in this field. National Natural Science Foundation of China is the main fund in this field. (2) Beijing Jishuitan Hospital, China and Hospital for Special Surgery in United States have made great publications to the research in this field. (3) World Neurosurgery, Spine, and Operative Neurosurgery are the main publication journals in this field. (4) Keyword analysis showed that the research mainly focused on the accuracy of robot-assisted spinal surgery, minimally invasive surgery, robotic spinal surgery, and navigation technology. (5) The results of the co-citation analysis of the literature exhibit that robot-assisted technology has significant advantages in spinal surgery. Compared with traditional surgery, spinal surgical robots such as ROSA® Spine, ExcelsiusGPS, Mazor X, and TiRobot have the advantages of high-precision navigation, precise pedicle screw placement, and real-time feedback. They reduce X-ray radiation exposure during surgery, diminish the risk of complications for patients, and improve the success rate of surgery, showing their application prospects in the field of spinal surgery. (6) Despite this, the application and accuracy of related technologies still need to accumulate experience for improvement. Robotic surgery technology has shown cost-effectiveness in reducing surgical radiation exposure and enhancing surgical accuracy. However, it is needed to explore its accuracy in pedicle screw placement surgery, the impact of surgical time, and economic benefits. (7) The results of the analysis of highly cited literature from 2021 to 2024 further show that the latest research hotspots in this field are currently focused on the application of virtual reality and augmented reality technologies, the improvement of the accuracy of robot-assisted pedicle screw placement, and the application of navigation robot spinal surgery platforms. For example, innovative technologies such as organic electrochemical neurons provide new integrated solutions for brain-computer interfaces, prosthetics, and intelligent soft robotics. Simultaneously, virtual reality and augmented reality technologies have shown broad application prospects in areas such as spinal deformity correction. 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