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28 September 2025, Volume 29 Issue 27 Previous Issue    Next Issue

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Finite element analysis of three internal fixation methods for treating Pauwels III femoral neck fractures with anterior medial bone defects Mutalipu·Silamujiang, Yusufu·Reheman, Ren Zheng, Alimujiang·Yusufu, Ran Jian, Wang Jian 2025, 29 (27):  5721-5727.  doi: 10.12307/2025.195 Abstract ( 89 )   PDF (2064KB) ( 35 )   Save BACKGROUND: Unstable femoral neck fracture with anterior medial bone defect is very rare and difficult to manage. The best internal fixation scheme for the treatment of this kind of fracture has been a controversial topic among orthopedic surgeons.  OBJECTIVE: To evaluate the biomechanical properties of different internal fixation in the treatment of Pauwels III femoral neck fracture with anterior medial defect by finite element analysis in order to provide experimental support for clinical operation decision. METHODS: The models of femoral neck fracture with anterior medial defect and Pauwels angle of 70° were constructed by Mimics 21.0, Geomagic, and Solidworks software. Three internal fixation methods were simulated: group A (3 hollow nails+medial plate), group B (femoral neck dynamic crossover nail+1 hollow nail), and group C (4 hollow nails “diamond fixation”). The stress and displacement changes of femur, internal fixation, and femoral head were analyzed under 2 100 N load of 3 times body weight.   RESULTS AND CONCLUSION: (1) The overall stress of the femur in group A was the smallest, and the force was more uniform and dispersed. The stress of the internal fixation model in group B was smaller, indicating that it had a better effect of stress dispersion and shear resistance. The stress on the stress side of the femur in group A was significantly lower than that in the other two groups, and there was no stress concentration. (2) The displacement of the whole femoral model, internal fixation or femoral head in group A was less than that in the other two groups, indicating that “hollow nail combined with medial plate” could play a better stabilizing role and could better reduce the occurrence of hip varus. (3) The application of three screws combined with medial supporting plate in vertical, unstable and anteromedial bone defect of femoral neck fracture can significantly improve the stability of fracture and resistance to deformation. It is a good choice for the treatment of this type of fracture. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of three internal fixation methods for type AO/OTA A3 distal femoral fractures Zhang Jinhui, Liu Hui, Xu Weizhen, Xiong Yuanfei, Zhang Jianping, Wu Jin 2025, 29 (27):  5728-5734.  doi: 10.12307/2025.805 Abstract ( 77 )   PDF (3485KB) ( 50 )   Save BACKGROUND: The age distribution of patients with distal femur fracture is bimodal, being more common in young adults with high-energy injuries and older individuals with low-energy injuries. In cases of complex distal femoral fractures, a single less invasive stabilization system or retrograde femoral nail is insufficient to provide a stable environment for fracture healing and combined fixation is often necessary.  OBJECTIVE: A novel combined fixation method (less invasive stabilization system combined with retrograde tibial nail) was developed for the treatment of type A3 distal femur fractures. Using finite element analysis, the bio-mechanical properties of this method were compared with two common combined fixation methods—dual plate (less invasive stabilization system combined with locking compression plate) and nail plate combination (less invasive stabilization system combined with retrograde femoral nail). This study aims to provide a theoretical basis for the selection of clinical internal fixation methods for distal femur fracture.  METHODS: CT images of a 23-year-old healthy male volunteer were utilized to reconstruct the femur three-dimensional model using Mimics and Geomagic Studio software. This model was then compared with in vitro finite element analysis data from existing literature to validate the accuracy of the femoral three-dimensional model. The three-dimensional model of type A3 distal femur fractures and internal fixation were then created using Creo 5.0 software. Three kinds of different combined fixation methods (less invasive stabilization system + retrograde tibial nail, less invasive stabilization system + locking compression plate, less invasive stabilization system + retrograde femoral nail) were assembled and subjected to Boolean operation to establish three sets of finite element models. These models were then imported into Abaqus finite element analysis software to assign material properties, apply consistent boundary conditions, and submit calculations under three loads (normal standing, slow walking, and descending stairs). The resulting stress distribution within the internal fixation as well as overall and local deformation of the femur was analyzed. Furthermore, the failure risk and anti-deformation ability of the new combined fixation method (less invasive stabilization system combined with retrograde tibial nail) were evaluated. RESULTS AND CONCLUSION: (1) Although the anti-deformation ability of the less invasive stabilization system combined with retrograde tibial nail was approximately 10% lower than that of the less invasive stabilization system combined with locking compression plate, it was comparable to that of less invasive stabilization system combined with retrograde femoral nail and demonstrated good anti-deformation ability. (2) The stiffness of the femur with all three combined fixation methods remained consistent during gait, while femur displacement increased linearly with load, indicating high stability. (3) The failure risk associated with less invasive stabilization system combined with retrograde tibial nail was lower than that of the other two methods, with a 2.94% reduction in failure risk compared to less invasive stabilization system combined with locking compression plate. (4) This new combined fixation method offers distinct advantages in terms of anti-deformation ability, safety, and effectiveness, laying a theoretical foundation for further clinical application.   Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of application of variable angle screws in posterolateral tibial plateau fractures Hu Zhenghui, Zhang Wen, Heng Hongquan, Ren Weizhi, Wu Chenying, Gu Zenghui, Peng Jian, Li Liubing, Xu Wei 2025, 29 (27):  5735-5742.  doi: 10.12307/2025.823 Abstract ( 110 )   PDF (1630KB) ( 54 )   Save BACKGROUND: During the treatment of posterolateral tibial plateau fractures through the fibular head approach, the gap between the fibular head and the lateral plateau cannot accommodate the posterior placement of a plate for all patients. OBJECTIVE: To analyze, via finite element analysis, the differences in fixation strength resulting from varying the angles and quantities of horizontal arm variable angle screws in the plate during the treatment of posterolateral tibial plateau fractures through the fibular head approach. METHODS: A finite element model was established based on CT images of the knee to ankle joints of a 30-year-old healthy adult male volunteer. The models were divided into two categories: posteriorly placed group and non-posteriorly placed group based on whether the lateral locking compression plate was posteriorly placed. The posteriorly placed group was further subdivided into groups A-D based on the offset angle of the two variable angle screws (0°, 5°, 10°, and 15°). The non-posteriorly placed group was subdivided into groups E and F based on offset angles (0° and 15°). Finite element analysis was used to evaluate the von Mises stress distribution, maximum von Mises stress, and compressive displacement under loads of 250, 500, and 750 N, exploring the mechanical differences between the groups. RESULTS AND CONCLUSION: (1) Finite element analysis results showed that under a 750 N load, the maximum compressive displacement trend of the internal fixation device was D < B=C=F < A < E. The trend for maximum von Mises stress was B < C < A < D < F < E. The trend for maximum compressive displacement on the bone was C=D < B < A < F < E, and for maximum von Mises stress, it was B < C < A < F < D < E. The displacement and stress trends for the six models were similar under loads ranging from 250 N to 750 N. (2) These results suggest that for posterolateral tibial plateau fractures fixed through the fibular head approach, posterior placement of the plate should aim to accommodate two screws. If only one screw can be fixed during surgery, variable angle screws should be offset in the range of 0-15° to increase the probability of securing two screws.  Figures and Tables | References | Related Articles | Metrics

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Effect of line adjustment area of lower limbs on knee joint function and kinematics after high tibial osteotomy Wei Changqiang, Yu Hongjian, Liu Ningning, Zhang Yinxiao 2025, 29 (27):  5743-5749.  doi: 10.12307/2025.196 Abstract ( 104 )   PDF (1178KB) ( 75 )   Save BACKGROUND: The adjustment of force lines in open wedge high tibial osteotomy can affect the retroversion of the knee joint and the height of the patella. In addition, the adjustment of force lines in open wedge high tibial osteotomy is also different according to different varus deformity. At present, the difference of weight bearing line adjustment is still controversial for the correlation index of knee joint and the function of knee joint after surgery. OBJECTIVE: To investigate the effect of line adjustment area on postoperative knee function and joint kinematics during open wedge high tibial osteotomy.  METHODS: Totally 76 patients with knee osteoarthritis who received open wedge high tibial osteotomy in Binzhou People’s Hospital Affiliated to Shandong First Medical University from March 2022 to March 2023 were selected, including 33 males and 43 females, all on one knee. The lateral border of the tibial plateau was considered as 100%. The position of the central intercondylar ridge of the knee joint was 0%. The weight bearing line of the affected limb was divided into two groups according to the difference of the lateral plateau area of the affected limb: the area of the force line passing through the lateral plateau of the tibial plateau (0-29%) was classified as group A (n=39), and the area of the lateral plateau of the tibial plateau was classified as group B (n=37) by 30% to 40%. The changes of tibiofemoral angle, medial proximal tibial angle, posterior inclination of tibia, and patellar height before and after operation were analyzed. The symptoms and function of the knee were evaluated by the Numeric Rating Scale score and the Hospital for Special Surgery knee score. RESULTS AND CONCLUSION: (1) At 1 year after surgery, the posterior inclination of tibia and the medial angle of proximal tibia were increased in both groups  (P < 0.05), and the tibiofemoral angle was reduced and patellar height was decreased in both groups (P < 0.05). The posterior inclination of tibia, medial proximal tibial angle, tibiofemoral angle, and patellar height were significantly different between the two groups at 1 year after surgery (P < 0.05). (2) The Hospital for Special Surgery knee scores of the two groups of patients at all times after surgery were better than those before surgery, and showed a gradually increasing trend (P < 0.05). There was no significant difference in the Hospital for Special Surgery knee scores 1 week and 3 months after surgery between the two groups (P > 0.05). Hospital for Special Surgery knee score of group B at 6 and 12 months after surgery was better than that of group A (P < 0.05). (3) The Numeric Rating Scale score after surgery showed a gradual downward trend (P < 0.05). No significant difference was detected between the two groups (P > 0.05). (4) The results show that the knee function and symptoms were significantly improved in the early and middle period after open wedge high tibial osteotomy, and the knee joint related parameters changed with the outward shift of weight bearing line. At 1-year follow-up, the functional recovery of knee joint in group B was better than that in group A. Long-term knee function and clinical differences after surgery need further follow-up study. Figures and Tables | References | Related Articles | Metrics

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Effect of unilateral knee osteoarthritis on gait dynamics and muscle activation asymmetry in elderly women Li Yongjie, Liu Mengling, Zhang Dakuan, Fu Shenyu, Liu Hongju 2025, 29 (27):  5750-5756.  doi: 10.12307/2025.817 Abstract ( 91 )   PDF (1110KB) ( 83 )   Save BACKGROUND: Unilateral knee osteoarthritis patients experience abnormal alterations in lower extremity gait biomechanics, yet few studies have analyzed changes in gait dynamics and muscle activation in knee osteoarthritis patients from the perspective of gait asymmetry.  OBJECTIVE: To explore the effects of unilateral knee osteoarthritis on gait dynamics and muscle activation asymmetry in elderly women.  METHODS: Thirty female patients with unilateral knee osteoarthritis attending Beijing Jishuitan Hospital Guizhou Hospital from October 2023 to March 2024 were selected as the knee osteoarthritis group, and 30 healthy elderly females without musculoskeletal disorders from the neighboring community were recruited as the control group. The kinetic and muscle activation levels of the subjects in both groups during walking were synchronously collected by a P-6000 force platform and a Free EMG300 surface EMG device. Kinetic parameters included the first and second peak forces of vertical ground reaction force. Muscle activation indexes included normalized root mean square values of rectus femoris, long head of biceps femoris, and lateral gastrocnemius muscle during the braking and pushing phases. Asymmetry index of the kinetic and muscle activation indexes were calculated separately in patients with K-L grade II and III knee osteoarthritis and controls and compared between groups by independent samples t-test and one-way analysis of variance.  RESULTS AND CONCLUSION: (1) The difference between the second peak of vertical ground reaction force of both limbs in the knee osteoarthritis group was statistically significant (P < 0.05), as well as the difference between the standardized root mean square of rectus femoris in the braking phase and gastrocnemius and biceps femoris in the pushing phase (P < 0.05). (2) In terms of asymmetry index, the difference between the asymmetry index values of the first peak of vertical ground reaction force between the two groups of subjects was not statistically significant (P > 0.05), while the difference between the second peak asymmetry index values was statistically significant (P < 0.05). The difference in asymmetry index values of standardized root mean square of rectus femoris muscle during the braking phase as well as gastrocnemius and biceps femoris muscles during the pushing phase was statistically significant between the two groups of subjects (P < 0.05). (3) The asymmetry index of the standardized root mean square values of the second peak of vertical ground reaction force, rectus femoris in the braking phase, gastrocnemius in the pushing phase, and biceps femoris in the osteoarthritis group of the knee with K-L classification grade II and III were significantly higher than those of the control group (P < 0.05). The asymmetry indices of standardized root mean square values of the second peak of vertical ground reaction force, rectus femoris in the braking phase and biceps femoris in the pushing phase were higher in the osteoarthritis group of the knee with K-L classification III than in the osteoarthritis group of the knee with classification II (P < 0.05). (4) The asymmetry indices of the second peak of vertical ground reaction, the rectus femoris muscle in the braking phase, and the muscle activation of the biceps femoris and gastrocnemius muscles in the pushing phase can be used as an important index for identifying gait asymmetry in the knee osteoarthritis, which is helpful in providing a theoretical basis for the development of rehabilitation treatment programs. It is also worth noting that extra attention should be paid to patients with higher severity of knee osteoarthritis in the clinical monitoring of gait asymmetry.  Figures and Tables | References | Related Articles | Metrics

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Comparison of biomechanical characteristics of superior and inferior pubic ramus fractures fixed with different internal fixation methods Rao Xin, Jiang Daixiang, Lu Hui Luo Yangxing, Li Meng, Liu Dingxi, Wu Qimei, Liu Rong 2025, 29 (27):  5757-5764.  doi: 10.12307/2025.816 Abstract ( 86 )   PDF (2557KB) ( 13 )   Save BACKGROUND: Percutaneous retrograde screws and minimally invasive percutaneous plates are extensively used in the treatment of unilateral pubic ramus fractures. However, the above internal fixations have the disadvantages of mistakenly penetrating the hip joint and damaging the medial pelvic trophoblastic artery. A new type of retrograde superior pubic ramus intramedullary nail offers advantages, such as fewer radiographic exposures and shorter surgery times, but the validation of the biomechanical properties of the three endoprostheses is lacking. OBJECTIVE: To compare the biomechanical differences post-treatment of upper and lower pubic ramus fractures using percutaneous retrograde screws, minimally invasive percutaneous plates, and retrograde superior pubic ramus intramedullary nail under various conditions through finite element analysis. METHODS: Pelvic CT data were collected from one volunteer and imported into Mimics 20, Geomagic Wrap 2021, and SolidWorks 2019 to create geometric models of three types of internal fixation for treating unilateral pubic ramus fractures: hollow screw group, plate group, and intramedullary nail group. Each model was imported into Ansys 2022 software, where it was set up in vertical, book-opening, and shear conditions for preprocessing and calculation to compare and analyze the mechanical stability of the implants. RESULTS AND CONCLUSION: (1) In vertical conditions, the biomechanical stability of the hollow screw treatment for unilateral pubic fractures was superior to that of the steel plate and intramedullary nail, with the smallest peak stress in the implant, which was four times lower compared to the other two groups. (2) In book-opening conditions, the steel plate treatment for unilateral pubic fractures showed better biomechanical stability, particularly in reducing stress at the fracture ends of the upper pubic branch, with stress values five times higher in the other two groups. (3) In shear conditions, the intramedullary nail treatment for unilateral pubic fractures exhibited good biomechanical stability, maintaining the best pelvic displacement, with a 25% greater displacement observed in the other two groups. (4) These findings reveal the biomechanical differences of different implants: the peak stress of implants is the smallest under vertical working conditions with percutaneous retrograde screws. Minimally invasive percutaneous plates reduce the stress at the broken end of superior pubic branch under open-book working condition. Retrograde superior pubic ramus intramedullary nail of superior pubic branch maintains pelvic displacement under shear working condition. The surgeon can combine the biomechanical differences of the implants with the actual situation of pubic injury in clinical practice to make the best implant treatment. Figures and Tables | References | Related Articles | Metrics

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Biomechanical performance of novel fully cortical bone threaded screws in modified cortical bone trajectory screw technique for lumbar vertebrae Muzaipaer · Maitusong, Xiao Yang, Gulimire · Adili, Zhigeer · Lehalebieke, Aizihaier · Aisikaer, Wang Yixi, Chen Ruilin, Paerhati · Rexiti, , 2025, 29 (27):  5765-5772.  doi: 10.12307/2025.830 Abstract ( 166 )   PDF (1059KB) ( 55 )   Save BACKGROUND: Osteoporotic trabecular structures are insufficient to maintain screw holding force, often leading to spinal fixation failure. Currently, the following four aspects are mainly used to solve this problem: (1) screw material; (2) surface coating treatment; (3) screw channel solidification strategy; (4) screw shape. The screw channel of the modified cortical bone trajectory screw placement technique has been proven to have a good fixation effect, but there is an urgent need to develop matching screws.  OBJECTIVE: To compare the biomechanical performance differences of various types of spinal cortical bone thread screws in the modified cortical bone trajectory fixation of lumbar vertebrae using the finite element method. METHODS: The L4 vertebral models were constructed based on the CT data of three adult wet lumbar specimens (two males and one female) and subjected to finite element analysis. In the modified cortical bone trajectory fixation technique, fully cortical bone thread screws (single thread screws) with lengths of 45 mm and diameters of 5.5 mm and 4.5 mm were used and considered as groups A and B, which were compared with those of the traditional pedicle screw technique group (group C, 6.0 mm diameter, 45 mm length, double-threaded screw) and the cortical bone trajectory screw group (group D, 4.5 mm diameter, 45 mm length, double-threaded screw). Axial pull-out force, screw stability (determined by the displacement ratio of upper, lower, left, and right loads), and anti-spin-out torque were measured to compare fixation strength of each group of screws. RESULTS AND CONCLUSION: (1) Axial pull-out force: Group A > group B (P=0.003), and both group A and group B were greater than the group C (P < 0.001, P=0.003) and group D (all P < 0.001). (2) Screw stability: When load was applied in the upward and downward directions on the screw, the load displacement ratio of the four screw double threads was greater in group A than in group B (P > 0.05); both group A and group B were greater than the group C (all P < 0.001) and the group D (all P < 0.001). (3) Anti-spin-out torque: Group A > group B (P=0.008), and both group A and group B were greater than the group C (P=0.008, P=0.131). (4) It is indicated that during modified cortical bone trajectory fixation of lumbar vertebrae, the novel spinal cortical bone thread screw demonstrates superior biomechanical performance compared to double thread screws applied in the clinically classic pedicle screw trajectory and cortical bone trajectory. Additionally, the novel spinal cortical bone thread screw (D=5.5 mm, L=45 mm) becomes the optimal adaptation for the modified cortical bone trajectory screw path. Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis on treatment of different types of osteoporotic vertebral compression fractures with individualized precise puncture vertebral augmentation Pan Hongyu, Li Hongtao, Xiao Changming, Li Sen 2025, 29 (27):  5773-5784.  doi: 10.12307/2025.832 Abstract ( 84 )   PDF (2796KB) ( 63 )   Save BACKGROUND: The individualized precise puncture approach is a new approach proposed for vertebral body augmentation in recent years, and has achieved good clinical results, but there is still a lack of relevant biomechanical research. OBJECTIVE: To investigate the biomechanical effects of individualized precise puncture vertebral augmentation on the vertebral endplate and intervertebral disc of osteoporotic vertebral compression fracture using finite element analysis method.  METHODS: A total of six preoperative and postoperative models of wedge type, biconcave type, and collapse type were established using the preoperative and postoperative CT imaging data of three osteoporotic vertebral compression fracture patients who had completed individualized precise puncture vertebral augmentation. 500 N moment and 10 N/m rotation moment were loaded in the vertical direction of the vertebral body to simulate the normal physiological activities of the vertebral body, including forward flexion, back extension, left bending, right bending, left rotation, and right rotation, to observe the stress changes of endplates, adjacent endplates, and intervertebral discs of different types of fractured vertebral bodies after individualized precise puncture vertebral augmentation. RESULTS AND CONCLUSION: (1) Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established. (2) After individualized precise puncture vertebral augmentation, the maximum von Mises stress values of wedge-shaped, biconcave, and collapsed fractured vertebral endplates and adjacent vertebral endplates were reduced to a certain extent. The postoperative maximum von Mises stress value increased in the T10 inferior endplate of the superior vertebral body with wedge deformity and the L1 superior endplate of the inferior vertebral body with collapsed deformity. (3) After individualized precise puncture vertebral augmentation, the overall maximum von Mises stress value of adjacent intervertebral discs in the three finite element models decreased. (4) The results show that individualized precise puncture vertebral augmentation can reduce the maximum von Mises stress value of the endplate of wedge-shaped deformity, biconcave deformity and collapsed vertebral body to a certain extent, and diminish the risk of postoperative vertebral body re-fracture. In addition, individualized precise puncture vertebral augmentation decreases the maximum von Mises stress value of the intervertebral disc, which can theoretically alleviate intervertebral disc degeneration to a certain extent.   Figures and Tables | References | Related Articles | Metrics

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Measurement of intervertebral disc height and analysis of strength after induced resorption of herniated nucleus pulpous Bai Liang, Fu Su, Yan Xu, Zhang Chunlin, Li Ying 2025, 29 (27):  5785-5794.  doi: 10.12307/2025.834 Abstract ( 171 )   PDF (1600KB) ( 74 )   Save BACKGROUND: Induced resorption of herniated nucleus pulpous is a minimally invasive, non-invasive and innovative method for the treatment of cervical/lumbar intervertebral disc herniation. After induced resorption of herniated nucleus pulpous, the research about whether cervical/lumbar intervertebral disc can maintain the original biomechanical strength has not been reported. OBJECTIVE: To measure the height of adjacent vertebral centroid of cervical/lumbar intervertebral disc before and after induced resorption of herniated nucleus pulpous operation to analyze the changes of the biomechanical strength of the intervertebral disc after reclining and to provide a new basis for induced resorption of herniated nucleus pulpous treatment of cervical and lumbar intervertebral disc herniation.     METHODS: A retrospective analysis was performed on 140 patients with cervical/lumbar intervertebral disc herniation who received induced resorption of herniated nucleus pulpous surgery in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2023. Related software was used to measure the height of adjacent vertebral centroid of cervical/lumbar intervertebral disc of patients at each follow-up time point before and after induced resorption of herniated nucleus pulpous surgery in Magnetic Resonance Imaging image data under Artificial Intelligence-assisted calibration. Unoperated T1/T2 and T12/L1 segments were taken respectively as controls. Those with preoperative height of adjacent vertebral centroid less than 8% of the corresponding T1/T2 or T12/L1 control segment were in the “height reduction group” (hereafter referred to as group A) and the rest were in the “height unchanged group” (hereafter referred to as group B). The difference of height of adjacent vertebral centroid before and after operation between the group A and the group B was statistically analyzed. Simultaneously, the correlation between the volume of cervical and lumbar herniated discs and the changes of height of adjacent vertebral centroid was analyzed according to the result measured by artificial intelligence.  RESULTS AND CONCLUSION: (1) The study maintained a total of 140 patients, including 60 cases of cervical disc herniation and 80 cases of lumbar disc herniation. The postoperative follow-up period was 7 days to 12 months. (2) A total of 281 discs were measured in the cervical vertebra group, including 60 intervertebral discs in the control group. The mean value of height of adjacent vertebral centroid before and at the last postoperative follow-up was about 20.46 mm and 20.17 mm, respectively, with no statistical difference (P > 0.05). There were 162 cervical discs in group A. The average height of adjacent vertebral centroid before and after operation was 16.65 mm and 15.92 mm, respectively, with no statistically significant difference (P > 0.05). The mean cervical disc herniation volume before and after surgery was 510.28 mm³ and 364.76 mm³, respectively, which was not significantly correlated with height of adjacent vertebral centroid change (P > 0.05). There were 64 discs in the group B, with average of 20.15 mm before operation and 19.09 mm at the last follow-up, and there was no significant difference (P > 0.05). The mean volume of cervical disc herniation before and after surgery was 515.32 mm³ and 361.98 mm³, respectively, and there was no significant correlation with the change of height of adjacent vertebral centroid (P > 0.05). (3) A total of 258 discs were measured in the lumbar spine group, of which 80 intervertebral discs in the control group, the average height of adjacent vertebral centroid was 33.03 mm before operation and 32.40 mm at the last follow-up, and there was no significant difference. There were 59 discs in the group A, and the average height of adjacent vertebral centroid before and after operation was 30.08 mm and 31.67 mm, respectively, with no statistically significant difference. The mean volume of lumbar disc herniation before and after operation was 690.51 mm³ and 496.58 mm³, respectively, and there was no significant correlation with the change of height of adjacent vertebral centroid (P > 0.05). There were 119 discs in the group B, with an average height of adjacent vertebral centroid of 35.91 mm before surgery and 34.12 mm at the last follow-up. The mean volume of lumbar disc herniation before and after operation was 698.70 mm³ and 535.99 mm³, respectively, and there was no significant correlation with the change of height of adjacent vertebral centroid. (4) It is concluded that patients with cervical/lumbar intervertebral disc herniation can maintain the same intervertebral height level after induced resorption of herniated nucleus pulpous regardless of whether the intervertebral height has decreased before operation. It can be inferred that the resorption of the herniated disc does not affect its biomechanical strength. It suggests that induced resorption of herniated nucleus pulpous surgery should be performed before the intervertebral height of the degenerate segment has decreased. The induced resorption of herniated nucleus pulpous is more valuable to maintain the biomechanical strength of the resorptive disc. Figures and Tables | References | Related Articles | Metrics

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Quantitative evaluation of knee laxity after partial anterior cruciate ligament injury with a novel digital arthrometer Zhu Zheyue, Zhang Chen, Ge Ying, Xue Han, Li Ruochen, Wu Guangwei, Ma Rui 2025, 29 (27):  5795-5801.  doi: 10.12307/2025.184 Abstract ( 77 )   PDF (1263KB) ( 63 )   Save BACKGROUND: Quantitative measurement of knee laxity after partial anterior cruciate ligament injury is crucial for timely diagnosis, post-treatment, and rehabilitation. There is a lack of research on the use of articular ligament digital arthrometer in the diagnosis of partial anterior cruciate ligament injury.  OBJECTIVE: To investigate the diagnostic value of a new articular ligament digital arthrometer in partial anterior cruciate ligament injury.  METHODS: Totally 30 patients with partial anterior cruciate ligament injury and 20 healthy volunteers were included. The anterior tibial translation values under 80, 120, and 150 N loads were measured by a homebred digital arthrometer. The anterior tibial translation and side-to-side difference were compared between the partial anterior cruciate ligament group and control group. The receiver operating characteristic curve was analyzed and area under curve was calculated, and the diagnostic sensitivity and specificity of the digital arthrometer were determined.   RESULTS AND CONCLUSION: (1) There was no significant difference in age, sex, body mass index, and course of disease between the partial anterior cruciate ligament injury group and control group (P > 0.05). (2) The side-to-side difference values of the partial anterior cruciate ligament injury group were significantly higher than those of the control group (P < 0.05), and the anterior tibial translation values of the injured side were significantly higher than those of the healthy side in the partial anterior cruciate ligament injury group (P < 0.05). (3) When the load was applied at 80 N, the diagnostic accuracy was highest (cutoff value=10.45 mm); the area under curve was 0.813 (95%CI:0.708-0.919), and the sensitivity and specificity were 76.7% and 70.0%, respectively. (4) It is indicated that the digital arthrometer can objectively and quantitatively evaluate knee laxity after partial anterior cruciate ligament injury, and provide objective diagnostic basis for patients with partial anterior cruciate ligament injury.  Figures and Tables | References | Related Articles | Metrics

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Computer simulation analysis of medial tibial stress during running Sun Yuan, Yang Chen, Ma Yunchao 2025, 29 (27):  5802-5809.  doi: 10.12307/2025.836 Abstract ( 95 )   PDF (1312KB) ( 87 )   Save BACKGROUND: Medial tibial stress syndrome is a common chronic lower limb injury among runners, potentially linked to the “muscle traction theory.” However, this hypothesis has not been fully confirmed.  OBJECTIVE: To investigate whether the contraction characteristics of the soleus, posterior tibialis, and flexor digitorum longus muscles during running are correlated with stress levels at the medial tibial border and influence the occurrence and development of medial tibial stress syndrome using musculoskeletal simulation systems and finite element analysis.  METHODS: Motion capture data of six subjects running at different speeds were input into the Anybody Modeling System for inverse dynamic simulations during the stance phase at running speeds of 2.5, 3.5, and 4.5 m/s. The calculated boundary conditions were combined with finite element models to examine the stress distribution on the medial tibia. Partial least squares regression was used to analyze the correlation between independent variables (muscle force and elastic potential energy) and the dependent variable (tibial stress).  RESULTS AND CONCLUSION: (1) There were statistically significant differences in tibial stress levels across different speeds during the stance phase (1%-50%) (P=0.044, F=3.834, ηp2=0.040). (2) Among the three speeds, the average correlation between soleus muscle force and tibial stress was the highest (r=12.999), followed by the correlation between posterior tibialis muscle force and tibial stress (r=-10.735), flexor digitorum longus muscle force (r=-9.751), posterior tibialis elastic potential energy (r=8.012), soleus elastic potential energy (r=9.076), and flexor digitorum longus elastic potential energy (r=-4.782). (3) The results indicate that with increasing running speed, tibial stress levels rise. The contraction of the soleus muscle and the release of absorbed elastic potential energy during running have a significant impact on the development of medial tibial stress syndrome, whereas the roles of the posterior tibialis and flexor digitorum longus muscles have been overestimated. Overall, the study supports the hypothesis that the contraction of the soleus muscle plays a crucial role in the development of medial tibial stress syndrome, consistent with the “muscle traction” hypothesis. Figures and Tables | References | Related Articles | Metrics

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Navigation-assisted total knee arthroplasty using functional alignment restores constitutional alignment and joint line obliquity Wang Yijun, Zheng Kai, Zhang Lianfang, Zhu Feng, Zhang Weicheng, Li Rongqun, Zhou Jun, Xu Yaozeng 2025, 29 (27):  5810-5818.  doi: 10.12307/2025.825 Abstract ( 120 )   PDF (1893KB) ( 34 )   Save BACKGROUND: Mechanical alignment is the “gold standard” alignment technique in total knee arthroplasty, but regardless of advances in prosthetic materials and robotic-assisted navigation, mechanical alignment-total knee arthroplasty still has a patient dissatisfaction rate of about 20%.  OBJECTIVE: To evaluate the early efficacy of navigation-assisted total knee arthroplasty using functional alignment. METHODS: A total of 44 consecutive cases (50 knees) that underwent computer navigation-assisted total knee arthroplasty with functional alignment from October 2019 to June 2023 were retrospectively analyzed, including 12 males (14 knees) and 32 females (36 knees). A total of 46 consecutive cases (50 knees) that underwent navigation-assisted total knee arthroplasty with mechanical axis alignment by the same surgical team during the same period were selected as controls, including 5 males (5 knees) and 41 females (45 knees). The tibial osteotomy angle, tibial plateau osteotomy amount, femoral osteotomy angle, distal femoral, posterior and anterior osteotomy amount, and joint line movement were observed in the two groups of patients. Preoperative and postoperative flexion and extension gap internal and external laxity, hip-knee-ankle angle, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, joint line convergence angle, sagittal femoral component angle, posterior tibial slope, arithmetic hip-knee-ankle angle, joint line obliquity, coronal plane alignment of the knee classification, Western Ontario and McMaster Universities Osteoarthritis Index, and Hospital for Special Surgery score and forgotten joint score were compared between the two groups. RESULTS AND CONCLUSION: (1) The intraoperative tibial plateau osteotomy angle in the functional alignment group was greater than that in the mechanical axis alignment group, and the proportion of gap imbalance (2%) was smaller than that in the mechanical axis alignment group (18%). The differences were all significant (P < 0.05). (2) The hip-knee-ankle angle, mechanical medial proximal tibial angle, arithmetic hip-knee-ankle angle, and joint line obliquity in the functional alignment group were smaller than those in the mechanical axis alignment group postoperatively, and the differences were significant (P < 0.05). (3) The most common coronal plane alignment of the knee classification before surgery was type I (80% in the functional alignment group and 42% in the mechanical axis alignment group). (4) The proportion of joint line obliquity < 177° (44%) in the functional alignment group was greater than that in the mechanical axis alignment group (14%) postoperatively. (5) Hospital for Special Surgery score at 1 month, 6 months, and last follow-up after surgery was higher in the functional alignment group than that in the mechanical axis alignment group; the differences were statistically significant (P < 0.05). The Western Ontario and McMaster Universities Osteoarthritis Index 1 month after surgery was lower in the functional alignment group than that in the mechanical axis alignment group; the difference was statistically significant (t=-2.85, P=0.005). There was no significant difference in postoperative range of motion and forgotten joint score between the two groups (P > 0.05). (6) It is indicated that navigation-assisted total knee arthroplasty using functional alignment optimizes early clinical efficacy. The functional alignment technique has advantages in restoration of constitutional alignment and joint line obliquity and avoids soft tissue release compared to mechanical alignment technique. Figures and Tables | References | Related Articles | Metrics

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Correlation between preoperative knee extensor and flexor muscle strength and postoperative gait function in total knee arthroplasty Zhang Yilong, Wu Wanling, Yang Wenwu, Wu Hongtao, Liu Wengang, He Minyi, Zhao Chuanxi 2025, 29 (27):  5819-5825.  doi: 10.12307/2025.183 Abstract ( 113 )   PDF (1054KB) ( 79 )   Save BACKGROUND: Gait dysfunction is one of the significant reasons for patient dissatisfaction following total knee arthroplasty. Clinical studies have identified a relationship between the preoperative strength of the quadriceps and hamstring muscles and postoperative gait dysfunction, but the exact nature of this correlation is not yet fully understood. OBJECTIVE: To investigate the correlation between the preoperative strength of the quadriceps and hamstring muscles and postoperative gait dysfunction in total knee arthroplasty.  METHODS: A retrospective analysis was conducted on longitudinal data from 70 patients who underwent unilateral primary total knee arthroplasty. Preoperative measurements included peak torque of the extensor and flexor muscles, peak torque/body weight, and total work. Six months postoperatively, the Timed Up and Go Test and gait speed were measured. Ridge regression analysis was used to identify factors influencing postoperative gait function.  RESULTS AND CONCLUSION: (1) Preoperative peak torque, peak torque/body weight, and total work of the extensor muscles, as well as the peak torque and total work of the flexor muscles, showed a very strong positive correlation with postoperative gait speed (P < 0.001). The preoperative flexor muscle peak torque/body weight had a strong positive correlation with postoperative gait speed (P < 0.001). Preoperative extensor and flexor muscle peak torques, peak torque/body weight, and total work showed a very strong negative correlation with results from postoperative Timed Up and Go Test (P < 0.001). (2) Ridge regression analysis indicated a 94.2% likelihood that preoperative extensor muscle peak torque, peak torque/body weight, and total work, along with flexor muscle peak torque and total work, had a positive impact on gait speed after total knee arthroplasty (P < 0.001). The preoperative flexor muscle peak torque/body weight had a negative impact on postoperative gait speed (P < 0.001). There was an 87.7% likelihood that preoperative extensor and flexor muscle peak torques, peak torque/body weight, and total work, along with flexor muscle peak torque and total work, had a negative impact on postoperative Timed Up and Go Test (P < 0.05), while the flexor muscle peak torque/body weight had no impact on the Timed Up and Go Test (P > 0.05). (3) It is indicated that the strength of the quadriceps and hamstring muscles prior to total knee arthroplasty correlates with postoperative gait speed and Timed Up and Go Test, and can predict the outcomes of postoperative gait function. Enhancing preoperative knee muscle exercises may be a way to reduce the incidence of gait dysfunction following total knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Effect of patellar morphology on functional recovery and patellofemoral joint alignment after unicompartmental knee arthroplasty Sun Yingjin, Liu Ning, Huang Long, Feng Shuo, Chen Xiangyang 2025, 29 (27):  5826-5832.  doi: 10.12307/2025.803 Abstract ( 93 )   PDF (1070KB) ( 99 )   Save BACKGROUND: There are few studies on the effect of different patellar morphologies on the outcome after unicompartmental knee arthroplasty. OBJECTIVE: To investigate the effect of different patellar morphologies on functional recovery and patellofemoral joint alignment after unicompartmental knee arthroplasty based on patellar Wiberg classification. METHODS: A retrospective study was conducted in 186 patients with medial knee osteoarthritis who underwent unicompartmental knee arthroplasty at Affiliated Hospital of Xuzhou Medical University between January 2022 and March 2023. Patients were categorized into group A (type I, n=43), group B (type II, n=104), and group C (type III, n=39) according to the Wiberg classification. The Hospital for Specia Surgery knee score, Feller score, and incidence of anterior knee pain, as well as radiologic data (patellar index, patellar tilt angle, and lateral patellofemoral angle) were compared among the three groups. RESULTS AND CONCLUSION: (1) There was no significant difference in the Feller patellar score and Hospital for Specia Surgery score at the final postoperative follow-up in patients with Wiberg type I, type II, and type III patellae (P > 0.05). (2) Although there was no significant difference in the incidence of anterior knee pain among the three groups at the final follow-up, patients with type III patellae were significantly more likely to have experienced anterior knee pain early in the postoperative period. (3) Different patellar morphologies can improve patellar position to some extent after unicompartmental knee arthroplasty, but type III had greater patellar tilt than types I and II, both preoperatively and postoperatively. (4) This finding highlights the need for tailored morphological adjustments to the Wiberg III patella during unicompartmental knee arthroplasty to improve surgical outcomes.  Figures and Tables | References | Related Articles | Metrics

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Characteristic analysis of isometric muscle strength of knee joint in patients after unicompartmental knee arthroplasty Ding Yuan, Gong Jianbao, Zhang Jie, Qiao Yuan, Xu Wenlong 2025, 29 (27):  5833-5838.  doi: 10.12307/2025.180 Abstract ( 108 )   PDF (884KB) ( 122 )   Save BACKGROUND: The knee osteoarthritis, a major cause of disability in the elderly, is currently treated with surgical procedures including unicompartmental knee arthroplasty in end-stage patients, but the recovery of muscle strength in patients after unicompartmental knee arthroplasty is not well understood.  OBJECTIVE: To analyze the short-term and medium-term knee isometric muscle strength characteristics of patients with unilateral knee osteoarthritis after unicompartmental knee arthroplasty, to compare with those of the unaffected side, and to analyze the recovery of muscle strength in the affected limb.  METHODS: Patients undergoing unicompartmental knee arthroplasty in the Qingdao Municipal Hospital from June to December 2023 were recruited to undergo standardized functional rehabilitation exercises. The A8-2M multi-joint isokinetic training and testing system was used to detect the peak torque and the maximum one-repetition work of the extensor muscle of the unaffected side and the affected side of the knee joint at the angular velocity of 60 (°) /s and the range of joint motion of 0°-90° before, 1 and 3 months after surgery.  RESULTS AND CONCLUSION: (1) At an angular velocity of 60 (°)/s, the peak moment and maximum one-repetition work of the flexor and extensor muscles of the affected side were lower than those of the unaffected side preoperatively (P < 0.05). (2) The peak moment and maximum one-repetition work of the flexor and extensor muscles were significantly lower than those of the unaffected side 1 month postoperatively (P < 0.05). Meanwhile, the peak moment of the flexor and extensor muscles and the maximum one-repetition work of the flexor and extensor muscles on the affected side at 1 month postoperatively were significantly lower than those on the affected side preoperatively (P < 0.05). (3) The peak moment of the flexor and extensor muscles and the maximum one-repetition work of the flexor and extensor muscles on the affected side at 3 months postoperatively had no significant difference from those on the unaffected side. The peak flexor-extensor moment of the flexor-extensor muscles on the affected side was higher than that preoperatively (P < 0.05). (4) It is indicated that after unicompartmental knee arthroplasty, the muscle strength on the affected side is poor after 1 month after standard functional rehabilitation. However, after 3 months, there was no significant difference between the affected side and the unaffected side.   Figures and Tables | References | Related Articles | Metrics

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Assessment on initial effectiveness of a novel local infiltration anesthesia in total knee arthroplasty Wang Jun, Zhang Hui, Li Zhengyuan, Hao Lin, Chen Shenghong, Yin Zongsheng 2025, 29 (27):  5839-5844.  doi: 10.12307/2025.850 Abstract ( 97 )   PDF (1233KB) ( 72 )   Save BACKGROUND: After total knee arthroplasty, patients may experience significant pain, which has negative effects on functional recovery. Exploring and seeking effective means of analgesia has important clinical value. OBJECTIVE: To explore an effective perioperative analgesic strategy for total knee arthroplasty patients, we first proposed a novel local infiltration anesthetic formulation consisting of morphine, flurbiprofen, and compound betamethasone, and we explored its efficacy and safety. METHODS: This study retrospectively analyzed the clinical data of 60 patients who underwent unilateral total knee arthroplasty at First Affiliated Hospital of Anhui Medical University from November 2023 to April 2024. Based on whether local anesthesia was used during surgery, the patients were divided into the control and study groups, each consisting of 30 cases. In the study group, the local infiltration anesthesia mixture consisting of morphine, flurbiprofen, and compound betamethasone was injected into the joint cavity around the knee during surgery. No analgesic drugs were used in the control group as a blank control. We recorded and compared the postoperative visual analog scale pain scores, knee range of motion, knee function score, degree of postoperative knee edema, and incidence of postoperative complications between the two groups at different time points. RESULTS AND CONCLUSION: (1) Compared with the control group, the visual analog scale pain score in the study group was lower at 6, 12, and 24 hours after operation, and the difference was statistically significant (Z=-2.367, -2.906, -4.199, P < 0.05). However, there was no significant difference in the pain visual analog scale score between the two groups at 48 and 72 hours after operation (Z=-1.287, -1.478, P > 0.05). (2) The postoperative knee range of motion and knee function score of the study group were better than those of the control group, and the difference was statistically significant (t=-2.519, -8.027, P < 0.05). (3) The degree of knee joint swelling in the study group was also lighter than that in the control group, and the difference was statistically significant (Z=-2.818, P < 0.05). (4) In the early postoperative period, there was no significant difference in fever between the two groups (P > 0.05). There was no poor wound healing or periprosthetic infection in the two groups. (5) The results show that applying local infiltration anesthesia composed of morphine, flurbiprofen axetil, and compound betamethasone in total knee arthroplasty can relieve early postoperative pain and show high safety. However, prospective studies with large samples are still needed to provide data support. Figures and Tables | References | Related Articles | Metrics

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Construction of a risk prediction model for failure of proximal femoral nail antirotation fixation in intertrochanteric fractures Tu Zesong, Xu Daxing, Luo Hongbin, Wang Yusheng, Feng Xinglun, Peng Zhonghua, Du Shaolong 2025, 29 (27):  5845-5853.  doi: 10.12307/2025.840 Abstract ( 95 )   PDF (1389KB) ( 92 )   Save BACKGROUND: Intertrochanteric femoral fractures are the main type of fragility fracture in the elderly, and proximal femoral nail antirotation is the preferred surgical option, but the factors associated with postoperative internal fixation failure are controversial. OBJECTIVE: A new “three-column” classification of intertrochanteric femoral fractures was proposed by evaluating patients’ imaging data preoperatively and analyzing its interaction with postoperative internal fixation failure. A risk prediction model was developed and validated by using numerical algorithms, which facilitates clinicians to identify and intervene in high-risk patients preoperatively.  METHODS: Patients with intertrochanteric femur fractures in Sanshui Branch of Foshan Hospital of Traditional Chinese Medicine between June 2012 and June 2022 were selected. The patients were divided into the internal fixation failure group and the internal fixation maintenance group according to whether they had internal fixation failure after surgery. According to the preoperative radiographs, the proximal femur was divided into three columns: the medial column, the lateral column, and the middle column. Each column had different subgroups. The relationship between the morphological characteristics of the “three columns” and the failure of proximal femoral nail antirotation internal fixation was analyzed, and the independent risk factors for internal fixation failure were screened out by single and then multifactorial logistic regression analyses. A risk prediction model was constructed according to the independent risk factors using R language software. The Bootstrap method was used to resample 1 000 times. The area under the curve, calibration curve, and clinical decision curve were used to evaluate the differentiation, calibration ability, and clinical application value of the model. The Youden index was used to determine the optimal risk cut-off value of the prediction model, according to which the patients were divided into high and low risk groups. The stability and extensibility of the model were evaluated according to the accuracy of its risk prediction ability. RESULTS AND CONCLUSION: (1) The four independent risk factors for postoperative internal fixation failure after surgery were predicted using the “three-column” typing system: medial column (comminuted fracture of the lesser trochanter and femoral talar) [odds ratio=5.385, 95%CI(1.961, 14.782), P=0.001], medial column (chimney type) [odds ratio=2.893, 95%CI(1.167, 7.173), P=0.022], lateral column (lateral wall thickness < 20.5 mm) [odds ratio=2.804, 95%CI(1.078, 7.297), P=0.035] and lateral column (lateral wall fracture) [odds ratio=4.278, 95%CI(1.670, 10.959), P=0.012]. (2) The constructed risk prediction model showed good discrimination and accuracy [area under the receiver operating characteristic curve=0.852, 95%CI(0.837, 0.922)]. The calibration curve showed good agreement between the model-predicted risk and the actual risk of occurrence. (3) The clinical decision curve suggested that the model had good clinical applicability when the risk threshold probability was in the range of 0.2-0.82. The risk probability of 28% was the optimal threshold for risk stratification of the model, and the predictive performance of the model was better in patients with different risk groups. (4) The “three-column” typing system constructs a predictive model to calculate the risk probability of postoperative internal fixation failure in patients with intertrochanteric femoral fractures. This method is accurate, simple, and easy to apply clinically, and can be used as a digital tool to guide personalized clinical treatment. Figures and Tables | References | Related Articles | Metrics

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Correction effect of local kyphosis of the spine after percutaneous kyphoplasty in super-aging patients with vertebral compression fractures Wu Yonghao, Zhu Shuaiqi, Li Yuqiao, Zhang Chenfei, Xia Weiwei, Zhu Zhenqi, Wang Kaifeng 2025, 29 (27):  5854-5861.  doi: 10.12307/2025.843 Abstract ( 80 )   PDF (1539KB) ( 58 )   Save BACKGROUND: Percutaneous kyphoplasty was a common surgical procedure for the treatment of osteoporotic vertebral compression fracture. However, there was no research to confirm whether percutaneous kyphoplasty could effectively correct the local kyphoplasty of the spine in patients over 80 years old with osteoporotic vertebral compression fracture.  OBJECTIVE: To investigate the effect of percutaneous kyphoplasty on local kyphosis in super-aging patients with osteoporotic vertebral compression fracture.    METHODS: Single-segment osteoporotic vertebral compression fracture patients treated with percutaneous kyphoplasty at the Department of Spinal Surgery, Peking University People's Hospital, from March 2016 to August 2022, were selected as the research cohort, and the follow-up data of patients in hospital and out-patient were collected. According to patients' age, patients were divided into the advanced age group (60-79 years old, n=126) and the super-aged group (≥ 80 years old, n=52). According to gender, body mass index, basic diseases (hypertension, diabetes, and cardiovascular diseases), fracture segments and the presence or absence of preoperative intravertebral cleft, the two groups of patients were matched 1:2 by propensity score matching. The lumbar CT values, injection amount of bone cement, preoperative and postoperative vertebral height, preoperative collapse rate of the vertebral body, preoperative and postoperative Cobb angle, recovery rate of Cobb angle, distance between the bone cement and anterior edge of the vertebral body, sagittal position of cement filling, contact between the bone cement and endplate, distance between the bone cement and vertebral endplates, bone cement distribution score, bone cement leakage, and vertebral refracture were compared between the two groups.  RESULTS AND CONCLUSION: (1) After matching the propensity score, 115 patients were included, with 71 patients in the advanced age group and 44 patients in the super-aged group. There was no statistically significant difference in baseline data, including gender, body mass index, hypertension ratio, diabetes ratio, cardiovascular disease ratio, fracture section, and preoperative intravertebral cleft, between the two groups (P > 0.05). The postoperative Cobb angle of the super-aged patients was significantly smaller than that of the elderly patients (P < 0.05). There was no significant difference in lumbar CT values, injection amount of bone cement, preoperative and postoperative vertebral height, preoperative collapse rate of the vertebral body, preoperative Cobb angle, recovery rate of Cobb angle, postoperative distance between the bone cement and anterior edge of the vertebral body, sagittal position of cement filling, contact between the bone cement and endplate, distance between the bone cement and vertebral endplates, bone cement distribution score, bone cement leakage, and vertebral refracture ratio between the two groups (P > 0.05). (2) These findings indicate that percutaneous kyphoplasty can effectively correct local kyphosis of the spine in super-aging patients with osteoporotic vertebral compression fractures. Figures and Tables | References | Related Articles | Metrics

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Effects of unilateral biportal endoscopic transforaminal lumbar interbody fusion on paraspinal muscles Wang Qianliang, Zhang Qianzhongyi, Peng Yujian, Yan Jun 2025, 29 (27):  5862-5868.  doi: 10.12307/2025.831 Abstract ( 94 )   PDF (1042KB) ( 74 )   Save BACKGROUND: With the development of unilateral biportal endoscopic technology, endoscopic lumbar fusion surgery has become an increasingly popular development trend in spinal surgery. Unilateral biportal endoscopic transforaminal lumbar interbody fusion shows significant advantages for preserving paravertebral muscle and reducing intraoperative bleeding in spinal stenosis and lumbar spondylolisthesis in the lumbar spine with degenerative changes.  OBJECTIVE: To compare the effects of unilateral biportal endoscopic lumbar interbody fusion and traditional open transluminal lumbar interbody fusion on paraspinal muscles.  METHODS: A retrospective analysis was conducted on the clinical data of 60 patients who visited the Department of Spine Surgery, Second Affiliated Hospital of Soochow University from October 2019 to November 2022 and underwent single segment unilateral decompression fusion. They were divided into two groups according to different surgical procedures. Group A received unilateral biportal endoscopic lumbar interbody fusion. Group B received traditional open transluminal lumbar interbody fusion. All patients underwent magnetic resonance imaging examination before and 3 months after surgery. Basic patient information, last follow-up time, magnetic resonance imaging images, visual analog scale scores for lower back and leg pain, and Oswestry Disability Index were collected.   RESULTS AND CONCLUSION: (1) Three months after surgery, the cross-sectional area of the bilateral multifidus muscle in group A was significantly larger than that of group B (P < 0.05), and the degree of fat infiltration was lower (P < 0.01). (2) There was no significant difference in the cross-sectional area and degree of fat infiltration of bilateral erector spinae muscles between the two groups 3 months after surgery (P > 0.05). (3) It is concluded that unilateral biportal endoscopic lumbar interbody fusion is more effective than traditional open transluminal lumbar interbody fusion in protecting multifidus muscle, reducing multifidus muscle atrophy and fat infiltration. Both surgical methods did not have a significant impact on the erector spine muscle. Figures and Tables | References | Related Articles | Metrics

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Comparison of imaging findings of paraspinal muscle tissue degeneration in patients with degenerative and isthmic spondylolisthesis Wang Shoukang, Liang Gang, Liu Xiaolei, Hong Chunbo, Xin Bing 2025, 29 (27):  5869-5875.  doi: 10.12307/2025.804 Abstract ( 69 )   PDF (1041KB) ( 46 )   Save BACKGROUND: Existing studies have compared patients with degenerative lumbar spondylolisthesis with healthy populations, but comparative studies focusing on differences in this aspect of the parameter between these different lumbar spondylolisthesis are lacking. OBJECTIVE: To explore the differences in paraspinal muscle degeneration between isthmic spondylolisthesis and degenerative lumbar spondylolisthesis, and their correlation with low back pain symptoms. METHODS: A total of 107 patients with lumbar spondylolisthesis treated in Affiliated Hospital of Xuzhou Medical University between February 2019 and August 2023 were analyzed retrospectively. They were divided into the isthmic spondylolisthesis group (39 patients) and the degenerative lumbar spondylolisthesis group (68 patients) according to the type of spondylolisthesis. Paravertebral muscle tissue parameters were compared and analyzed as well as functional scores (visual analog scale for low back pain) in both groups. According to the visual analog scale score, the two groups of patients were divided into two subgroups: those with a visual analog scale score ≤45 mm and those with a visual analog scale score > 45 mm, and the relationship between the difference in visual analog scale score and the parameters of paraspinal muscle tissue degeneration was analyzed. RESULTS AND CONCLUSION: (1) The percentage of fat infiltration in the multifidus muscle was higher in the degenerative lumbar spondylolisthesis group than in the isthmic spondylolisthesis group (P=0.003). (2) The percentage of fat infiltration in the multifidus muscle was significantly lower in patients with a visual analog scale score of ≤ 45 mm than in patients with a visual analog scale score of > 45 mm in both groups (P=0.021, P < 0.001). (3) Patients in the isthmic spondylolisthesis group also showed a significantly lower percentage of fat infiltration in patients with visual analog scale score ≤ 45 mm compared with those with visual analog scale score > 45 mm (P=0.002). (4) These results showed that there was a significant difference in paraspinal muscle tissue degeneration between isthmic spondylolisthesis patients and degenerative lumbar spondylolisthesis patients, and that degenerative lumbar spondylolisthesis patients demonstrated more severe paraspinal muscle degeneration compared to isthmic spondylolisthesis patients. In addition, the percentage of fatty infiltration of the multifidus muscle was relatively greater in those with higher pain scores in both groups of lumbar spondylolisthesis patients.  Figures and Tables | References | Related Articles | Metrics

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Schroth therapy combined with core strength training improves scoliosis angle in patients with mild adolescent idiopathic scoliosis Zhang Juanjuan, Jiang Nannan, Wu Yajun, Gu Qian, He Linfei, Ji Yongxin, Liu Su 2025, 29 (27):  5876-5882.  doi: 10.12307/2025.185 Abstract ( 248 )   PDF (989KB) ( 96 )   Save BACKGROUND: The definitive cause of adolescent idiopathic scoliosis is not yet known. The search for a clinical approach to address adolescent idiopathic scoliosis is imminent.  OBJECTIVE: To investigate the effect of Schroth therapy combined with core strength training on mild adolescent idiopathic scoliosis and to provide more bases for the clinical treatment of mild adolescent idiopathic scoliosis.  METHODS: 110 patients with mild adolescent idiopathic scoliosis attending the Department of Rehabilitation Medicine and Department of Spine Surgery of Affiliated Hospital of Nantong University from July 2022 to January 2024 were selected as the study subjects. They were divided into the trial group and the control group according to the wishes of the patients and their parents, with 55 cases in each group. The control group was observed and followed up, and the trial group underwent Schroth therapy combined with core strength training for 45 minutes a day for 24 weeks. The differences in imaging parameters, body surface indexes, three-dimensional ultrasound imaging angle, and quality of life were compared between the two groups before and after treatment. RESULTS AND CONCLUSION: (1) At 24 weeks after treatment, major curve Cobb, apical vertebral translation, and cervical lordosis were significantly improved in the trial group (P < 0.05), while there was no significant difference in the control group (P > 0.05). Major curve Cobb and apical vertebral translation in the trial group were significantly better than those in the control group (P < 0.05). (2) At 24 weeks after treatment, angle of trunk rotation in the trial group was significantly lower than that before treatment (P < 0.05), while there was no significant difference between before and after treatment in the control group (P > 0.05), and angle of trunk rotation in the trial group was significantly lower than that of the control group (P < 0.05). (3) At 24 weeks after treatment, the center of laminae angle of three-dimensional ultrasound imaging was significantly reduced in the trial group (P < 0.05), while there was no significant difference in the control group before and after treatment (P > 0.05). The center of laminae angle of three-dimensional ultrasound imaging was smaller in the trial group than that in the control group (P < 0.05). (4) At 24 weeks after treatment, in terms of the quality of life, pain dimension score in the trial group was significantly increased (P < 0.05). Both trial and control groups showed significantly higher scores in the self-image dimension compared with that before treatment (P < 0.05). Both groups had significantly lower scores in the mental health dimension compared with that before treatment (P < 0.05). In the dimensions of pain, self-image, mental health, and satisfaction, the trial group was significantly higher than the control group (P < 0.05). (5) It is indicated that Schroth therapy combined with core strength training can improve the major curve Cobb, apical vertebral translation, and cervical lordosis angle, reduce the angle of trunk rotation, decrease the center of laminae angle of three-dimensional ultrasound imaging, and improve the quality of life, and it is effective in the treatment of mild adolescent idiopathic scoliosis. Figures and Tables | References | Related Articles | Metrics

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Application of 3D printing technology in traumatic fractures Lian Zeshuang, Xu Qiang, Wang Aoting, Li Ding, Qin Jialin, Wang Junfang 2025, 29 (27):  5883-5889.  doi: 10.12307/2025.811 Abstract ( 140 )   PDF (856KB) ( 157 )   Save BACKGROUND: 3D printing technology can design and construct models, surgical guides and personalized implants or fixture according to the actual condition and treatment demand of patients, which has great application prospects in the repair of traumatic fractures.  OBJECTIVE: To review the application of 3D printing technology in traumatic fractures.  METHODS: Web of Science, PubMed and CNKI databases were searched for relevant literature on the application of 3D printing technology in the field of trauma orthopedics published from 2020 to 2024. Chinese and English search terms were “traumatic fracture, 3D printing technology, digital model, surgical guide.” Finally, 60 articles were included for analysis.  RESULTS AND CONCLUSION: (1) Traumatic fracture is a fracture phenomenon with interruption of bones continuity and destruction of integrity caused by various injurious factors. Improving reduction and healing effects with reliable schemes has become a hot issue that needs to be handled urgently in orthopedics related field. (2) 3D printing technology is a three-dimensional entity technology to meet demands based on digital model data, in which adhesive forming materials (powdered metal or polymer), stereolithography, deposition modeling, and optical polymer spray are used, and it is widely used in the field of digital orthopedic biomedicine. (3) 3D printing technology has played significant advantages in disease diagnosis, preoperative planning, reconstructing fracture 3D model, customizing orthopedic implants, customizing fixation braces and prosthetics, fabrication of surgical guide and repair of bone defects, which can design and construct models, surgical guides, and personalized implants or fixture according to the actual conditions and treatment demands of patients. It can provide new ideas for the treatment of traumatic fractures. Figures and Tables | References | Related Articles | Metrics

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Objective accuracy of six degree of freedom gait analysis system in evaluating the severity of knee osteoarthritis Shaban Amiri Nzelekela, Yang Lianbo, Li Peng 2025, 29 (27):  5890-5896.  doi: 10.12307/2025.192 Abstract ( 157 )   PDF (831KB) ( 127 )   Save BACKGROUND: Traditional assessment methods for knee osteoarthritis rely on clinical symptoms, physical examinations, and imaging findings of patients. However, these methods fail to reflect the dynamic changes in knee joint kinetics and do not comprehensively depict the objective status of the knee joint. The emergence of the 6 degree of freedom gait analysis system provides a more objective and practical dynamic assessment method for the severity of knee osteoarthritis. This system serves as a basis for more precise treatment strategies for different patients, thereby optimizing patient treatment approaches. OBJECTIVE: To review relevant assessment systems for knee osteoarthritis, compare the 6 degree of freedom gait analysis with traditional methods for assessing knee osteoarthritis severity, and explore the application of 6 degree of freedom gait analysis in guiding knee osteoarthritis treatment strategies. METHODS: A computer search was conducted using Google Scholar and PubMed databases for relevant articles published from January 2002 to June 2023. English search terms included “knee osteoarthritis, knee osteoarthritis severity, 6DOF gait analysis, evaluation methods, WOMAC, KOOS.” Chinese search terms were “knee osteoarthritis, osteoarthritis evaluation system, 6 degree of freedom gait analysis.” Based on inclusion and exclusion criteria, a total of 65 articles were selected for synthesis and summarization. RESULTS AND CONCLUSION: (1) The 6 degree of freedom gait analysis improves the accuracy of knee osteoarthritis severity assessment. Treatment plans based on this method significantly improved patient prognosis. (2) Current research findings suggest standardizing the integration of 6 degree of freedom gait analysis and traditional assessment methods in clinical practice for an objective and accurate evaluation of knee osteoarthritis. This enables better selection of treatment plans and evaluation of the long-term effectiveness of individualized treatment strategies. Figures and Tables | References | Related Articles | Metrics

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Correlation and mechanism between lumbar disc degeneration and paraspinal muscle changes Liu Jiashun, Xie Hongru, Sun Yunkai, Li Shujin, Mao Tengfei, An Yaoyao, Zhang Qin 2025, 29 (27):  5897-5906.  doi: 10.12307/2025.835 Abstract ( 170 )   PDF (963KB) ( 197 )   Save BACKGROUND: Paraspinal muscle degeneration is one of the main causative factors of low back pain, and the changes in the paraspinal muscles are closely related to its occurrence and development. At present, clinical practitioners focus on the changes of paraspinal muscles in degenerative lumbar diseases to prevent and treat lumbar diseases, but ignore the connection and related mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles. OBJECTIVE: To comprehensively summarize the interaction between paraspinal muscles and lumbar intervertebral discs, and to review the relationship and mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles, in order to provide a reference for clinical prevention and treatment. METHODS: Chinese keywords “lumbar intervertebral disc, paraspinal muscle, multifidus muscle, low back pain, degeneration, imaging, magnetic resonance imaging” were used to search the relevant literature in Chinese databases such as CNKI, VIP, and WanFang. English keywords “lumbar disc, paraspinal muscle, multifidus muscle, low back pain, degeneration, imaging, MRI” were used to search the relevant literature in databases such as Medline, PubMed, and Web of Science. After preliminary screening of titles and abstracts, 68 articles were finally selected for result analysis according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) Researchers have used various methods to evaluate the degree of paraspinal muscle degeneration, and at the same time evaluated the degree of lumbar intervertebral disc degeneration according to the Pfirrmann grading system. It is found that clinical diagnosis and treatment should pay attention to gender differences, and the influence of factors such as obesity on the degeneration of intervertebral discs and muscles, in order to develop more individualized treatment plans. (2) There is a certain correlation between lumbar intervertebral disc degeneration and paraspinal muscle fat infiltration, but the research results are controversial. Most studies have found that fat infiltration of the paraspinal muscles (especially the multifidus muscle) is positively correlated with the degree of lumbar intervertebral disc degeneration. (3) It is currently believed that the three mechanisms of disuse atrophy, denervation, and inflammatory factors may interact with each other to jointly lead to structural and functional changes in the paraspinal muscles, which are closely related to the occurrence of lumbar intervertebral disc degeneration and low back pain. (4) Clinically, attention should be paid to the changes of the muscles at the level below the affected nerve root segment, which is helpful for the diagnosis and localization of lumbar radiculopathy. At the same time, inhibition of inflammatory factors may become a potential target for treatment. (5) Clinically, the first step is to correct nerve root compression through appropriate medication or surgery to control inflammatory reactions and nerve root pain, and then carry out targeted muscle rehabilitation training. If necessary, consider using new treatment methods such as interferential current electrical stimulation to improve the patient’s symptoms and prognosis. Figures and Tables | References | Related Articles | Metrics

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Mechanism by which diabetes exacerbates intervertebral disc degeneration Ma Jikun, Wang Jianru, Qi Junjie, Liu Haifei 2025, 29 (27):  5907-5913.  doi: 10.12307/2025.193 Abstract ( 102 )   PDF (1188KB) ( 50 )   Save BACKGROUND: Diabetes exacerbates intervertebral disc degeneration in a number of ways, and good glycemic control is beneficial in preventing intervertebral disc degeneration. OBJECTIVE: To review the relationship between diabetes and intervertebral disc degeneration to provide a reference for the clinical treatment of disc degeneration in patients with diabetes. METHODS: Literature searches were performed in CNKI and PubMed databases for articles published from 1980 to 2023. The Chinese and English search terms were “diabetes, intervertebral disc degeneration, cartilage endplate degeneration, apoptosis, advanced glycation end products, osmotic stress.” Finally, 73 articles were included for summary and analysis. RESULTS AND CONCLUSION: (1) The pathophysiological process of diabetes-induced intervertebral disc degeneration is different from that of physiological degeneration. The main mechanisms of diabetes-induced intervertebral disc degeneration include: intracellular hyperglycemia, impaired blood supply to the intervertebral discs due to microvascular pathology, cellular senescence, apoptosis, and autophagy, accumulation of advanced glycation end products, osmotic stress, and destruction of the extracellular matrix components due to other pathways. (2) Drugs such as curcumin, resveratrol, and lupeol have therapeutic effects on intervertebral disc degeneration, but their safety and effectiveness need to be further demonstrated in clinical treatment. Figures and Tables | References | Related Articles | Metrics

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Non-surgical influencing factors of rotator cuff retear after arthroscopic rotator cuff repair 2025, 29 (27):  5914-5923.  doi: 10.12307/2025.842 Abstract ( 97 )   PDF (969KB) ( 106 )   Save BACKGROUND: Currently, arthroscopic rotator cuff repair has become the main method for treating rotator cuff tears. The recurrence of rotator cuff tears after arthroscopic rotator cuff repair is the result of multiple factors, and the occurrence of recurrent tears is a current research hotspot. Currently, comprehensive reviews of non-surgical factors that contribute to recurrent tears after arthroscopic rotator cuff repair are less common.  OBJECTIVE: To explore the non-surgical risk factors that lead to the rotator cuff tear again after arthroscopic rotator cuff repair, provide theoretical guidance for clinical intervention, and reduce the occurrence of postoperative rotator cuff tear again.  METHODS: The first author searched PubMed, Web of Science, and China National Knowledge Infrastructure in May 2023 and supplemented the literature from May 2023 to July 2024 for observational studies on non-surgical risk factors for rotator cuff retear after arthroscopic repair. The search used a combination of subject terms and free words. The literature search period was 2000-01-01/2024-07-01. RESULTS AND CONCLUSION: (1) A total of 70 articles were included for review according to the inclusion and exclusion criteria. (2) We analyzed the influence of non-surgical factors such as demographic and social risk factors, anatomical factors, rotator cuff quality, postoperative rehabilitation, type of rotator cuff tear, and timing of surgery on rotator cuff retear. (3) Aging was associated with degenerative changes in the rotator cuff, increasing the possibility of re-tearing. Metabolic diseases such as diabetes and hyperlipidemia could indirectly affect the quality and stability of repair by affecting local blood supply and tissue quality. (4) Critical shoulder angle and joint glenoid inclination were considered to be a key anatomical parameter that affects the risk of re-tearing. Patients with a critical shoulder angle >35° had a significantly increased risk of re-tearing. A larger glenoid inclination would change the biomechanical environment of the shoulder and increase the risk of tearing. (5) The quality of the rotator cuff tendon, such as fatty infiltration and muscle retraction, and the type of tear (such as large or complex tear shape) also affected the re-tear rate. (6) Postoperative rehabilitation also had a significant impact on re-tear, including the time and method of recovery. Moderate activity helped improve blood circulation and tendon healing, but premature or excessive activity might increase the risk of tearing. Customized personalized rehabilitation programs played an important role in preventing rotator cuff re-tearing. (7) Although surgical technique is crucial to the success of rotator cuff repair, these non-surgical factors also affect postoperative outcomes and risk of retearing, and should be fully considered in clinical practice. Figures and Tables | References | Related Articles | Metrics

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Comparison of medial-lateral and lateral-only fixation for pediatric supracondylar humeral fractures: a systematic review and meta-analysis Chen Zhen, Chen Xi, Li Xiaoting, Chen Daxin, Hong Weiwu 2025, 29 (27):  5924-5932.  doi: 10.12307/2025.826 Abstract ( 89 )   PDF (2686KB) ( 118 )   Save OBJECTIVE: Supracondylar humeral fractures are the most common type of elbow fractures in children. Closed reduction fixation is the preferred treatment for displaced supracondylar humeral fractures. However, there is still disagreement over the choice of the right technology. Therefore, the purpose of this meta-analysis was to evaluate the efficacy of unilateral and bilateral cross-pinning in children with supracondylar humeral fractures, and to provide a reference for clinical treatment.  METHODS: A comprehensive search of relevant randomized controlled trials published from inception to January 6, 2023 was conducted on PubMed, Embase, Web of Science, and the Cochrane Library to compare the difference between two types of intralateral cross fixation and lateral fixation in children with supracondylar humeral fractures. The main outcome measures were imaging results (Baumann angle loss and carrying angle loss), elbow function results, and common complications (iatrogenic ulnar nerve injury and needle tract infection).  RESULTS: (1) A total of 18 studies were included. (2) There was no statistical difference in the imaging results of Baumann angle loss (P=0.47) and carrying angle loss (P=0.47) between the two groups. The proportion of excellent children with joint function recovery score was 70.7% and 74.9% in the lateral fixation group and medial-lateral cross fixation group, with no statistical difference (P=0.12). There was also no statistically significant difference in the incidence of needle tract infection between the two groups (P=0.9), but the risk of iatrogenic ulnar nerve injury was higher in the medial-lateral cross fixation group (P=0.02). (3) However, there was no significant difference in the frequency of ulnar nerve injury in the intralateral cross fixation group when combined exploration with mini-open approach was performed compared with lateral fixation alone (P=0.2). (4) In the Gartland type III subgroup, there were no significant differences in joint functional recovery scores (P=0.13), ulnar nerve injury (P=0.13), and needle tract infection (P=0.61).  CONCLUSION: The meta-analysis reveals that compared with the lateral fixation technique, the medial-lateral cross fixation method is more likely to cause iatrogenic nerve injury in the forearm, but it also increases the stability of the structure. However, the small incision method combined with the medial-lateral cross fixation seems to reduce the risk of nerve injury in patients. Thus, the therapy of children with displaced supracondylar humeral fractures involves medial-lateral crossing pinning fixation using a mini-open approach as a reliable and secure method. Figures and Tables | References | Related Articles | Metrics

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Visual analysis of application of three-dimensional finite element method in femoral head necrosis Liu Yuhang, Li Hongyu, Wang Yong, Wang Fengxing 2025, 29 (27):  5933-5940.  doi: 10.12307/2025.839 Abstract ( 133 )   PDF (2100KB) ( 119 )   Save BACKGROUND: Finite element analysis is a kind of analysis method widely used in the field of engineering technology, but because of its characteristics of high precision analysis of complex structures, the application of finite element analysis in the field of orthopedics is also increasing year by year. In recent ten years, numerous achievements have been made in the study of femoral head necrosis by finite element analysis at home and abroad. However, the analysis of current research status and hot trends is still lacking. OBJECTIVE: To visually analyze research status and hotspot of finite element method in the field of femoral head necrosis in recent years.  METHODS: Articles related to finite element analysis of femoral head necrosis during 2014-2023 were selected from CNKI database and Web of Science database. Citespace 6.1.R6 visual analysis software was used to summarize the main research contents of relevant articles and draw the scientific knowledge graph such as the annual number of publications, author graph, co-citation papers and hot keywords for summary.  RESULTS AND CONCLUSION: (1) After literature retrieval according to relevant keywords, Citespace software was imported. After software deduplication function was used to remove duplicate articles, Web of Science core collected 385 related articles and CNKI database 149 related articles. (2) The keyword co-occurrence analysis found that the keyword frequency ranking in Web of Science database in recent ten years was as follows: finite element analysis (163 times), femoral head (83 times), arthroplasty (44 times), fixation (40 times), and replacement (39 times); centrality ranking: finite element method (0.21), hip joint (0.21), stability (0.19), fixation (0.15), and contact pressure (0.15). (3) The ranking of keywords frequency in CNKI database in recent ten years was as follows: finite element analysis (91 times), biomechanics (45 times), femoral head necrosis (42 times), femoral neck fracture (33 times), internal fixation (16 times), and the centrality ranking was as follows: internal fixation (0.45), 3D printing (0.44), Jianpi Huogu formula (0.43), three-dimensional reconstruction (0.42), and femur head necrosis (0.38). (4) In the past ten years, the research in the field of femoral head necrosis had developed from “static” to “dynamic”' at home and abroad. The overall process was basically similar, and the research on gait model and risk prediction was more in-depth. In addition, with the deepening of domestic scholars’ research on traditional Chinese medicine, the curative effect of traditional Chinese medicine in the treatment of femoral head necrosis had also been well verified. In the past ten years, the fields of medical materials and computer technology can become the focus of research at home and abroad. (5) Although the research in related fields in China is relatively slow, more clinical studies are still needed to verify. However, with the progress of science and technology in China, it is believed that domestic scholars will truly apply the finite element analysis of femoral head necrosis to clinical practice in the future, and play a role in assisting patients with individualized treatment and improving long-term efficacy. Figures and Tables | References | Related Articles | Metrics