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28 May 2026, Volume 30 Issue 15 Previous Issue   

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Influence of different trabecular bone volume fractions on crack propagation in femoral neck fractures: a finite element analysis Du Chuanjia, Jiao Jiao, Zhou Jihe, Wang Shuai, Liu Guohui, Wang Yang, Shang Huayu, Wang Huiming, Zhang Xiaopei 2026, 30 (15):  3753-3759.  doi: 10.12307/2025.880 Abstract ( 102 )   PDF (1877KB) ( 37 )   Save BACKGROUND: Femoral neck fractures are among the most common and severe fractures in the elderly, with incidence rates rising sharply as age advances. At present, the injury mechanism of femoral neck fractures remains incompletely understood, specifically regarding the mechanical characterization, crack initiation, and failure mechanisms. OBJECTIVE: To analyze the effect of different trabecular bone volume fractions on femoral neck crack propagation using finite element analysis, and to provide theoretical support for in-depth analysis of the mechanical mechanism of femoral neck fracture. METHODS: CT data of the proximal femur from a healthy volunteer were imported into Mimics 19.0 for three-dimensional reconstruction, creating a model that includes both cortical and trabecular bone. This model was then imported into ABAQUS/CAE 2021, where appropriate material properties were assigned. Subsequently, a Python script for random batch deletion was utilized to generate finite element models of the proximal femur with trabecular bone volume fraction of 35%, 30%, 25%, and 20%. Cohesive Zone Model analysis was performed to investigate the mechanical response behaviors and damage mechanisms of femoral neck fractures under a 2 mm axial displacement load.   RESULTS AND CONCLUSION: (1) Compared with the 35% trabecular bone volume fraction model, the 20% trabecular bone volume fraction model exhibited a 10.02% reduction in load-bearing capacity, indicating that a decrease in trabecular bone volume fraction compromises the mechanical integrity of the femoral neck and increases fracture risk. (2) The maximum ratio of shear failure elements to total failure elements exceeded 90% in all models. Under high-speed axial impact loading, shear failure is the dominant mechanism in the formation of femoral neck fractures. (3) These findings indicate that a decrease in trabecular bone volume fraction significantly weakens the mechanical properties of the femoral neck, thereby increasing the risk of fracture. Furthermore, under high-speed axial impact loading, the mechanism of femoral neck fracture is predominantly characterized by shear failure.  Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of combined fixation of Pauwels type III femoral neck fracture with posteromedial bone defects of varying degrees using a medial support plate Yusufu·Reheman , Mutalipu·Silamujiang , Alimujiang·Yusufu , Zhang Ziyi , Ran Jian 2026, 30 (15):  3760-3771.  doi: 10.12307/2026.733 Abstract ( 87 )   PDF (4410KB) ( 57 )   Save BACKGROUND: Pauwels type III femoral neck fractures are often accompanied by different degrees of bone defect. The degree of bone defect and stability of internal fixation are key factors affecting fracture healing. OBJECTIVE: To simulate and compare the stability of different degrees of bone defects fixed by finite element analysis to provide experimental basis for actual clinical surgery.  METHODS: Mimics 21.0, Geomagic and Solidworks software were used to construct a model of femoral neck fracture with Pauwels angle of 70° and four posteromedial bone defects of different degrees. Three internal fixation methods of hollow nail combined with medial support plate, femoral neck dynamic cross-fixing system combined with medial support plate, and femoral neck dynamic cross-fixing system alone were simulated to form 12 groups of fracture bone defect internal fixation model groups. The stress and displacement changes of femur, internal fixation, and femoral head of 12 groups of models were analyzed under the load of 3 ploid mass of 2 100 N.  RESULTS AND CONCLUSION: (1) In all degrees of bone defects, the displacement and stress of the hollow nail combined with the medial steel plate were smaller than those of femoral neck dynamic cross-fixing system combined with the medial steel plate and femoral neck dynamic cross-fixing system fixation alone, regardless of whether the femur was fixed as a whole or internally. (2) With the increase of the volume of the posterior medial femoral bone defect, the displacement of the femur and internal fixation showed an increasing trend. (3) It is concluded that compared with femoral neck dynamic cross-fixing system combined with steel plate fixation, hollow nail combined steel plate fixation has more advantages in biomechanics, which is manifested as smaller displacement peak, more uniform stress distribution and lower stress concentration risk. Structural support reconstruction of the bone defect is extremely important for the treatment of femoral neck fractures with moderate to large bone defects. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of mechanical differences between different entry points of elastic intramedullary nail in treatment of double fractures of radioulnar shaft Chen Wei, Yang Yuting, Wang Yan, Nie Weizhi 2026, 30 (15):  3772-3779.  doi: 10.12307/2026.329 Abstract ( 101 )   PDF (1842KB) ( 32 )   Save BACKGROUND: For the treatment of double fractures of the radioulnar shaft with percutaneous elastic intramedullary nails, the main entry points on the radius are the Lister tubercle and the radial styloid process. However, no reports have been found on the comparison between these two entry points. OBJECTIVE: To establish three-dimensional finite element models of double fractures of the radioulnar shaft with entry points at the Lister tubercle and the radial styloid process respectively through three-dimensional finite element technology, simulate the normal movement of the human forearm, and analyze their biomechanical stability and safety. METHODS: The geometric shapes of the radius and ulna were reconstructed based on the CT images of the radioulnar bones of a 24-year-old healthy adult male. The finite-element analysis software Mimics was used to establish two models with different entry points for double fractures of the radioulnar shaft, namely, the Lister tubercle entry-point model and the radial styloid process entry-point model. Four types of stresses, including rotation, flexion, tension, and compression, were applied to the models in Ansys software, and their biomechanical changes were analyzed. RESULTS AND CONCLUSION: (1) Through three-dimensional finite element biomechanical analysis, by comparing the maximum displacement, stress peaks, and stress distributions of the two models with different entry points for double fractures of the radioulnar shaft under different stresses, it was found that both Lister tubercle and radial styloid process entry points could effectively control the displacement of the fracture ends, especially showing remarkable effects in resisting flexion stress. (2) The fixation stabilities of the two groups were similar. The maximum displacement value of the radial styloid process entry-point group was slightly smaller when resisting the four types of stresses, but the internal fixation stress was more concentrated. (3) Both models could effectively disperse the pressure, making the bone stress evenly distributed. The peak stresses of the bone and the internal fixation were concentrated at the entry point of the olecranon of the ulna. When resisting flexion stress, the internal fixation stress peak of the radial styloid process entry-point group was the largest, with a risk of nail breakage or stress fractures. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of effect of tibial plateau prosthesis posterior tilt angle on life of unicompartmental knee replacement prosthesis during anterior cruciate ligament rupture Wang Jidong, Tao Shuaixian, Liu Shuo, Ji Shouzhang, Nie Haitao, Pu Xinwei, Luo Songjiumei, Li Zhaowei, Ren Rong 2026, 30 (15):  3780-3790.  doi: 10.12307/2026.682 Abstract ( 97 )   PDF (3765KB) ( 26 )   Save BACKGROUND: Clinical application of unicompartmental knee replacement is limited by the abnormal knee joint dynamics caused by anterior cruciate ligament rupture. The posterior tilt angle of the tibial plateau prosthesis is a key parameter for regulating the stress distribution of the tibiofemoral joint. The relationship between the two and the long-term wear of the prosthesis is not clear. OBJECTIVE: To explore the effects of different tibial plateau tilt angles on prosthesis life in unicompartmental knee arthroplasty with anterior cruciate ligament rupture using finite element analysis, aiming to identify an optimal tibial plateau tilt angle. METHODS: Thin-slice CT scan data of the knee joint of a healthy volunteer were used to construct knee models with intact and ruptured anterior cruciate ligaments. Prosthesis models were assembled according to standard unicompartmental knee arthroplasty surgical procedures at varying tibial plateau tilt angles of 3°, 5°, 7°, 9°, and 11°. Finite element analysis of the models revealed the maximum principal stress, force contours, and maximum principal stress change rates of each prosthesis component. RESULTS AND CONCLUSION: (1) When the tibial plateau prosthesis was tilted 3°, 5°, 7°, 9°, and 11°, the maximum principal stress of the femoral condyle prosthesis, tibial plateau pad prosthesis, and tibial plateau prosthesis before and after the anterior cruciate ligament rupture was close, and there was no obvious change pattern in the maximum principal stress of each prosthesis. The stress of the tibial plateau prosthesis, femoral prosthesis, and tibial plateau pad prosthesis decreased in turn. (2) When the tibial plateau prosthesis tilted 5°, the maximum stress change rate of each prosthesis was the smallest, and the maximum principal stress of the tibial plateau prosthesis was greater. (3) It is suggested that if unicompartmental knee replacement is performed without repairing the ligament, it is recommended that the intraoperative tibial plateau prosthesis tilt angle should be 3°-5°, which may compensate for the adverse effects of anterior cruciate ligament rupture on the prosthesis service life. Figures and Tables | References | Related Articles | Metrics

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Two internal fixation methods for Sanders type II-IV calcaneal fractures: a 2-year clinical follow-up and finite element analysis Xiang Hao, Li Yuwan, Xu Zhi, Li Guichuan, Liao Wei, Cai Peng, Zhu Chengxing, Yan Ling 2026, 30 (15):  3791-3800.  doi: 10.12307/2026.152 Abstract ( 121 )   PDF (2066KB) ( 27 )   Save BACKGROUND: For Sanders II-IV type calcaneal fractures, traditional plate fixation is effective but invasive, while minimally invasive cannulated screw fixation has become a research hotspot in recent years due to its advantages in reducing soft tissue damage and trauma. OBJECTIVE: To evaluate the clinical efficacy and biomechanical properties of cannulated screw closed reduction technology with spatial weaving technique versus traditional plate fixation in the treatment of Sanders type II-IV calcaneal fractures. METHODS: This study used a combination of clinical case analysis and finite element analysis. A total of 34 patients with Sanders type II-IV calcaneal fractures who were treated at Zunyi First People's Hospital from January 2022 to June 2024 were randomly divided into two groups (n=17). The cannulated screw group received percutaneous cannulated screw fixation with spatial weaving technique. The plate group received sinus tarsi approach with plate screw fixation. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time, visual analog scale pain score, American Orthopedic Foot & Ankle Society ankle-hindfoot score, and economic benefits were compared between the two groups. Additionally, 64-row spiral CT scans were used to construct 3D models of calcaneal-hollow screw and calcaneal-plate assemblies. Mesh division and finite element analysis were performed using Hypermesh 14.0 and Abaqus 6.14 software to evaluate the biomechanical performance of the different fixation methods. RESULTS AND CONCLUSION: (1) Clinical indicators: The cannulated screw group showed significant advantages in operation time (P=0.002), intraoperative blood loss (P < 0.001), and incision length (P < 0.001) compared with the plate group. Postoperative follow-up results showed that the visual analog scale score and American Orthopedic Foot & Ankle Society ankle-hindfoot score were consistently better in the cannulated screw group compared with the plate group (P < 0.05), indicating that the cannulated screw fixation was more effective in reducing pain and improving functional recovery. (2) Finite element analysis: The cannulated screw group showed significantly lower maximum stress and maximum displacement compared with the plate group, with a more uniform stress distribution, suggesting better performance in maintaining fracture stability. (3) Economic benefits: The material cost (P < 0.001) and total hospitalization cost (P < 0.001) were significantly lower in the cannulated screw group than in the plate group. (4) It is indicated that compared with traditional plate fixation, the cannulated screw closed reduction technology shows significant advantages in treating Sanders type II–IV calcaneal fractures. These advantages include reduced trauma, shorter recovery time, fewer complications, improved biomechanical stability, and enhanced cost-effectiveness. This provides new evidence supporting minimally invasive treatment and merits further promotion and application. Figures and Tables | References | Related Articles | Metrics

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Fully visualized foraminoscopy for treating lumbar intervertebral space infection: finite element analysis of spinal stability Zhang Junhui, Chen Jinxu, Liang Zhuoxian, Deng Deli, Liu Jun 2026, 30 (15):  3801-3809.  doi: 10.12307/2026.684 Abstract ( 102 )   PDF (1981KB) ( 18 )   Save BACKGROUND: The fully visualized foraminoscopy currently serves as a reliable approach for managing lumbar intervertebral space infections. There is still a lack of biomechanical research on lumbar spine stability in patients after transforaminal endoscopic treatment of intervertebral disc infection. OBJECTIVE: To analyze the biomechanical changes in lumbar stability before and after fully visualized foraminoscopy in patients with lumbar intervertebral space infections, and to determine whether this procedure affects lumbar spine stability and whether secondary rigid internal fixation is necessary to ensure postoperative spinal stability. METHODS: Preoperative CT images from a patient treated with fully visualized foraminoscopy for intervertebral disc infection and followed up for 2 years later were collected. A preoperative finite element model (M1) of the L4/5 (intervertebral disc infection segment) was established using Mimics, Geomagic, SolidWorks, and Ansys. Based on this model, a postoperative model M2 of the patient who underwent fully visualized foraminoscopy for intervertebral disc infection was reconstructed based on the patient's postoperative CT data and laminar/articular process osteotomy. Identical test stresses were applied to the L4 vertebra in both models, while the L5 vertebra was fixed and supported. The range of motion and peak Von Mises stress of the annulus fibrosus were analyzed under six directions (flexion, extension, left rotation, right rotation, left lateral bending, and right lateral bending). RESULTS AND CONCLUSION: (1) Compared with M1, M2 exhibited range of motion increases of 0.863° (flexion), 0.326° (extension), 0.580° (left lateral bending), 0.476° (right lateral bending), 0.283° (left rotation), and 0.054° (right rotation). The total range of motion changes remained below 2°, indicating minimal impact on segmental stability. (2) Annulus fibrosus stress analysis revealed peak Von Mises stress increases of 0.290 9 MPa (flexion), 0.407 6 MPa (extension), 0.933 6 MPa (left lateral bending), 0.195 5 MPa (right lateral bending), 0.349 7 MPa (left rotation), and 0.061 5 MPa (right rotation) in M2 compared with M2. The peak Von Mises stress of the annulus fibrosus of the M1 and M2 models under different load states did not change significantly, and were far below the threshold value (2 MPa). (3) It is indicated that postoperative stability of the affected segment in patients with lumbar intervertebral disc infection treated with fully visualized foraminoscopy is minimally altered. After active control of the infection, secondary spinal fixation may not be necessary to ensure spinal stability. Figures and Tables | References | Related Articles | Metrics

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Biomechanical finite element analysis of lumbar degeneration based on radiological imaging Gao Sheng, Xin Shimin, Liu Xingquan, Kang Liqing, Ren Baolin, Wang Haiyan 2026, 30 (15):  3810-3819.  doi: 10.12307/2026.151 Abstract ( 102 )   PDF (2578KB) ( 20 )   Save BACKGROUND: Lumbar degeneration can cause lower back pain. Understanding the underlying mechanical mechanisms of pain caused by lumbar degeneration is crucial. OBJECTIVE: To analyze the biomechanical differences between normal and degenerated lumbar vertebrae, providing a basis for further exploring the lumbar degeneration mechanisms and their implications. METHODS: Three-dimensional reconstruction was performed based on lumbar CT images of healthy and lumbar degenerative male subjects, and a L1-S1 finite element model was established. Finite element analysis was performed on the biomechanical properties of normal and degenerated lumbar spines. By loading physiological conditions, the differences in the six ranges of motion of flexion, extension, left and right lateral flexion, and left and right rotation were analyzed in particular. The finite element model with osteophytes on the anterior edge of the vertebral body was evaluated in different motion modes for the lumbar spine as a whole, the range of motion of each segment, and the stress distribution of the vertebrae, annulus fibrosus, nucleus pulposus, and facet joints. RESULTS AND CONCLUSION: (1) The degenerated lumbar spine exhibited a decrease in overall and segmental range of motion to varying degrees, with significant movement limitations particularly noted in extension and lateral bending. (2) Degeneration altered the mechanical environment, resulting in increased stress on the vertebrae, intervertebral discs, and facet joints of adjacent segments. (3) Lumbar degeneration leads to reduced range of motion, especially affecting extension and lateral bending. (4) The L4 segment experiences higher stress post-degeneration, which may be a critical factor in lower back pain. (5) The redistribution of mechanical load in the degenerated lumbar spine significantly impacts adjacent segments.  Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of effect of passive support of deep intrinsic lumbar muscle groups on the lumbar spine Li Chunchao, Julaiti·Maitirouzi, Xie Xuechen, Zhang Le, Wang Yixi, Paerhati·Rexiti 2026, 30 (15):  3820-3831.  doi: 10.12307/2026.191 Abstract ( 82 )   PDF (2958KB) ( 188 )   Save BACKGROUND: Finite element analysis based lumbar biomechanical modeling technology, because it can quantitatively assess the lumbar range of motion and disc and other structures of stress distribution characteristics, has become an important tool to study the mechanism of lumbar diseases and surgical plan optimization. At present, the common finite element models of lumbar spine include vertebrae, intervertebral discs, endplates, articular cartilage and ligaments. The existing finite element models of lumbar spine generally do not consider the effect of passive support of deep intrinsic muscle groups on the stability of lumbar spine segments. OBJECTIVE: A finite element model of the lumbosacral musculoskeletal muscles containing the deep intrinsic muscle groups of the lumbar spine was established, and the biomechanical differences between the lumbosacral skeletal finite element model and the lumbosacral skeletal muscle finite element model were compared using finite element analysis. METHODS: A finite element model of the lumbosacral spine skeleton was reconstructed based on CT data from a healthy volunteer aged 27 years, and the deep intrinsic lumbar muscle groups were reconstructed on this basis. The effect of passive support on lumbar spine was evaluated by finite element analysis of the changes of lumbar range of motion, intervertebral disc stress, and vertebral cortical bone stress after increasing passive support of lumbar deep intrinsic muscle groups at different working conditions. RESULTS AND CONCLUSION: After applying the same load, under the combined conditions of forward flexion, extension, left and right lateral bending, left and right axial rotation, forward flexion and axial rotation: (1) Lumbar range of motion: The range of motion of lumbosacral musculoskeletal finite element model with passive muscle support was less than that of lumbosacral skeletal finite element model, and the more types of muscles, the smaller the range of motion. The range of motion of lumbosacral musculoskeletal model including lumbar intertransverse lateral muscles and lumbar circumflex muscles was less than that of lumbosacral skeletal finite element model, while the range of motion of lumbosacral musculoskeletal model including lumbar intertransverse lateral muscles, lumbar circumflex muscles and lumbar multifidus muscles was the smallest. (2) Intervertebral disc and vertebral cortical stress: In the lumbosacral skeletal finite element model, the addition of passive muscle support factors reduced the maximum stress values of the intervertebral disc and vertebral body, but their stresses showed a similar distribution, and the degree of stress reduction was related to the number of muscles, in which the lumbosacral musculoskeletal model including the lumbar intertransverse lateral muscles and lumbar circumflex muscles had smaller maximum stress values of the intervertebral disc and vertebral cortical bone than the lumbosacral skeletal finite element model, while the lumbosacral musculoskeletal model including the lumbar intertransverse lateral muscles, lumbar circumflex muscles and lumbar multifidus muscles had the smallest maximum stress values of the intervertebral disc and vertebral cortical bone. It is suggested that passive support of deep intrinsic muscles of lumbar spine slows down the range of motion, intervertebral disc stress and cortical bone stress of lumbar spine, especially under the conditions of forward flexion, extension, left and right lateral bending, forward flexion and axial rotation. Figures and Tables | References | Related Articles | Metrics

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Effect of contralateral cortical locking plate length on biomechanics of internal fixation for distal femur fractures Ouyang Hanbin, Lin Kewei, Zhang Xin, Zhang Ziwei, Feng Bolin, Zhong Huan, Huang Huajun 2026, 30 (15):  3832-3838.  doi: 10.12307/2026.544 Abstract ( 76 )   PDF (1852KB) ( 14 )   Save BACKGROUND: Contralateral cortical locking technique has achieved good clinical outcome in the treatment of distal femur fractures in clinical practice, but the influence of the choice of contralateral cortical locking plate length on biomechanics of internal fixation for distal femur fractures has not been clarified. Thus, the clinical guidance for contralateral cortical locking application remains unavailable.   OBJECTIVE: To explore the effect of different contralateral cortical locking plate lengths on the biomechanics of internal fixation of distal femur fractures.  METHODS: CT image data of the 4th generation synthetic Sawbones femur model were used to create a digital model of the comminuted fracture defect of a distal femur (AO-A3) using three-dimensional reconstruction techniques. On this basis, three different lengths of contralateral cortical locking steel plates with 14, 16, and 18 holes were simulated. Finite element analysis was performed by applying equal axial compression loads to the three sets of internal fixation models to compare the stiffness, the magnitude of displacement change at the fracture end, and the maximum equivalent stress among different models. RESULTS AND CONCLUSION: (1) For different lengths of contralateral cortical locking plates, the 16-hole plate model had the lowest axial stiffness, the highest displacement at the fracture, and the peak equivalent stress was located at the proximal P4 screw, with values that were 7.47% and 1.80% higher compared to the 14-hole and 18-hole screws with the highest stress, respectively. (2) Comparing the plate stresses of the three models, the 16-hole plate had the smallest peak stress and the highest stress was located at the first nail hole proximal to the plate. (3) The stability of contralateral cortical locking plate fixation for distal femur fractures did not improve with the increase in length. The appropriate plate length should be selected following the principles of patient individualization and trauma control in clinical practice.  Figures and Tables | References | Related Articles | Metrics

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Relationship of inertial measurement unit gait stability with pain intensity and kinesiophobia in patients with medial meniscus injuries Chen Yiyan, Wang Liyan, Fan Zhiying, Zhou Haibin, Cheng Peng, Lu Aming 2026, 30 (15):  3839-3847.  doi: 10.12307/2026.694 Abstract ( 70 )   PDF (3073KB) ( 128 )   Save BACKGROUND: Pain alters motor control through neuromuscular changes, leading to gait alterations. Clarifying the effect of pain characteristics on gait performance in patients with medial meniscus injuries facilitates the development of individualized rehabilitation programs. OBJECTIVE: To investigate the effect of pain characteristics on gait performance in patients with medial meniscus injury. METHODS: Gait data were collected using inertial measurement units and a constant velocity camera from 32 healthy people (17 men and 15 women) and 51 patients with medial meniscus injuries (24 men and 27 women). Pain characteristics such as pain freedom, pain intensity, pain psychology, and pain stage were also assessed. Independent samples t-tests were used to compare the differences between groups. Multiple linear regression analyses were performed with pain characteristics as the independent variable and gait indicators as the dependent variable. RESULTS AND CONCLUSION: (1) Compared with the control group, the patients' step length, thigh angular velocity during the support period, calf angular velocity during the support period, foot angular velocity during the support period, calf angular velocity during the swing period, foot angular velocity during the swing period, symmetry index of the hip range of motion, coefficient of variation of the hip range of motion, and muscular contribution during the support period of the rectus femoris muscle significantly decreased (P < 0.05), and the symmetry index of the step length, symmetry index of the knee range of motion, coefficient of variation of the step length, and muscular contribution during the swing period of the biceps femoris muscle significantly increased (P < 0.05). (2) The predictive variables of step length were whether knee extension was painful, pain intensity, and kinesiophobia. The predictive variables of thigh angular velocity in the support phase, thigh angular velocity in the swing phase, calf angular velocity in the swing phase, and muscle contribution in the support phase of the rectus femoris muscle were whether knee extension was painful. The predictive variable of the coefficient of variation for the range of motion of the hip joint was pain intensity. (3) It is indicated that pain characteristics (such as pain intensity and kinesiophobia) in patients with medial meniscus injuries affect gait performance and improve stability by slowing down movement speed, shortening stride length, and other kinematic manifestations in the presence of an imbalance in thigh muscle coactivation effects. Future research directions should include pain management with gait retraining. Figures and Tables | References | Related Articles | Metrics

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Analysis of spinal morphology and plantar pressure characteristics under different standing postures Han Zijia, He Xiaochen, Wang Jiarong, Tian Yichao, Wang Lixin, Yang Xiaotong, Gong Shuhui 2026, 30 (15):  3848-3854.  doi: 10.12307/2025.841 Abstract ( 127 )   PDF (1265KB) ( 44 )   Save BACKGROUND: Abnormal standing posture is common and causes harm to people’s experience. It is very important to find a good standing posture. OBJECTIVE: Taking Chinese healthy young people as the target population, the effects of different standing postures on spinal morphology and plantar pressure were discussed, and the harm of abnormal standing posture to human body was analyzed, so as to provide theoretical basis for finding a good standing posture. METHODS: Forty-nine subjects were selected as the research subjects. The DIERS formetric 4D spine evaluation system combined with the plantar pressure system was used to collect the spine, pelvis and plantar parameters of the three standing positions of the in-toeing standing, the out-toeing standing and the parallel standing. The standing duration of each test was 10 seconds, and the test results were statistically described. RESULTS AND CONCLUSION: (1) Compared with the out-toeing standing, the maximum lumbar lordosis angle, the peak pressure of left hind foot and right hind foot, and the proportion of forefoot pressure in the in-toeing standing increased significantly (P < 0.05), while the peak pressure of left forefoot, the contact area of left foot and right foot, and the proportion of hind foot pressure decreased significantly (P < 0.05). (2) Compared with parallel standing, the sagittal inclination angle, the maximum lumbar lordosis angle, the pelvic sagittal inclination angle, the pelvic torsion angle, the peak pressure of left hind foot, right forefoot, right hind foot, the average pressure of left foot and right foot, and the proportion of forefoot pressure in the in-toeing standing increased significantly (P < 0.05), and the contact area of left foot and right foot and the proportion of hind foot pressure decreased significantly (P < 0.05). (3) Compared with the parallel standing, the sagittal inclination angle, the maximum lumbar lordosis angle, the pelvic sagittal inclination angle, the pelvic torsion angle, the peak pressure of the left forefoot and the right forefoot, the average pressure of the left foot and the right foot, and the proportion of the forefoot pressure of the out-toeing standing were significantly increased (P < 0.05), and the proportion of the hindfoot pressure was significantly decreased (P < 0.05). (4) Among the three standing postures, the torso of the in-toeing and out-toeing standings leaned forward in the sagittal direction, the maximum lumbar lordosis angle increased, and the plantar pressure parameters were quite different, which was easy to cause damage. The spine and pelvis parameters of parallel standing tend to be neutral, and the difference of plantar pressure parameters is small. Therefore, parallel standing can be considered as a better standing position. Figures and Tables | References | Related Articles | Metrics

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Correlation between quantitative indicators of three-dimensional deformity of the first metatarsal bone and functional prognosis after osteotomy and orthopedic treatment in patients with hallux valgus deformity Sun Meilan, Zhao Xiaoliang, Yan Tianyuan, Zhang Shizhe, Niu Guochang, Guan Yulong, Li Hua 2026, 30 (15):  3855-3861.  doi: 10.12307/2026.592 Abstract ( 83 )   PDF (1250KB) ( 17 )   Save BACKGROUND: Bunion is mainly treated by osteotomy and orthopedic surgery, but there is a risk of recurrence and deformity in the postoperative period, so postoperative evaluation of deformity is of great importance.  OBJECTIVE: To analyze the correlation of the changes in the three-dimensional deformity indicators of the first metatarsal bone after conventional osteotomy for correction of hallux valgus deformity with postoperative functional prognosis, and their guiding significance for clinical treatment.  METHODS: One hundred patients (feet) with hallux valgus deformity in Department of Hand and Foot Surgery, Hengshui People’s Hospital were selected from January to December 2022, and all of them underwent Scarf osteotomy and orthopedic surgery. Preoperative and 6-month postoperative orthopedic X-rays of the foot in weight-bearing position and simulated weight-bearing position CT films were taken to observe and measure the intermetatarsal angle of the first and second metatarsal bones, tibial lateral sesamoid bone position on orthopedic X-rays of the foot, first metatarsal rotational α-angle, distal articular facet fixation angle, and the angle of the hallux valgus. The correlation of deformity quantifiers at the three-dimensional level of the first metatarsal bone was analyzed, and deformity quantifiers and American Orthopaedic Foot & Ankle Society scores were compared preoperatively and at 6 months postoperatively. The correlation between the quantitative index of deformity at the three-dimensional level of the first metatarsal bone and the American Orthopaedic Foot & Ankle Society score 6 months after treatment was analyzed to evaluate the efficacy of the quantitative indicators of the deformity in predicting functional prognosis. RESULTS AND CONCLUSION: (1) Before treatment, the hallux valgus angle had no correlation with the first metatarsal rotational α-angle (P > 0.05), but was positively correlated with distal articular facet fixation angle, intermetatarsal angle of the first and second metatarsal bones, and tibial lateral sesamoid bone position on orthopedic X-ray films of the foot (P < 0.05). Distal articular facet fixation angle, intermetatarsal angle of the first and second metatarsal bones, first metatarsal rotational α-angle, and tibial lateral sesamoid bone position on orthopedic X-rays of the foot were all positively correlated (P < 0.05). (2) American Orthopaedic Foot & Ankle Society scores were significantly higher at 6 months postoperatively compared with preoperatively (P < 0.05), and the deformity quantifiers were all lower (P < 0.05). (3) There was a negative correlation of the deformity quantifiers at 6 months postoperatively with the American Orthopaedic Foot & Ankle Society score function, pain, force line, and total score (P < 0.05). (4) The quantitative deformity index of the first metatarsal bone in three dimensions is of high value for the preoperative evaluation, which provides a reference basis for clinical preoperative evaluation and assessment of the efficacy of the treatment, in order to carry out the follow-up treatment, reduce the risk of postoperative recurrence, and improve the prognosis. Figures and Tables | References | Related Articles | Metrics

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Accuracy of personalized 3D printed guide plate guided cortical bone trajectory screw placement during thoracolumbar spine surgery Zhu Yin, Wang Liming, Sha Weiping, Song Jincheng, Lin Xiaolong, Cao Ze, Sheng Xiaolei 2026, 30 (15):  3862-3870.  doi: 10.12307/2026.156 Abstract ( 65 )   PDF (1336KB) ( 32 )   Save BACKGROUND: Compared with traditional pedicle screws, cortical bone trajectory screw provides a more secure fixation by running entirely through cortical bone. However, precise and safe implantation of cortical bone trajectory screws requires high technical expertise from spine surgeons. Theoretically, the use of personalized guides produced with 3D printing technology can potentially enhance accuracy, streamline the procedure, and enhance surgical efficiency, but there is limited scholarly literature available on this topic. OBJECTIVE: To investigate the accuracy and safety of utilizing personalized 3D printed guide plates to assist in the placement of cortical bone trajectory screws in thoracolumbar fractures complicated with osteoporosis. METHODS: A total of 58 patients with thoracolumbar spine fractures (T11-L4) complicated with osteoporosis who underwent internal fixation using cortical bone trajectory screws between January 2020 and January 2024 were selected for this study. In total, 348 screws were analyzed, and the patients were divided into two groups based on the surgical approach. The 3D guide group consisted of 30 patients who received personalized 3D printing-assisted screw placement, accounting for 180 screws. The control group comprised 28 patients, in which a total of 168 screws were placed manually. The effectiveness and applicability of the different surgical methods were evaluated by comparing operative indicators, the accuracy of screw placement, the reduction of injured vertebrae, the correction of kyphotic deformity, and postoperative outcomes between the two groups. RESULTS AND CONCLUSION: (1) The 3D guide group demonstrated significant improvements over the control group across several operation-related metrics, including incision length, operation time, screw placement time, fluoroscopy times, intraoperative blood loss, postoperative drainage volume, and length of hospitalization (P < 0.05). However, there was no significant difference in the total cost between the two groups (P > 0.05). (2) The accuracy of screw placement was higher in the 3D guide group, with a significantly lower invasion rate of screws to the upper articular process compared with the control group (P < 0.05). (3) Postoperative evaluations revealed that the anterior vertebral height, Cobb angle, visual analog scale score, and Oswestry disability index improved for both groups relative to pre-surgery measurements, with these differences being statistically significant (P < 0.05). Compared with the other groups, the 3D guide group had a lower Oswestry disability index, indicating superior thoracolumbar function (P < 0.05). However, no significant differences were observed between the groups regarding postoperative anterior vertebral height, Cobb angle, and visual analog scale scores (P > 0.05). (4) Throughout the perioperative and follow-up periods, no complications were reported in either group. (5) It is indicated that the use of a personalized 3D printed guide plate for assisting in the placement of cortical bone trajectory screws in the treatment of thoracolumbar fractures with osteoporosis is feasible approach, offering advantages such as minimal invasiveness, efficiency, accuracy, safety, and satisfactory clinical outcomes. Figures and Tables | References | Related Articles | Metrics

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Method and verification of three-dimensional finite element modeling for cervical spondylotic radiculopathy Liang Long, Liu Guangwei, Yu Jie, Wei Xu, Li Jing, Lu Guangqi, Zhu Liguo, Yin Xunlu, Feng Minshan 2026, 30 (15):  3871-3877.  doi: 10.12307/2025.954 Abstract ( 97 )   PDF (1205KB) ( 39 )   Save BACKGROUND: Currently, finite element model studies involving cervical spondylotic radiculopathy either directly use normal human imaging data to construct the model, or use imaging data of a patient with cervical spondylotic radiculopathy to construct the model, which lacks simulation and representativeness. OBJECTIVE: To explore the simulation performance of the three-dimensional finite element model of cervical spondylotic radiculopathy, so as to provide references for the later research on cervical spondylotic radiculopathy and even spinal degenerative diseases.   METHODS: First, CT was used to scan the cervical spine of a normal person. Through multiple software, geometric reconstruction, reverse engineering, meshing, material assignment and other processes were carried out to construct a complete three-dimensional finite element model of the cervical spine including vertebrae (C0-T1), intervertebral discs (C2-C7), ligaments, articular cartilages, muscles and other structures, and verify the model. Then, a model was created for intervertebral disc degeneration to simulate the occurrence and development process of cervical spondylotic radiculopathy. Finally, verification was carried out by measuring the height of the intervertebral space, the size of the transverse and longitudinal diameters of the intervertebral foramen and their change amplitudes under different loading conditions.  RESULTS AND CONCLUSION: (1) After the successful construction of the three-dimensional finite element model of cervical spondylotic radiculopathy, except that the transverse diameter of the intervertebral foramen did not change, the height of the intervertebral space and the longitudinal diameter of the intervertebral foramen gradually decreased from moderate to severe intervertebral disc degeneration. (2) The dynamic verification results showed that after applying different loading conditions, in the three-dimensional finite element models of cervical spondylotic radiculopathy with moderate and severe intervertebral disc degeneration, the change amplitudes of the height of the intervertebral space and the transverse and longitudinal diameters of the intervertebral foramen decreased, indicating that the volume of the intervertebral foramen and the ability to accommodate nerve roots decreased. (3) Therefore, the finite element model of cervical spondylotic radiculopathy constructed in this study conforms to the pathogenesis characteristics of this disease.  Figures and Tables | References | Related Articles | Metrics

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Reconstruction of bone defect at the top of acetabulum during revision total hip arthroplasty with cup blocking screws and impaction bone grafting Guan Mingqiang, Wei Jinqiang, Chen Weijian, Zhou Guanming 2026, 30 (15):  3878-3884.  doi: 10.12307/2026.051 Abstract ( 98 )   PDF (891KB) ( 21 )   Save BACKGROUND: Bone defect at the top of acetabulum during revision total hip arthroplasty is a common and complex challenge, because it often affects the initial and mid-term to long-term stability of the acetabular cup during revision surgery.  OBJECTIVE: To evaluate the effect of bone defect reconstruction at the top of acetabulum with cup blocking screws and impaction bone grafting during revision total hip arthroplasty.   METHODS: Between March 2018 and December 2022, 11 patients with acetabular cup loosening and acetabular top Paprosky IIIA bone defect after total hip arthroplasty in Foshan Hospital of Traditional Chinese Medicine were selected. All patients were reconstructed with acetabular blocking screw combined with particle impaction bone grafting technology. Harris score, satisfaction score, and leg length discrepancy were recorded and compared before revision and at the final follow-up after revision. X-ray films were observed to evaluate the condition of acetabular cups and blocking screws. RESULTS AND CONCLUSION: (1) All 11 patients were followed up for 20-72 months. (2) Harris score, satisfaction score, and leg length discrepancy were significantly improved at the last follow-up (P < 0.001). (3) Last postoperative X-ray films showed good bone ingrowth around the cup and no acetabular loosening in all patients. (4) No cup blocking screw was found to be broken or displaced in last postoperative X-ray films. (5) All these results imply that cup blocking screws combined with impaction particulate bone grafting is a simple and reliable technique in reconstructing the bone defect at the top of acetabulum during revision. This technique can not only simplify the achievement of initial stability during revision, but can also strengthen the mid-term to long-term stability of the cup.  Figures and Tables | References | Related Articles | Metrics

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Application of a novel femoral neck anteversion angle measurement device in intramedullary nailing fixation for intertrochanteric fractures Wang Shufang, Kang Xiaoqin, Liu Zhi, Shen Bing, Zhang Feng, Song Yuanzheng, Zhang Shuaigong 2026, 30 (15):  3885-3896.  doi: 10.12307/2026.725 Abstract ( 85 )   PDF (1921KB) ( 40 )   Save ACKGROUND: During intramedullary nailing fixation for intertrochanteric femoral fractures, surgeons encounter challenges in real-time assessment of the anteversion angle during femoral neck guide needle placement. Current clinical practice lacks specialized instrumentation for this specific functionality. OBJECTIVE: To develop a measurement device compatible with common surgical instruments that enables real-time intraoperative monitoring and indication of the femoral neck guide needle anteversion angle, thereby assisting surgeons in achieving rapid and precise placement. METHODS: Based on Brunner's method for measuring femoral neck anteversion, a digital model of the femoral anteversion angle measuring device was designed and 3D-printed. A surgical model was constructed using anatomically scaled human femur phantoms and auxiliary structures to simulate intertrochanteric fracture fixation for intertrochanteric fractures on a traction bed. The 3D-printed prototype was utilized to assist guide needle insertion. Three groups of femur models were tested, with experimental data recorded and statistically analyzed. The device design was optimized, and a physical prototype was produced. Twenty patients with intertrochanteric femoral fractures were prospectively enrolled (trial group: n=10, control group: n=10). The trial group underwent guide needle placement assisted by the measurement device, while the control group received conventional treatment by the same surgical team. Comparative analysis of surgical parameters was conducted to evaluate device efficacy and clinical utility. RESULTS AND CONCLUSION: (1) The novel femoral neck anteversion angle measurement device (Patent No. ZL202120806525.X) enables real-time measurement of the anteversion angle of the proximal guide frame during intramedullary nailing. (2) The novel anteversion angle measurement device can accurately reflect the femoral neck anteversion measured by Brunner's method and indicate the required proximal guide frame angle for guide needle insertion. (3) Clinical trial results showed that compared with the control group, the trial group had shorter surgical time (P=0.042), less femoral neck guide wire deviation (P=0.001), fewer fluoroscopy sessions, fewer repeated guide wire placements, and shorter guide wire placement time (P < 0.05). (4) The novel anteversion angle measurement device can accurately measure and indicate the anteversion angle of the femoral neck guide wire during real-time intraoperative use. It can be used with a variety of proximal femoral intramedullary nail fixation device systems, does not directly contact the human body, and does not cause additional damage, making it valuable for clinical promotion.  Figures and Tables | References | Related Articles | Metrics

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Comparison of Zero-profile self-stabilizing fusion devices and traditional plate fusion systems in treatment of single-level cervical spondylosis Wang Jianru, Ma Jikun, Qi Junjie, Jiang Zilong, Sun Yunlong, Chen Longwei, Jiang Lianghai, Wei Jianwei, Liu Haifei 2026, 30 (15):  3897-3905.  doi: 10.12307/2026.695 Abstract ( 91 )   PDF (1642KB) ( 11 )   Save BACKGROUND: Plate fixation has traditionally been the method of choice in anterior cervical discectomy and fusion procedures. In recent years, the Zero-profile self-stabilizing fusion device (ROI-C, LDR, Troyes, France) has gained popularity in anterior cervical discectomy and fusion; however, its potential to replace conventional plate fixation remains a subject of debate. OBJECTIVE: To compare the effectiveness and complications associated with single-level cervical spondylotic myelopathy treated via anterior cervical discectomy and fusion using a self-adjustable cage (ROI-C) versus traditional plate fixation. METHODS: A retrospective analysis was conducted on 63 patients diagnosed with single-level cervical spondylosis who underwent anterior cervical discectomy and fusion at Eastern District of Qingdao Municipal Hospital between January 2019 and July 2023. Based on the type of internal fixation employed, patients were categorized into two groups: ROI-C group (22 cases utilizing ROI-C fixation) and plate group (41 cases employing traditional plate and screw fixation). Various parameters were compared between both groups, including operation time, intraoperative blood loss, Japanese Orthopaedic Association Scores, Visual Analogue Scale scores, Neck Disability Index, C2-7 cobb angle, T1 Slope, and intervertebral space height recorded preoperatively as well as immediately, 3, 6, and 12 months postoperatively. Furthermore, swallowing function outcomes and instances of adjacent segment degeneration were evaluated across both groups. RESULTS AND CONCLUSION: (1) Compared with the plate group, the operation time was significantly shorter, and intraoperative blood loss was notably lower in the ROI-C group (P < 0.05). (2) The Japanese Orthopaedic Association Scores, C2-7 cobb angle, and intervertebral space height immediately, 3, 6, and 12 months postoperatively, and T1 Slope 3 and 6 months postoperatively were significantly increased compared with those preoperatively (P < 0.05). Visual Analogue Scale scores and Neck Disability Index were decreased immediately, 3, 6, and 12 months postoperatively (P < 0.05). In the plate group, the Japanese Orthopedic Association score, C2-7 Cobb angle, intervertebral space height, and T1 Slope immediately, 3, and 6 months after surgery were significantly increased compared with those before surgery. The visual analog scale score and Neck Disability Index immediately, 3, 6, and 12 months after surgery were significantly decreased compared with those before surgery (P <  0.05). (3) The incidence of dysphagia in the ROI-C group (0%) was significantly lower 3 months after surgery than in the plate group (17%) (P=0.041). 12 months after surgery, the incidence of adjacent segment degeneration was 5% (1/22) in the ROI-C group and 7% (3/41) in the plate group. Both groups had significantly lower intervertebral heights of the upper and lower adjacent segments compared to the immediate postoperative period, with the plate group showing a greater decrease in intervertebral height than the ROI-C group (P < 0.05). (4) This suggests that both ROI-C and traditional plate and screw fixation for the treatment of single-segment cervical spondylosis can effectively improve neurological function, relieve pain, and enhance cervical biological parameters. However, the ROI-C group had a shorter operation time, less blood loss, and a lower incidence of postoperative dysphagia, with less impact on adjacent segment degeneration. Figures and Tables | References | Related Articles | Metrics

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Angle control pedicle screw implantation tool in conjunction with a 3D model and guide plate to assist in accuracy of screw implantation Yang Zhenyuan, Zhang Jiwei, Zhang Kaidong, Ma Bingqing, Zhang Yanjun, Li Junjie 2026, 30 (15):  3906-3912.  doi: 10.12307/2026.059 Abstract ( 78 )   PDF (1500KB) ( 21 )   Save BACKGROUND: Pedicle screws are widely used in spine surgery, and their precise placement is the focus of attention. In this study, a new pedicle screw placement method was explored to improve the accuracy of clinical nail placement. OBJECTIVE: To observe the application value of the self-developed angle control pedicle screw implantation tool combined with 3D model and guide plate in auxiliary pedicle screw implantation.  METHODS: Totally 96 patients with spinal surgery who received pedicle screw internal fixation from March 2023 to June 2024 were selected and divided into two groups by random sampling method, namely the assisted group and the freehand group, with 48 patients in each group. The assisted group used an angle-controlled pedicle screw implantation tool with 3D model and guide plate to assist screw implantation, while the freehand group relied on C-arm X-ray machine for positioning and freehand screw implantation. All patients underwent CT examination to evaluate the differences in the time, accuracy, and frequency of C-arm X-ray machine use between the two methods.  RESULTS AND CONCLUSION: (1) A total of 286 screws were implanted in the assisted group, with an implantation time of (2.51±1.26) min/screw and an accurate implantation success rate of 95.8%, while (1.45±2.12) times/screw were required by using C-arm fluoroscopy equipment; 264 screws were implanted in the freehand group, with an implantation time of (3.27±1.54) min/screw, an accurate implantation success rate of 87.2%, and the number of C-arm fluoroscopy was (2.19±1.73) times/screw. (2) In comparison, the assisted group showed significant advantages in these three indicators: shorter single screw implantation time, higher screw placement accuracy, and lower C-arm fluoroscopy times, which were significantly different from those in the freehand group (P < 0.05). (3) It is concluded that the use of angle-controlled pedicle screw implantation tools, combined with 3D model and guide plate assist, in pedicle screw implantation surgery can significantly enhance accuracy, shorten the time needed for placement, as well as reduce radiation exposure, all of which have clinical applications. Figures and Tables | References | Related Articles | Metrics

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A controlled analysis of phenomenon of acupoint sensitization in osteonecrosis of the femoral head Yao Kexin, Yang Yidan, Li Yapeng, Zhu Xuanye, Wang Qiuyuan, Guo Jiayi, Liu Youwen, Yue Chen 2026, 30 (15):  3913-3919.  doi: 10.12307/2025.871 Abstract ( 95 )   PDF (898KB) ( 15 )   Save BACKGROUND: Acupoints are known to be sensitized in various disorders involving chronic musculoskeletal pain, which may be useful to target during acupuncture. However, whether such acupoint sensitization occurs in osteonecrosis of the femoral head is unclear.  OBJECTIVE: To examine whether acupoints are sensitized in osteonecrosis of the femoral head patients through comparison with healthy controls.  METHODS: Mechanical pressure pain thresholds were measured at 6 acupoints and 3 non-acupoints on the affected and unaffected sides of 50 patients with osteonecrosis of the femoral head. The 6 local acupoints on the affected side of the hip that were commonly used to treat osteonecrosis of the femoral head included Chengfu (BL36), Zhibian (BL54), Juliao (GB29), Huantiao (GB30), Qichong (ST30), and Biguan (ST31). At the same time, three non-acupoints were selected, one on each side of the anterior, lateral, and posterior sides of the hip joint. The pain thresholds of the same parts of 50 healthy control subjects matched with the patients in sex and age were also measured. All measurements were performed at a single time point. RESULTS AND CONCLUSION: (1) Acupoints on the affected side of 36%-60% of osteonecrosis of the femoral head patients showed a mechanical pressure pain threshold that was lower than acupoints on the unaffected side, suggesting peripheral sensitization. (2) Acupoints on the unaffected side of 34%-48% of patients showed a pain threshold that was lower than acupoints on the corresponding side of healthy controls, suggesting central sensitization. (3) Among patients with osteonecrosis of the femoral head, sensitization was significantly higher at all acupoints than at all non-acupoints on the affected side (P < 0.05), but it did not differ significantly between acupoints and non-acupoints on the unaffected side. (4) This study provides the first evidence of acupoint sensitization associated with osteonecrosis of the femoral head. Stimulating sensitized acupoints, particularly on the affected side, may help mitigate pain in the disorder.   Figures and Tables | References | Related Articles | Metrics

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Analysis of risk factors for secondary fractures after hip fracture surgery in the elderly La Rui, Wu Qian, Zhang Zhongtai, Xu Wu, Ding Qingfeng, Zhang Zhigang, Jiang Dinghua, Huang Lixin, Wang Shenghao 2026, 30 (15):  3920-3928.  doi: 10.12307/2026.727 Abstract ( 102 )   PDF (1121KB) ( 17 )   Save BACKGROUND: Secondary fracture has gradually become the most problematic postoperative health threat in elderly hip fracture patients. However, the findings on the occurrence of secondary fracture and risk factors are still controversial. OBJECTIVE: To investigate the incidence and distribution of postoperative secondary fractures in elderly patients with hip fractures, and to further investigate the risk factors for postoperative secondary fractures in these patients. METHODS: A total of 573 patients aged 60-85 years who underwent surgical treatment at the First Affiliated Hospital of Soochow University for initial femoral neck fracture or intertrochanteric femoral fracture between January 2018 and December 2020 were retrospectively analyzed. Patients were categorized into the secondary fracture group and the no secondary fracture group according to the occurrence of secondary fracture at the final follow-up. The differences in indicators between the two groups were compared, and indicators that might be meaningful were included in multivariate logistic regression analysis to explore the independent risk factors for postoperative secondary fracture. RESULTS AND CONCLUSION: (1) The incidence of postoperative secondary fractures in elderly hip fracture patients was 20.2% (116/573). The sites and proportions of secondary fractures were as follows: 68 lower extremity fractures, accounting for 58.6%; 33 spine fractures, accounting for 28.5%; and 15 upper extremity fractures, accounting for 12.9%. (2) Comparison of baseline data showed that there was a significant difference between patients in the secondary fracture group and patients in the group without secondary fracture in terms of age, history of cerebrovascular disease, history of Parkinson's disease, preoperative prealbumin level, mechanism of injury for the initial hip fracture, Singh index grading on the healthy side, and early postoperative mobility (P < 0.05). (3) Multivariate logistic regression analysis showed that history of Parkinson's disease (OR=3.00, 95%CI=1.05-8.43, P=0.036) and need for assistance in early postoperative mobility (OR=2.78, 95%CI=1.39-5.51, P=0.003) were independent risk factors for secondary fractures. (4) The incidence of postoperative secondary fractures in elderly hip fracture patients is not low. In the future, multidisciplinary co-management of patients, especially those with a history of comorbid Parkinson's disease, should be strengthened and enhanced recovery after surgery strategy should be persistently promoted to reduce the incidence of secondary fractures. Figures and Tables | References | Related Articles | Metrics

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Accuracy and stability of digital algorithm-based CT imaging recognition software in identifying AO-C2 type distal radius fractures Liu Fei, Deng Xinheng, Cheng Yongzhong, Yin Xiaodong, Li Xiaomin, Zhu Shuchao, Wang Chaolu 2026, 30 (15):  3929-3935.  doi: 10.12307/2026.534 Abstract ( 90 )   PDF (1174KB) ( 72 )   Save BACKGROUND: Traditional interpretation of fracture CT images primarily depends on physician experience, leading to substantial subjectivity and potential for significant error. Consequently, developing fracture CT image recognition software based on digital algorithms can effectively assist physicians in accurately identifying fracture types, displacement, rotation, and other features, which is of great clinical significance. OBJECTIVE: To validate the diagnostic accuracy and stability of fracture point recognition of self-developed CT imaging recognition software for AO-C2 type distal radius fractures, compare the differences in displacement and rotation data of fracture fragments measured by the software and physicians, and explore the clinical application prospects of the CT imaging recognition software.  METHODS: CT images were collected from 25 cases of AO-C2 type distal radius fractures treated at Nanyang Traditional Chinese Medicine Hospital between January and June 2024. A series of validations were performed using the fracture CT imaging recognition software, assessing its performance in fracture type identification, fracture point recognition, and displacement measurement. Differences between the software and physician measurements based on the picture archiving and communication system were compared. The stability and consistency of the results were analyzed using the coefficient of variation, intraclass correlation coefficient, and Bland-Altman analysis.   RESULTS AND CONCLUSION: (1) The fracture CT imaging recognition software achieved a 92% accuracy rate in identifying fracture types. The overall coefficient of variation for fracture point recognition was below 19%, with coefficient of variation for joint surface fracture points under 25% and for bone shaft fracture points under 18%, demonstrating good stability in fracture point recognition. (2) Intraclass correlation coefficient analysis revealed high consistency in displacement and rotation measurements of fracture fragments by physicians of varying experience levels using the fracture CT image recognition software. (3) Bland-Altman analysis showed no significant differences in fracture displacement measurements between the software and those obtained by physicians using the picture archiving and communication system, while the software exhibited high precision in measuring the rotation of fracture fragments. (4) This study indicates that the fracture CT imaging recognition software, based on digital algorithms, shows good stability in recognizing fracture points and strong consistency and precision in identifying fracture displacement and rotation. The recognition of fracture rotation is significantly better than that of picture archiving and communication system. It holds promising clinical application prospects for AO-C2 type distal radius fractures, enabling physicians to make quicker treatment decisions.  Figures and Tables | References | Related Articles | Metrics

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Differences in clinical function and imaging between robot-assisted and conventional total knee arthroplasty Liu Haoyang, Li Hongxu, Zhou Yu, Yue Debo, Wang Bailiang, Ma Jinhui 2026, 30 (15):  3936-3945.  doi: 10.12307/2026.683 Abstract ( 111 )   PDF (1552KB) ( 18 )   Save BACKGROUND: With the rise of robotic-assisted total knee arthroplasty, its advantages in implant positioning accuracy have garnered significant attention. However, current evidence remains inconclusive regarding whether robotic-assisted total knee arthroplasty is superior to conventional total knee arthroplasty in improving postoperative joint range of motion, prosthesis revision rates, limb alignment, and patient satisfaction.  OBJECTIVE: To investigate the differences in clinical function and radiographic outcomes between Mako robotic-assisted total knee arthroplasty and conventional total knee arthroplasty, as well as their clinical significance. METHODS: A retrospective analysis was conducted on 66 osteoarthritis patients who underwent Mako robotic-assisted total knee arthroplasty (robotic-assisted group) at the China-Japan Friendship Hospital between January 2023 and September 2024. A matched cohort of 59 patients who underwent conventional total knee arthroplasty (conventional total knee arthroplasty group) was selected based on age, gender, and body mass index. The operation time, blood loss, tourniquet usage time, and clinical outcomes of the two groups before, and 3, 6, and 12 months after surgery were recorded, including Hospital for Special Surgery knee score, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society Score (functional score), and knee range of motion. Full-length X-rays of both lower limbs in the anteroposterior weight-bearing position were taken before and 1 week after surgery, and the hip-knee-ankle angle, valgus correction angle, lateral distal femoral angle, lateral proximal femoral angle, and medial proximal tibial angle were measured and compared between both groups of patients.  RESULTS AND CONCLUSION: (1) The robotic-assisted group had a longer operative time but a shorter tourniquet time compared with the conventional total knee arthroplasty group, with comparable blood loss between groups. (2) At one week postoperatively, range of motion improved in both groups, with a slightly greater improvement in the conventional total knee arthroplasty group (P > 0.05). (3) Hospital for Special Surgery scores indicated similar functional improvements postoperatively, with no significant differences (P > 0.05). At one year, the robotic-assisted group had significantly higher Knee Society Score function scores compared with the conventional total knee arthroplasty group (P < 0.05). Western Ontario and McMaster Universities Osteoarthritis Index scores showed improvements in both groups, but the robotic-assisted group had superior outcomes at six months and one year compared with the conventional total knee arthroplasty group (P < 0.05). (4) Radiographic analysis demonstrated improved lower limb alignment and optimal prosthesis positioning in all patients, with no severe adverse events during follow-up. (5) Imaging measurement displayed that the robotic-assisted group showed significant improvements in hip-knee-ankle angle, medial proximal tibial angle, and lateral proximal femoral angle postoperatively (P < 0.05), whereas valgus correction angle and lateral distal femoral angle remained unchanged (P > 0.05). In the conventional total knee arthroplasty group, hip-knee-ankle angle and medial proximal tibial angle significantly improved (P < 0.05), while valgus correction angle, lateral proximal femoral angle, and lateral distal femoral angle remained unchanged (P > 0.05). No significant differences were observed in postoperative radiographic indices between the two groups (P > 0.05). except for valgus correction angle and lateral proximal femoral angle, the preoperative and postoperative changes in other values were not significantly different (P > 0.05). (6) The incidence of postoperative complications was not significantly different between groups (P > 0.05). (7) These findings suggest that Mako robotic-assisted total knee arthroplasty offers superior intraoperative precision in angular alignment, limb axis correction, and soft tissue balancing compared with conventional total knee arthroplasty, enhancing the accuracy and personalization of bone resection and implant placement. Postoperative lower limb alignment and clinical outcomes were non-inferior to conventional total knee arthroplasty, demonstrating promising potential for broader clinical application. Figures and Tables | References | Related Articles | Metrics

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Micro-CT evaluation of trabecular morphology in different regions of the talus Li Lei, Zhang Fengzhen, Yin Zhaozheng, Yi Yuying, Shen Xiaoke, Duan Bo, Wang Zhiqiang, Ren Xiaoyan, Li Kun, Li Zhijun, Wang Qijiao, Wang Xing, Zhang Shaojie 2026, 30 (15):  3946-3952.  doi: 10.12307/2026.876 Abstract ( 79 )   PDF (1408KB) ( 12 )   Save BACKGROUND: Talus fractures are difficult to treat and are prone to multiple complications, leading to poor prognosis. Therefore, it is necessary to further understand the distribution characteristics of trabeculae in the talus and their relationship with fracture occurrence. OBJECTIVE: Micro-CT technology was used to scan talus specimens, observe the structural characteristics and morphometric parameters of trabeculae, explore the differences in trabeculae in different regions of the talus, and provide a basis for the prevention, treatment, and study of fracture mechanisms of talus fractures. METHODS: A total of 53 adult talus specimens were selected for Micro-CT scanning. The imaging data were imported into Avata software for three-dimensional reconstruction. By selecting and reconstructing the trabeculae in the three regions of interest (head, neck, and body of the talus), their morphological characteristics were observed, and the differences in the morphometric parameters of trabeculae in different regions were measured and analyzed. RESULTS AND CONCLUSION: (1) Micro-CT scans showed that the cortical bone of the head and body of the talus was thinner, while the cortical bone of the neck was relatively thicker. The trabeculae in the neck were sparsely distributed, while those in the head and body were relatively dense. (2) The bone volume, bone volume fraction and trabecular pattern factor of talar trabeculae showed significant differences between the head and the neck, and the body (P < 0.05). The bone surface area, bone surface area to tissue volume ratio, trabecular separation and fractal dimension of talar trabeculae showed significant differences of the neck with the head and the body (P < 0.05). The trabecular thickness of talar trabeculae showed significant differences of the body with the head and the neck (P < 0.05). The bone surface area to bone volume ratio, trabecular thickness, trabecular connectivity, trabecular connection density, degree of anisotropy and structural model index of talar trabeculae showed significant differences of the neck with the head and the body, and between the head and the body (P < 0.05). (3) It is concluded that Micro-CT technology can quantitatively analyze the morphometric parameters of trabecular bone in different regions of the talus. There are regional differences in the morphometric parameters of trabecular bone of the talus. The number and strength of trabeculae in the neck are lower, and it is the most prone to fracture. The distribution characteristics of trabecular bone explain the mechanism of talus fractures occurring frequently in the neck.  Figures and Tables | References | Related Articles | Metrics

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Relationship of femoral artery, vein and nerve projections with femoral head positions in patients with femoral neck fracture Tang Yuntao, Wu Zhonghan, Wang Jingkun, Li Tao, Lu Jingtao, Mao Shitan, Tang Jian, Xu Xinzhong 2026, 30 (15):  3953-3959.  doi: 10.12307/2025.854 Abstract ( 74 )   PDF (1136KB) ( 19 )   Save BACKGROUND: The blood supply to the femoral head is a significant factor affecting the prognosis of patients with femoral neck fractures. Therefore, a deep understanding of the femoral artery, vein, and femoral nerve is conducive to the smooth progression of closed reduction and internal fixation for femoral neck fractures.  OBJECTIVE: To obtain the projection and corresponding relations of femoral arteries, veins and femoral nerve on the femoral head by using the ultrasound to locate the position of femoral arteries, veins and femoral nerve.   METHODS: 195 patients with femoral neck fracture undergoing closed reduction and internal fixation treated between January 2014 and January 2020 were collected, among whom there were 108 females and 87 males, with an average age of 39.1 (23-65) years. There were Garden I in 13 cases, Garden II in 24 cases, Garden III in 90 cases, Garden IV in 68 cases, 99 cases on the left and 96 cases on the right as well as 55 cases of hypertension, 39 cases of diabetes mellitus, 15 cases combined with arrhythmia, and 9 cases with cerebral infarction. The ultrasound was applied to position the femoral vessels, femoral nerve and then mark their lines in the hip, and then Kirschner wire was placed on the marker line. The fluoroscopic imaging of Kirschner wire on the femoral head was used to obtain the relative relationship between the two. Zones A, B, C, and D were divided according to the tangent line of the medial and lateral margins of the femoral head and the perpendicular line of the central point of the femoral head.  RESULTS AND CONCLUSION: (1) The femoral arteries, veins and femoral nerves of 129 cases (66%) were located in the Zone A, 38 cases (20%) in Zone B, 28 cases (14%) in Zone C, and 0 cases in Zone D. Most of the femoral vessel and femoral nerve lines were overlapped with the medial projection of the femoral head, partial vessel and nerve lines overlapped with the femoral head projection, and there was no lateral projection of the femoral head. (2) Most of the femoral vessel and femoral nerve projection was located in Zone A, i.e., at the medial side of the femoral head. There was no vessel and femoral nerve projection at the lateral side of the femoral head, that was, Zone D was an avascular nerve area, so the needle entry at this area was absolutely safe. For the cases of femoral vessels and femoral nerve at the medial side of the femoral head, it was safe to insert the Kirschner wire vertically to fix the femoral head. (3) For the femoral vessels and femoral nerves in Zones B and C, the needle needs to be inserted at an angle to avoid damaging the vessels and femoral nerves.  Figures and Tables | References | Related Articles | Metrics

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Biomechanical function and clinical significance of the lateral wall integrity in intertrochanteric fractures of the femur Feng Tao, Yin Zhaoyang 2026, 30 (15):  3960-3970.  doi: 10.12307/2026.338 Abstract ( 97 )   PDF (1268KB) ( 51 )   Save BACKGROUND: In recent years, with the advancing research on the clinical characteristics and biomechanical mechanisms of the lateral femoral wall, the clinical value of the lateral wall has gained general recognition, and the integrity of the lateral wall is a core element in determining the prognosis of intertrochanteric femoral fractures. OBJECTIVE: A review of recent studies on the lateral wall of intertrochanteric femur fractures was conducted to provide a theoretical basis for clinical diagnosis and treatment, so as to optimize the choice of internal fixation techniques and control the related complications. METHODS: The author searched databases including WanFang, CNKI and PubMed for domestic and foreign relevant articles with search terms “intertrochanteric fracture of femur, biomechanics, finite element analysis, lateral femoral wall, fracture classification, fracture fixation” in Chinese and English. The search time was from 2015 to 2025 and a total of 70 articles were selected for review. RESULTS AND CONCLUSION: (1) The new comprehensive classification can describe the fracture morphology of intertrochanteric fractures in more detail, which has a greater potential for clinical application and can more effectively guide doctors to formulate treatment plans. (2) The finite element analysis of the lateral wall confirms that the complete lateral wall can enhance the strength and stability of intramedullary fixation, and its support strength is proportional to the thickness of the lateral wall. (3) The reconstruction of the lateral wall is conducive to the enhancement of the mechanical stability of the femur, and the intramedullary joint combination of intramedullary and extramedullary fixation showed better clinical results. Preoperative reconstruction of the posterolateral wall should be customized according to the patient’s specific condition. Figures and Tables | References | Related Articles | Metrics

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Mechanism and therapeutic potential of nuclear factor E2-related factor 2 in regulating non-infectious spinal diseases Huang Lei, Wang Xianghong, Zhang Xianxu, Li Shicheng, Luo Zhiqiang 2026, 30 (15):  3971-3982.  doi: 10.12307/2026.668 Abstract ( 88 )   PDF (2941KB) ( 105 )   Save BACKGROUND: Nuclear factor E2-related factor 2 is a key anti-oxidative stress transcription factor that regulates the expression of multiple antioxidant genes and protects cells from oxidative damage. Under normal physiological conditions, nuclear factor E2-related factor 2 activity is maintained at low levels by ubiquitination degradation mediated by Kelch-like ECH-related protein 1. During oxidative stress, Kelch-like ECH-related protein 1 changes conformation, releases nuclear factor E2-related factor 2 to the nucleus, and activates antioxidant genes. Nuclear factor E2-related factor 2 is closely related to non-infectious spinal diseases such as intervertebral disc degeneration, spinal cord injury, osteoporosis, and ankylosing spondylitis, and may play an important regulatory role in them. OBJECTIVE: To review the mechanism of action of nuclear factor E2-related factor 2 and its Kelch-like ECH-related protein 1-nuclear factor E2-related factor 2-antioxidant response element signaling pathway in non-infectious spinal diseases, and to explore potential therapeutic strategies to improve these diseases by regulating the activity of the nuclear factor E2-related factor 2 pathway, so as to provide new directions for clinical drug treatment.  METHODS: Using the Chinese search terms “intervertebral disc degeneration, spinal cord injury, osteoporosis, osteoblasts, osteoclasts, ankylosing spondylitis, nuclear factor E2-related factor 2” and the English search terms “intervertebral disc degeneration, spinal cord injury, osteoporosis, osteoblasts, osteoclasts, ankylosing spondylitis, Nrf2,” all research articles published from the establishment of the database to January 2025 were searched in the CNKI and PubMed databases. According to the inclusion criteria, 109 core related articles were finally included for review. RESULTS AND CONCLUSION: (1) Nuclear factor E2-related factor 2 significantly delays the process of intervertebral disc degeneration by inhibiting cell death modes such as ferroptosis, apoptosis and autophagy. (2) Nuclear factor E2-related factor 2 can reduce oxidative stress and inflammatory response in spinal cord injury, protect nerve cells, and promote functional recovery. (3) Nuclear factor E2-related factor 2 plays a bidirectional regulatory role in osteoporosis. In osteoclasts, nuclear factor E2-related factor 2 inhibits their differentiation and bone resorption, slowing down bone loss. In osteoblasts, moderate activation of nuclear factor E2-related factor 2 can promote the expression of bone formation-related genes and support bone formation, but excessive activation may inhibit osteoblast differentiation. (4) Nuclear factor E2-related factor 2 activates antioxidant defense mechanisms in ankylosing spondylitis, reducing tissue damage and inflammatory response. Figures and Tables | References | Related Articles | Metrics

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Risk factors for axial symptoms following posterior cervical laminoplasty: a systematic review and meta-analysis Ma Le, Song Yuke, Zhong Xianxing, Zhang Wensheng 2026, 30 (15):  3983-3992.  doi: 10.12307/2026.356 Abstract ( 98 )   PDF (1938KB) ( 12 )   Save OBJECTIVE: Axial symptoms are among the most common complications following posterior cervical laminoplasty, significantly affecting patients' quality of life. Currently, there is no systematic analysis of the risk factors associated with axial symptoms. This study aims to evaluate the incidence and risk factors of axial symptoms through a meta-analysis, providing evidence-based guidance for clinical management. METHODS: A systematic search was conducted in PubMed, Cochrane Library, Web of Science, Embase, CNKI, WanFang Data, VIP, and Chinese Biomedical Literature Database for case-control studies on axial symptoms following cervical open-door laminoplasty. The search period extended from the inception of each database to April 2025. Search strategies were tailored to the characteristics of each database. Basic characteristics, incidence rates, and risk factors for axial symptoms were extracted from the included studies. Risk of bias and quality of the included studies were assessed. Meta-analysis was performed using R software (version 4.4.2) to evaluate the incidence and risk factors of axial symptoms. RESULTS: (1) A total of 17 studies involving 2 156 patients were included in the analysis. The overall incidence of axial symptoms was 34.88% (95%CI: 0.301 6-0.399 0). Of them, 13 articles were of high quality. (2) Meta-analysis identified the following as independent risk factors for axial symptoms: preoperative neck and shoulder pain (OR=2.35, 95%CI: 2.20-2.50), cervical curvature < 12° (OR=3.16, 95%CI: 1.91-5.24), canal occupancy rate (OR=1.35, 95%CI: 1.02-1.79), facet joint violation (OR=2.87, 95%CI: 1.96-4.19), changes in cervical curvature (OR=1.10, 95%CI: 1.03-1.17), and changes in cervical range of motion (OR=1.09, 95%CI: 1.04-1.14). CONCLUSION: Preoperative neck and shoulder pain, cervical curvature < 12°, intraoperative facet joint violation, and postoperative changes in cervical curvature and range of motion were identified as independent risk factors for axial symptoms. Patients with these high-risk factors should be closely monitored and provided with timely interventions to reduce the incidence of axial symptoms and improve their quality of life. Figures and Tables | References | Related Articles | Metrics

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Network meta-analysis of core decompression combined with various therapies for early and mid-stage osteonecrosis of the femoral head Guo Yuqi, Li Jiacheng, Lu Bowen, Zhang Jiahao, Li Gang 2026, 30 (15):  3993-4009.  doi: 10.12307/2026.738 Abstract ( 83 )   PDF (3260KB) ( 347 )   Save OBJECTIVE: To evaluate the efficacy and safety of core decompression combined with various therapeutic strategies in patients with early to mid-stage osteonecrosis of the femoral head. METHODS: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, EMbase, China National Knowledge Infrastructure, VIP, WanFang Data, and Chinese Biomedical Literature Service System for randomized controlled trials published up to January 19, 2025, on core decompression combined with different interventions for early to mid-stage osteonecrosis of the femoral head. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to evaluate the quality of evidence. A Bayesian network meta-analysis model was constructed to synthesize the data. Effect sizes were estimated using standardized mean differences, and cumulative ranking probabilities were calculated to determine the relative effectiveness of each intervention. Sensitivity analyses were performed using the leave-one-out method, and the assumption of transitivity was examined based on baseline covariates. RESULTS: A total of 73 randomized controlled trials involving 5 148 patients and 5 777 hips were included, covering 15 different combination therapies. The findings revealed that: (1) In terms of overall clinical efficacy, core decompression combined with bone marrow aspirate concentrate of mononuclear cells, bone marrow mesenchymal stem cell transplantation, structural bone grafting, or kidney-tonifying and blood-activating decoction was superior to core decompression alone, with the combination involving bone marrow aspirate concentrate of mononuclear cells demonstrating the best effect (the area under the cumulative ranking probability curve = 96.23%). (2) For hip function improvement, core decompression combined with staged Chinese medicine treatment showed the highest efficacy (the area under the cumulative ranking probability curve = 93.85%). (3) Regarding pain relief, combinations with compound proprietary medicine treatment (kidney-tonifying and blood-activating plus blood-activating and stasis-resolving) or blood-activating and stasis-resolving decoction exhibited prominent benefits. (4) For radiological improvements, core decompression combined with autologous stem cell implantation showed the best outcomes (the area under the cumulative ranking probability curve = 82.56%). (5) In terms of safety, core decompression combined with blood-activating and stasis-resolving decoction was associated with a relatively lower incidence of adverse events (P < 0.05). Sensitivity analysis using the leave-one-out method confirmed the robustness of the findings. The model remained stable across analyses, and the transitivity assumption was supported by baseline covariate assessment. CONCLUSION: Core decompression combined with stem cell transplantation, Chinese medicine-based sequential therapies, and other combination strategies provides superior clinical outcomes compared with core decompression alone for patients with early to mid-stage osteonecrosis of the femoral head, particularly in terms of joint function preservation, structural restoration, and pain relief. Further high-quality, multicenter, large-sample randomized controlled trials are needed to confirm these findings due to limitations in sample size and methodological quality of some included studies. Figures and Tables | References | Related Articles | Metrics

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Stepwise surgical treatment of knee osteoarthritis and the application trends of three surgical procedures: a bibliometric analysis Wang Jingyi, An Shuai, Li Daoqin, He Tao, Feng Mingli, La Gaoyan, Li Zheng, Cheng Jingbo 2026, 30 (15):  4010-4020.  doi: 10.12307/2026.194 Abstract ( 92 )   PDF (3563KB) ( 34 )   Save BACKGROUND: In recent years, the number of literature related to the stepped treatment of knee osteoarthritis has increased year by year, but there is a lack of bibliometric studies.  OBJECTIVE: To analyze the current status of global research on total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy for the treatment of knee osteoarthritis from 2009 to 2023, and to predict the treatment trends and development of these three surgical procedures. METHODS: Articles related to the three procedures published from January 2009 to December 2023 were retrieved from Web of Science Core Database (WoSCC) and China National Knowledge Infrastructure (CNKI). Microsoft Office Excel2019, COOC, NoteExpress4.0.0.9756, bibliometric online analysis platform, CiteSpace6.3.R1, VOSviewer 1.6.20, and Biblioshiny were used for statistical analysis and literature visualization analysis. RESULTS AND CONCLUSION: (1) A total of 2 203 research articles in Chinese and 7 102 articles in English were retrieved and analyzed. The number of papers in this field is fluctuating year by year. (2) After analyzing the Chinese literature of CNKI, Chinese Journal of Tissue Engineering Research published the most papers with 127 papers. The Department of Orthopedics and Orthopedics of Beijing Jishuitan Hospital affiliated to Capital Medical University published 21 papers, which was the institution with the most papers. The clustering encompasses three main components: perioperative management and surgical materials technology, core surgical techniques and technological innovations, as well as pathogenesis, anatomical studies, and efficacy evaluation. (3) Analysis of English literature in Web of Science shows that the United States has the largest number of published literature, followed by China. The United States is the country with the highest total number of citations in the literature related to the three surgical procedures, followed by the United Kingdom, which has more cooperation with other countries. The Journal of Arthroplasty had the largest number of articles with 733. The New York Hospital for Special Surgery is the institution with the largest number of publications, with a total of 201 articles. (4) In the co-occurrence analysis, the keywords related to the three surgical methods can be divided into three categories, focusing on: perioperative surgical methods and efficacy evaluation, disease classification and pathological mechanism, cross-joint treatment and comprehensive evaluation. The number of studies on total knee arthroplasty is the largest, followed by unicompartmental knee arthroplasty and high tibial osteotomy, among which the average occurrence time of keywords of unicompartmental knee arthroplasty and high tibial osteotomy is late but, on the rise, among which high tibial osteotomy has gradually shown a trend of equaling unicompartmental knee arthroplasty, and total knee arthroplasty has always been a research hotspot. (5) It is concluded that with the deepening of the aging trend, the incidence of knee osteoarthritis and the number of publications in this field will continue to increase, and the research volume of "knee-saving" surgery unicompartmental knee arthroplasty and high tibial osteotomy will continue to increase, and total knee arthroplasty will continue to be a research hotspot as a classic surgery for the end-stage treatment of osteoarthritis. Figures and Tables | References | Related Articles | Metrics