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Objective: To explore the potential effect of three allogenic bone substitute configurations on the viability, adhesion, and spreading of osteoblasts in vitro. Methods: Freeze‐dried cortical bone were ground and fractions were divided into three groups with different sizes and shapes, defined as bone fiber (0.1 mm × 0.1 mm × 3 mm), bone powder (0.45–0.9 mm), and bone granule group (3–6 mm). MC3T3‐E1 cells were divided and co‐cultured within groups to induce cell adhesion. The configuration of allogenic bone was captured by scanning electron microscopy and confocal laser scanning microscopy, and substrate roughness values were quantified. Cell adhesion rate was assessed using the hemocyte counting method, cell viability was determined by CCK‐8 assay and live/dead staining, and cell morphology was visualized by Phalloidin and DAPI, and the mRNA expression of adhesion‐related gene (vinculin) of different substitutes were determined with quantitative real‐time polymerase chain reaction. Results: The roughness values of bone fiber, bone powder, and bone granule group were 1.878 μm (1.578–2.415 μm), 5.066 μm (3.891–6.162 μm), and 0.860 μm (0.801–1.452 μm), respectively (bone powder group compared with bone granule group, H = 18.015, P < 0.001). Similar OD values of all groups in CCK‐8 assay indicated good biocompatibility of these substitutes (bone fiber, 0.201 ± 0.004; bone powder, 0.206 ± 0.008; bone granule group, 0.197 ± 0.006; and the control group, 0.202 ± 0.016, F = 0.7152, P > 0.05). In addition, representative cell adhesion rates at 24 h showed significantly lower cell adhesion rate in bone fiber group (20.3 ± 1.6%) compared to bone powder (29.3 ± 4.4%) and bone granule group (27.3 ± 3.2%) (F = 10.51，P = 0.009 and P = 0.034, respectively), but there was no significant difference between the latter two groups (P > 0.05). Interestingly, the expression of vinculin mRNA steadily decreased in a time‐dependent manner. The vinculin expression reached its peak at 6 h in each group, and the vinculin levels in bone fiber, bone powder, and bone granule group were 2.119 ± 0.052, 3.842 ± 0.108, and 3.585 ± 0.068 times higher than those in the control group, respectively (F = 733.643, all P < 0.001). Meanwhile, there was a significant difference in the expression of target gene between bone powder and bone granule group (P = 0.006). Conclusion: All allogenic bone substitutes presented an excellent cell viability. Moreover, bone powder and bone granule group were more likely to promote cell adhesion and spreading compared to bone fiber group. [ABSTRACT FROM AUTHOR]

Objective: For reconstructing the posterior cervical muscular–ligament complex, attachment points and various modified techniques were designed and applied in clinical practice. This study investigated the clinical and radiographic outcomes of open door laminoplasty with modified centerpiece mini‐plate fixation and extensor attachment point reconstruction in the treatment of cervical spondylotic myelopathy (CSM). Methods: Sixty‐nine patients with CSM who underwent C3–C7 open door laminoplasty at our hospital from January 2016 to May 2018 were divided into two groups: 37 and 32 patients underwent laminoplasty with modified and conventional centerpiece titanium plate fixation (MPF and CPF groups), respectively. Changes in cervical spinal angle (CSA), cervical range of motion (ROM), posterior cervical muscle atrophy, neurological function (Japanese Orthopaedic Association [JOA] score), Neck Disability Index (NDI), and axial symptom severity were compared between the two groups. Results: There were no significant differences in operative duration (136.7 ± 23.9 vs 128.3 ± 21.5 min, t = 1.525, p > 0.05), volume of intraoperative blood loss (275.9 ± 33.1 vs 268.2 ± 31.6 ml, t = 0.984, p > 0.05), lamina open angle (41.2° ± 4.5° vs 39.4° ± 4.1°, t = 1.726, p > 0.05), and spinal cord drift distance (2.4 ± 0.3 vs 2.3 ± 0.4 mm, t = 1.184, p > 0.05) between the two groups. After surgery, JOA score significantly increased (p < 0.05), and neurological recovery rates were similar (62.7% vs 63.4%, t = 0.208, p > 0.05). The NDI score was significantly decreased in both the groups (p < 0.05); however, the MPF group recovered to a greater degree than the CPF group (8.3 ± 1.2 vs 9.8 ± 1.4) (t = 4.793, p < 0.05). There was no significant change in cervical ROM postoperatively compared with preoperatively in either group (p > 0.05). CSA decreased from 21.7° ± 2.8° to 18.3° ± 2.1°, and posterior cervical muscle cross‐sectional area decreased from 35.2 ± 4.9 cm2 to 31.0 ± 4.1 cm2 in the CPF group (p < 0.05), but no significant change was observed in the MPF group (20.6° ± 2.5° to 20.4° ± 2.6°and 35.9 ± 5.1 to 34.1 ± 4.6 cm2, respectively) (p > 0.05). Postoperative axial symptom severity was significantly worse in the CPF group than in the MPF group (Z = −2.357, p < 0.05). Conclusions: As an improvement to the conventional titanium plate, the modified centerpiece titanium plate effectively provides an attachment point for the posterior muscle–ligament complex, reducing posterior cervical muscle atrophy and improving neck function, without inflicting additional surgical trauma. [ABSTRACT FROM AUTHOR]

Objective: Pre‐implantation sterilization procedures for tendons are important measures to reduce the risk of disease transmission, however these procedures may compromise tendon microarchitecture and biomechanical properties to varying degrees. We explore the effects of different sterilization procedures on the micro‐histology, biomechanical strength and biochemical properties of human tendon allografts in vitro study. Methods: The tendon allografts were harvested from cadaveric donors after the donors were serologically screened by antibody or nucleic acid testing of infectious agents. All samples were divided into five groups, which were fresh‐frozen group (control group), 15 kGy gamma irradiation group, 25 kGy gamma irradiation group, 70% ethanol group, and peracetic acid‐ethanol group. Each group included 10 tendons for testing. Histological staining and transmission electron microscopy were applied to observe the internal structure and arrangement of tendon collagen fibers, while the machine learning classifier was trained to distinguish the darker cross‐sections of collagen fibers and brighter backgrounds of the electron micrograph to detect the distribution of diameters of tendon collagen fibers. The viscoelasticity, mechanical properties and material properties of tendon allografts were examined to detect the influence of different intervention factors on the biomechanical properties of tendons. Results: Histological staining and transmission electron microscopy showed that the structure of fresh‐frozen tendons was similar to the structures of other experimental groups, and no obvious fiber disorder or delamination was observed. In the uniaxial cyclic test, the cyclic creep of 25 kGy irradiation group (1.5%) and peracetic acid‐ethanol group (1.5%) were significantly lower than that of the control group (3.6%, F = 1.52, P = 0.039) while in the load‐to‐failure test, the maximum elongation and maximum strain of the peracetic acid‐ethanol group were significantly higher than those of the control group (F = 4.60, P = 0.010), and there was no significant difference in other biomechanical indicators. According to the experimental results of denatured collagen, it could be seen that no matter which disinfection procedure was used, the denaturation of the tendon sample would be promoted (F = 1.97, P = 0.186), and high‐dose irradiation seemed to cause more damage to collagen fibers than the other two disinfection procedures (296.2 vs 171.1 vs 212.9 μg/g). Conclusion: Biomechanical experiments and collagen denaturation tests showed that 15 kGy gamma irradiation and 70% ethanol can preserve the biomechanical strength and biochemical properties of tendons to the greatest extent, and these two sterilization methods are worthy of further promotion. [ABSTRACT FROM AUTHOR]

Unicompartmental knee osteoarthritis (UKOA) is the early stage of knee joint degeneration, which is characterized by unicompartmental degeneration and mostly occurs in medial compartment. Pain and limited motion are main symptoms, which affect patients' life quality. Periarticular knee osteotomy (PKO) for lower extremity alignment correction is an effective treatment for UKOA with abnormal alignment, which could relieve pain and improve joint function by adjusting lower extremity alignment. At present, no clinical guidelines are available for the treatment of UKOA by PKO for lower extremity alignment correction. Experts from the Clinical New Technology Application Committee of the Chinese Hospital Association, Joint Surgery Study Group of the Chinese Orthopaedic Association of the Chinese Medical Association, and Osteoarthritis Study Group of the Chinese Association of Orthopaedic Surgeons of the Chinese Medical Doctor Association formulated these guidelines. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) grading system and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) were adopted to select 25 most concerning questions. Finally, 25 recommendations were formulated through evidence retrieval, evidence quality evaluation, and the determination of directions and strength of recommendations. Recommendation items 1–5 are indications and contraindications for PKO for lower extremity alignment correction, items 6–21 are surgical methods and principles, item 22 describes 3D printing corrective osteotomy technique, and items 23–25 address the perioperative period, follow‐up management, and other content. These guidelines are designed to improve the normalization and standardization of KOA treatment by PKO for lower extremity alignment correction. [ABSTRACT FROM AUTHOR]

Objective: To propose a simple and practical clinical classification for tenosynovial giant cell tumor (TGCT) of the knee. Methods: A retrospective study was conducted to verify the value and significance of this clinical classification. TGCT growth patterns, knee joint capsule, and bone erosion were applied to establish this novel clinical classification. Seventy‐eight patients who underwent surgery for TGCT from 2008 to 2016 were identified. This novel clinical classification was retrospectively applied to patients' existing classification, and patients with different TGCT types were statistically compared to verify the significance of the clinical classification. Results: The clinical classification included three types and four subtypes. Type 1: localized TGCT, Subtype 1a: localized intra‐articular TGCT, Subtype 1b: localized extra‐articular TGCT. Type 2: diffuse TGCT, Subtype 2a: diffuse intra‐articular TGCT with bone normal, Subtype 2b: diffuse intra‐articular TGCT with bone destruction. Type 3: diffuse TGCT across the knee joint capsule. The mean follow‐up time for the 78 patients was 59.6 months. Twenty‐one patients were in Subtype 1a, four were Subtype 1b, 38 were Subtype 2a, seven were Subtype 2b, and eight were Type 3. Oncological results and surgical complications differed significantly (P = 0.000, P = 0.000). The mean Musculoskeletal Tumor Society functional scores differed significantly at 27.8 for Type 1 patients, 22.9 for Type 2 patients, and 17.0 for Type 3 patients (P = 0.000). Conclusions: This clinical classification can be easily used to evaluate TGCT of all knees prior to surgery or other treatments and can help determine surgical options. [ABSTRACT FROM AUTHOR]

Objective: To investigate the correlation between computed tomography (CT) values and bone mineral density (BMD) in elderly Chinese patients with proximal humeral fractures. Methods: This was a single‐center retrospective study involving 166 elderly patients with proximal humeral fractures between January and June 2015 in our hospital. Following the inclusion and exclusion criteria, 89 patients were finally enrolled in this study. The spiral CT scanning was performed on these patients, and the CT images were obtained by using MIMICS software. The CT values in axial, coronal, and sagittal images of healthy proximal humeri were measured using a circular region of interest (ROI) by Image J. The bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual‐energy X‐ray absorptiometry (DXA). Spearman rank correlation methods were used for analysis of the association between the proximal humerus average CT value (CTMean) and the lumbar spine as well as femoral neck BMD in patients with proximal humeral fractures, or osteoporotic patients. Results: Among the included 89 patients, there were 26 males and 63 females, 69% and 84% of whom were diagnosed with osteoporosis, respectively. The lumbar spine and femoral neck BMD and the CTMean of the proximal humerus were higher in males than females with proximal humeral fractures (P < 0.05). This gender difference was also found in the osteoporotic patient population (P < 0.05). The Spearman rank correlation method showed that the lumbar spine and femoral neck BMD was closely related to the proximal humeral CTMean in males (r = 0.877, P = 0.000; r = 0.832, P = 0.000; respectively) and females (r = 0.806, P = 0.000; r = 0.616, P = 0.000; respectively) with proximal humeral fractures, as well as osteoporotic male (r = 0.745, P = 0.000; r = 0.575, P = 0.000; respectively) and female (r = 0.613, P = 0.000; r = 0.629, P = 0.000; respectively) patients. Conclusions: The CT value of the proximal humerus is a rapid and accurate method by which bone quality can be assessed in elderly patients with proximal humeral fractures. Moreover, the CT value of the proximal humerus is an alternative measurement of BMD that can guide surgeons in selecting the appropriate internal fixation material. [ABSTRACT FROM AUTHOR]

Objectives: To describe the technique of the aorta balloon occlusion, and evaluate the blood loss in lumbar spine tumor surgery assisted by aortic balloon occlusion, and to observe the balloon‐related complications. Methods: Six patients with lumbar spine tumor underwent resuscitative endovascular balloon occlusion of the aorta prior to tumor resections in our institution between May 2018 to January 2021. Medical records including demographic, diagnosis, tumor location, surgical approach, intraoperative blood loss, surgical duration, and perioperative balloon‐related complication were evaluated retrospectively. Results: This series included four males and two females, with a median age of 50 years (range 22 to 69). Of these, three primary tumors were plasmacytoma, giant cell tumor of bone, and osteosarcoma, while recurrence of undifferentiated pleomorphic sarcoma (UPS), recurrence of giant cell tumor of bone (GCT), and metastatic thyroid cancer were diagnosed in cases 1, 6, and 2, respectively. L2 was involved in cases 1 and 5. L3 was involved in case 6. L4 was involved in case 2, 3, and 6. L5 was involved in case 4. One‐stage total en bloc resection surgery (TES) was accomplished in all patients; of this series, signal anterior approach was conducted in case 1, signal posterior approach was utilized in cases 2, 3, and 6, while combined anterior and posterior approach was performed in cases 4 and 5. The median intraoperative blood loss was 1683 mL and ranged from 400 to 3200 mL with a median surgical duration of 442 min and a range from 210 to 810 min. During the perioperative period, no serious balloon‐related complications occurred. Conclusions: Endovascular balloon occlusion of the aorta successfully controls intraoperative exsanguination, contributing to a more radical tumor resection and a low rate of tumor cell contamination in lumbar tumor surgery. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the biomechanical contact characteristics of rotating hinge knee (RHK) prostheses with different motion axial systems. We performed finite element (FE) analyses to investigate and compare the peak contact stress and contact location on tibial insert and bushing during a gait cycle. The biaxial (BA) system and spherical center axial (SA) system RHK prostheses were included in this study. The comparisons between experimental tests and FE analyses were performed to verify the validation of FE models. Decreased ISO loadings were then applied to the validated FE models to investigate the peak contact stress and contact location on tibial insert and bushing. The contact areas obtained from experimental tests and FE analyses were in a good agreement. The peak contact stresses on tibial insert and bushing of BA prosthesis were higher than those of SA prosthesis. The contact locations on the superior surface of tibial insert in SA and BA prostheses were at the middle‐posterior and posterior side, while those on the rotating axial surface were at the medial and lateral sides, respectively. This study indicate that the tibial insert and bushing of an SA prosthesis have lower peak contact stresses and better contact locations than those of a BA prosthesis during a gait cycle, which may decrease the risk of long‐term complications of RHK prostheses. Future studies should be performed to confirm the relationship between the contact characteristics and wear in RHK prostheses. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present paper was to explore the clinical effect of one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation for thoracolumbar osteoporosis vertebral compression fractures (OVCF). Methods: This is a single‐center retrospective analysis. A total of six thoracolumbar OVCF patients (four women and two men) with an average age of 65.2 years (58–72 years) who were treated between June 2016 and May 2018 were enrolled in the present study. The lesion segments included: 1 case at T11, 1 case at T12, 3 cases at L1, and 1 case at L2. The six thoracolumbar OVCF patients were treated with one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation. After general anesthesia, patients were placed in the right lateral decubitus position, an approximately 10–15‐cm oblique incision was made along corresponding ribs, and the conventional left retroperitoneal and/or the extrapleural approach was performed for anterior lateral exposure. First, anterior decompression and fixation were performed, and then through the unilateral paraspinal muscle approach, posterior pedicle screw fixation was performed under the same incision. The back pain visual analogue scale (VAS), the Oswestry disability index (ODI), and the MacNab criteria were used to evaluate the clinical outcome. The radiographic analysis included the regional kyphosis angle and the fusion rate. Neurological status, operation time, intraoperative bleeding, the time of ambulation, hospital stay, and surgical complications were also assessed. Results: Surgery was successful in all six patients, who were followed up for 31.6 months (range, 23–46 months). The operation time was 125–163 min, with a median of 135 min. The preoperative blood loss was 580–1230 mL, with a median of 760 mL. The time of ambulation was 3–5 days, with a median of 4.2 days. The hospital stay was 8–15 days, with the median of 10.5 days. According to the Frankel classification of neurological deficits, of two patients with grade C preoperatively, one had improved to grade D and one had improved to grade E at final follow up; among four patients with grade D preoperatively, at the final follow up one remained the same and three had improved to grade E. The postoperative back pain VAS score decreased significantly, from 6.17 ± 0.75 preoperatively to 0.83 ± 0.41 postoperatively (P < 0.05). The mean ODI score was 73.7 ± 5.86 preoperatively and reduced to 21.85 ± 3.27 postoperatively (P < 0.05). According to the MacNab criteria, at the final follow up, two patients rated their satisfaction as excellent, three patients as good, and one patient as fair. The mean regional kyphosis angle was 22.17° ± 6.01°before surgery, which improved to 9.33° ± 3.88° at the final follow up (P < 0.05). At the final follow up, there were two patients who had achieved a grade 2 bony fusion (33.3%), three patients grade 3 (50.0%), and one patient grade 4 (16.7%). No incision infections, internal fixation failures or other complications were found during the perioperative and the follow‐up period. Conclusion: One approach anterior decompression and fixation with posterior unilateral pedicle screw fixation provides a novel method for thoracolumbar OVCF disease, with a satisfactory clinical outcome. [ABSTRACT FROM AUTHOR]

Although the structure and composition of collagen have been studied by polarized light microscopy since the early 19th century, many studies and reviews have paid little or no attention to the morphological problems of histopathological diagnosis. The morphology of collagen fibers is critical in guiding mechanical and biological properties in both normal and pathological tendons. Highlighting the organization and spatial distribution of tendon‐containing collagen fibers can be very useful for visualizing a tendon's ultrastructure, biochemical and indirect mechanical properties, which benefits other researchers and clinicians. Picrosirius red (PSR) staining, relying on the birefringence of collagen fibers, is one of the best understood histochemical methods that can highly and specifically underline fibers better than other common staining techniques when combined with polarized light microscopy (PLM). Polarized light microscopy provides complementary information about collagen fibers, such as orientation, type and spatial distribution, which is important for a comprehensive assessment of collagen alteration in a tendon. Here, this brief review serves as a simplistic and important primer to research developments in which differential staining of collagen types by the Picrosirius‐polarization method is increasing in diverse studies of the medical field, mainly in the assessment of the morphology, spatial distribution, and content of collagen in tendons. [ABSTRACT FROM AUTHOR]

Objective: To investigate the surgical strategy, safety, and efficacy of close reduction and robot‐aided minimally invasive lumbopelvic fixation in treatment of traumatic spinopelvic dissociation. Methods: Data of 32 patients (21 males and 11 females) with traumatic spinopelvic dissociation treated by lumbopelvic fixation with robot‐aided minimally invasive technique or conventional open procedure in our institution from March 2010 to April 2019 were retrospectively analyzed, and divided into robot group and control group. Intraoperative blood loss, surgical time, fluoroscopy frequency, total drilling times, infection rate, hospitalization time, and sacral fracture healing time were reviewed. Radiographs and computed tomography (CT) scans were totally acquired to evaluate the reduction quality, residual fracture displacement, and Gras classification on screws insertion after surgery. According to the Majeed scoring system, functional outcome was assessed for each patient at the final follow‐up. Results: There were 12 patients in the robot group and 20 patients in the control group with no significant difference about the demographic data. The average surgical time was 148.3 ± 40.5 min with intraoperative blood loss of 142.5±36.7 mL in the robot group and 185.0 ± 47.8 min with 612.5 ± 182.7 mL in the control group (P = 0.034, P = 0.000). The robot group had a shorter mean hospitalization time at 19.9 ± 7.0 days compared to the control group with 28.6 ± 5.4 days (P = 0.010). The fluoroscopy frequency was 35.4 ± 3.0 in the robot group and 45.5 ± 3.6 in the control group (P = 0.000) and total drilling times were 7.1 ± 1.1 and 9.6 ± 1.3 (P = 0.000), respectively. The infection rate was 0% (0/12) in the robot group and 15% (3/20) in the control group (P = 0.159). According to the Gras classification on screw positioning, there were 11 cases in Grade I and 1 case in Grade II in the robot group, and 14 cases in Grade I and 6 cases in Grade II in the control group. All the patients were followed up consecutively for at least 12 months, with an average follow‐up period of 17.1 ± 3.6 months. All sacral fractures healed with an average time of 3.8 ± 0.6 months in the robot group and 4.7 ± 0.7 months in the control group (P = 0.000). According to Majeed functional assessment investigation, the mean score of the patients was 87.2 ± 4.0 in the robot group and 83.1 ± 4.5 in the control group (P = 0.015). Conclusions: Robot‐aided minimally invasive lumbopelvic fixation for traumatic spinopelvic dissociation is a safe and feasible option with advantages of less intraoperative blood loss, less radiation damage, less hospitalization time, and better functional outcome. [ABSTRACT FROM AUTHOR]

Evaluation of the biomechanical properties of soft tissues by measuring the stress–strain relationships has been the focus of numerous investigations. The accuracy of stress depends, in part, upon the determination of the cross‐sectional area (CSA). However, the complex geometry and pliability of soft tissues, especially ligaments and tendons, make it difficult to obtain accurate CSA, and the development of CSA measurement methods of soft tissues continues. Early attempts to determine the CSA of soft tissues include gravimetric method, geometric approximation technique, area micrometer method, and microtomy technique. Since 1990, a series of new methods have emerged, including medical imaging techniques (e.g. magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging (USI)), laser techniques (e.g. the laser micrometer method, the linear laser scanner (LLS) technique, and the laser reflection system (LRS) method), molding techniques, and three‐dimensional (3D) scanning techniques. [ABSTRACT FROM AUTHOR]

More revisionary reconstruction procedures are required following failing anterior cruciate ligament (ACL) reconstructions, which are often regarded as a technique challenge with very limited goals. This study will be performed to compare the outcomes between groups of primary and revision knee reconstruction. Two observers conducted the literature retrieval from the platforms of PubMed, Embase, and CENTRAL. Studies which compared knee function and stability between primary and revisionary reconstructions were included. The data was synthesized by meta‐analysis with fixed‐ or random‐effects models as appropriate. A total of 10 eligible studies were included with 954 subjects in the primary group and 378 in the revision group. The International Knee Documentation Committee International Knee Documentation Committee (IKDC) subscores, side‐to‐side difference, and Lysholm score were demonstrated to be significantly improved at final follow‐up in both groups, while Tegner score was not. The overall IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scores were significantly inferior in the revision group compared to the primary group. However, knee laxity according to side‐to‐side difference was demonstrated to be similar between the two groups. Revision ACL reconstruction (RACLR) could provide patients with excellent restoration of knee outcomes compared to the status before revision. Also, while knee function in the revision group was inferior to the primary group, knee stability was equivalent between the two groups at the final follow‐up. [ABSTRACT FROM AUTHOR]

Osteosarcoma is the most common primary malignant bone tumor, occurring mainly in children and adolescents, and the limbs are the main affected sites. At present, limb‐salvage treatment is considered as an effective basic standard treatment for osteosarcoma of the limb. China has a vast territory, but the development of technology is not balanced,which requires sufficient theoretical coverage, strong technical guidance and the application of limb‐salvage treatment guidelines to the treatment of osteosarcoma. Therefore, to standardize and promote the development of limb‐salvage surgery technology and improve the success rate of limb‐salvage treatment, this guide systematically introduces limb‐salvage techniques for the treatment of patients with limb osteosarcoma through definition of limb‐salvage treatment, surgical methods, efficacy evaluation, postoperative treatment and prevention of complications, rehabilitation guidance, and follow‐up advice. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the mechanical properties and provide a theoretical basis of a diaphyseal prosthesis with tooth mechanism using the finite element analysis method from the point of view of biomechanics. Methods: A 3D digital femur model was generated based on a 28‐year‐old healthy man's femoral computed tomography (CT) data in Mimics 17.0 and the customized diaphyseal prostheses with/without tooth mechanism were designed in SolidWorks 2016. The 3D femur model after 8 cm osteotomy in the middle of its shaft and the prostheses with/without tooth mechanism was imported into Abaqus 2016 and the finite element analysis models were established. Three biomechanical tests (compression test, torsion test, and 3P‐bending test) under broken load were simulated in FEA to evaluate the performance of the prostheses. Results: The stress distributions of the two prostheses were similar and the maximum von Mises stresses placed on them were very close in each test. The maximum von Mises stresses on the prosthesis with tooth mechanism were 31.55, 319.7, and 447.4 MPa, respectively, and those on the prosthesis without tooth mechanism were 26.26, 300.4, and 455.2 MPa, respectively, in the compression, torsion, and 3P‐bending tests. The maximum von Mises stresses on them were far below the ultimate tensile strength or ultimate compressive strength of the titanium alloy. Conclusions: The diaphyseal prosthesis with tooth mechanism is helpful to adjust the rotation of the long bone during operation. Compared with the conventional diaphyseal prosthesis (without tooth mechanism), the diaphyseal prosthesis with tooth mechanism also has a good biomechanical performance and does not increase the risk of prosthetic failure. [ABSTRACT FROM AUTHOR]

Objective: To characterize the visceral metastasis as a predictive tool for the survival of patients with spinal metastases through an exploratory meta‐analysis. Methods: Two investigators independently searched PubMed and Embase databases for eligible studies from 2000–2016. The effect estimates for the hazard ratio (HR) or risk ratio (RR) and 95% confidence interval (CI) were collected and pooled with a random‐ or fixed‐effect model. Results: In total, 18 eligible studies were retrieved with 5468 participants from nine countries. The overall pooled effect size for HR and RR was 1.50 and 3.79, respectively, which was proved to be statistically significant. In the subgroup of prostate cancer (PCa) and non‐small cell lung cancer (NSCLC), statistical significance and marginal statistical significance was presented for the pooled HR (HR = 1.76, 95% CI 1.35–2.29) and (RR = 1.56, 95% CI 0.99–2.48), respectively. However, in the subgroup of thyroid cancer, breast cancer, and renal cancer, statistical significance was not achieved (HR = 1.17, 95% CI 0.75–1.83, Z = 0.70, P = 0.486). The results did not show any evidence of publication bias. Conclusions: This study demonstrated that visceral metastasis was a significant prognostic factor in patients with spinal metastases as a whole. Interestingly, the onset of visceral metastases differentially impacted the survival in different primary tumors. Therefore, the prognostic value of visceral metastasis might be related to the type of primary tumor. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the contact stress and the contact area o tibial inserts and bushings with respect to different congruency designs in a spherical center axis and rotating bearing hinge knee prosthesis under gait cycle loading conditions using finite element analysis. Methods: Nine prostheses with different congruency (different degrees of tibiofemoral conformity and different distances between the spherical center and the bushing) designs were developed with the same femoral and tibial components. The models were transferred to finite element software. The peak contact stresses and contact areas on tibial inserts and bushings under the gait cycle loading conditions were investigated and compared. Results: For tibial insert, the peak contact stress was the highest in the low conformity‐long group (61.4486 MPa), and it was 1.88 times higher than that in the group with the lowest stress (moderate conformity‐short group, 32.754 MPa). The contact area was the largest in the low conformity‐long group (420.485 mm2), and it was 1.19 times larger than that in the group with the smallest area (moderate conformity‐middle group, 352.332 mm2). For bushing, the peak contact stress was the highest in the high conformity‐long group (72.8093 MPa), and it was 3.21 times higher than that in the group with the lowest stress (high conformity‐short group, 22.6928 MPa). The contact area was the largest in the low conformity‐short group (2.41 mm2), and it was 2.27 times larger than that in the group with the smallest area (high conformity‐middle group, 1.063 mm2). Conclusion: The results of our study showed that the congruency of the tibiofemoral surface and bushing surface should be considered carefully in the design of the spherical center axis and rotating bearing hinge knee prosthesis. Different levels of contact performance were observed with different congruency designs. In addition, the influence of contact stress and contact area on the polyethylene wear of rotating hinge knee prostheses should be confirmed with additional laboratory tests. [ABSTRACT FROM AUTHOR]

Objective: To assess the defatting efficacy of high pressure washing and gradient alcohol and biomechanical properties of defatted bone. Methods: Fresh cancellous bone was obtained from the femoral condyle and divided into six groups according to different defatting treatments, which were: high pressure washing for 10 s (10S group), 20 s (20S group), and 30 s (30S group), gradient alcohol immersion (Alcohol group), acetone immersion (Acetone group), and non‐defatted (Fresh group). The appearance of six groups was observed, and the appearance of defatted bone and fresh bone was compared. The residual lipid content and infrared spectrum were used to compare the efficacy of defatting, the DNA content was used to compare the cell content after defatting, and the maximum stress and elastic modulus were used to compare the effects of defatting treatment on biomechanical properties. Results: The fresh bone was yellow and the pores contained a lot of fat. The defatted bone was white and the porous network was clear. There was no difference in residual lipid content among the three groups with high pressure washing (1.45% ± 0.16%, 1.40% ± 0.13%, and 1.46% ± 0.11%, respectively) (P = 0.828). There was no difference in residual lipid content among the 10S, alcohol, and acetone groups (1.45% ± 0.16%, 1.28% ± 0.07%, and 1.13% ± 0.22%, respectively) (P = 0.125). Infrared spectra showed that the fat content of the five defatting groups was significantly lower than that of the fresh group. There was no difference in residual lipid content among the three groups with high pressure washing (4.53 ± 0.23 ug/mL, 4.61 ± 0.18 ug/mL, and 4.66 ± 0.25 ug/mL, respectively) (P = 0.645). There was no difference in residual lipid content among the 10S, alcohol, and acetone groups (4.53 ± 0.23 ug/mL, 4.29 ± 0.24 ug/mL, and 4.27 ± 0.29 ug/mL, respectively) (P = 0.247). The maximum stress of the bone decreased significantly with the increase of the washing time (9.95 ± 0.31 Mpa, 9.07 ± 0.45 Mpa, and 8.17 ± 0.35 Mpa, respectively) (P = 0.003). The elastic modulus of the bone decreased significantly with the increase of the washing time (116.40 ± 3.54 Mpa, 106.10 ± 5.29 Mpa, and 95.63 ± 4.08 Mpa, respectively) (P = 0.003). There was no statistical difference in the maximum stress between the fresh group, the 10S group, the alcohol group, and the acetone group (10.09 ± 0.67 Mpa, 9.95 ± 0.31 Mpa, 10.11 ± 0.07 Mpa, and 10.09 ± 0.39 Mpa, respectively) (P = 0.963). There was no statistical difference in the maximum stress between the fresh group, the 10S group, the alcohol group and the acetone group (119.93 ± 4.94 Mpa, 116.40 ± 3.54 Mpa, 118.27 ± 0.85 Mpa, 118.10 ± 4.52 Mpa, respectively) (P = 0.737). Conclusion: The defatting efficiency was satisfactory at a time of 10 s under high pressure washing. In terms of defatting efficiency and its effect on biomechanical properties of bone, high pressure washing and gradient alcohol were similar to conventional acetone solvent extraction defatting. [ABSTRACT FROM AUTHOR]

Objectives: To describe the epidemiological characteristics of patients with spinal metastases between 2007 and 2019. Methods: Patients with spinal metastases were identified from several clinical centers in China between January 2007 and July 2019. Demographics, primary tumor types, spinal involvement, and Clinical indicators of each patient were reviewed. Results: A total of 1196 patients were included in this study, 717 males (59.95%) and 479 females (40.05%), with a male to female ratio of 1.50:1. Most patients (63.71%) were in the ages range of 50 to 69 years. The mean age was 58.6 ± 11.6 (range 13–89) years and the median age was 59.0 years. The average age of females was younger than that of males, and the difference was statistically significant. The proportion of male patients over 60 years old was higher than that of females, and the difference was statistically significant. The most common primary tumor was lung cancer (n = 437, 36.54%), followed by unknown origin (n = 194, 16.22%), kidney cancer (n = 78, 6.52%), breast cancer (n = 76, 6.35%), and liver/biliary cancer (n = 75, 6.27%). The most common primary tumor was lung cancer in both males and females, followed by unknown origin in males and breast cancer in females. There were 730 patients (61.04%) in the subgroup of the number<3; the highest level was lumbar vertebrae, with 250 patients (34.25%). The remaining 466 patients (38.96%) were included in the subgroup of the number ≥ 3; the highest level was tumor metastasis of multiple‐level of spine, with 334 patients (71.67%). Among the 1196 patients, spinal cord injury occurred in 54.01% of patients, 76.34% of patients developed moderate and above pain, 55.69% of patients had metastatic spinal cord compression, and only 26.67% of patients had a clear history of primary tumors. Conclusion: This study provided a relatively detailed description of epidemiological characteristics in spinal metastases in China, which could assist orthopaedic surgeons to understand the clinical characteristics of spinal metastases, and is of great significance in guiding clinical diagnoses and scientific research. [ABSTRACT FROM AUTHOR]

Objectives: To summarize the epidemiological characteristics of patients following surgery for spinal metastases retrospectively and make a univariate analysis to identify independent variables that could affect the operation decision making. Methods: This was a multicenter retrospective review of patients with spinal metastasis who were treated with surgery from 1 January 2007 to 31 July 2019. Basic clinical data were analyzed retrospectively by univariate analysis to identify independent variables that could affect the decision of operation modalities, including gender, age, spinal metastatic site, Frankel score, Karnofsky performance score (KPS), spinal instability neoplastic score (SINS), visual analogue scale (VAS), Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, primary tumor, extraspinal metastasis, visceral metastasis, and bone lesion (osteolytic, osteoblastic or mixed). Results: A total of 580 patients including 332 males and 248 females were enrolled in the study with an average age of 58.26 years old (range, 13–86 years old). The most common spinal metastatic level was the thoracic vertebra (190 [32.76%]), followed by the lumbar vertebra (146 [25.17%]), cervical vertebra (47 [8.10%]), and sacral vertebra (35 [6.03%]). Metastases involving more than two sites of the cervical, thoracic, lumbar, and sacral vertebrae arose in 162 (27.93%) patients. For primary tumor, there were 198 (34.14%) cases of lung cancer, 41 (7.07%) cases of kidney cancer, 39 (6.72%) cases of breast cancer, 38 (6.55%) cases of gastrointestinal cancer, 35 (6.03%) cases of lymphoma and myeloma, 25 (4.31%) cases of prostate cancer, 24 (4.14%) cases of liver cancer, 23 (3.97%) cases of mesenchymal tissue sarcoma, 20 (3.45%) cases of thyroid cancer, and 84 (14.48%) cases were tumor with unknown origin. Sixty‐three (10.86%) patients received minimally invasive surgery, 460 (79.31%) patients received palliative surgery, and the remaining 57 (9.83%) received tumor resection. According to the univariate analysis, the KPS score, SINS score, VAS score, Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, and bone lesion (osteolytic, osteoblastic or mixed) were independent and favorable factors affecting the surgery modalities. Conclusions: Surgical treatment for spinal metastases was mainly to relieve pain, rebuild spinal stability, improve nerve function, control local tumors, and improve the quality of life of patients. For middle‐aged and elderly patients with good general conditions, severe pain, spinal pathological fracture, spine instability and without urinary and fecal incontinence, early surgical treatment should be actively carried out. [ABSTRACT FROM AUTHOR]

Reconstruction of massive bone defects is challenging for orthopaedic clinicians, especially in cases of severe trauma and resection of tumors in various locales. Autologous iliac crest bone graft (ICBG) is the "gold standard" for bone grafting. However, the limited availability and complications at donor sites resulted in seeking other options like allografts and bone graft substitutes. Demineralized bone matrix (DBM) is a form of allograft using acidic solution to remove mineral components, while leaving much of the proteinaceous components native to bone, with small amounts of calcium‐based solids, inorganic phosphates, and some trace cell debris. It is an osteoconductive and osteoinductive biomaterial and is approved as a medical device for use in bone defects and spinal fusion. To pack consistently into the defect sites and stay firmly in the filling parts, DBM products have various forms combined with biocompatible viscous carriers, including sponges, strips, injectable putty, paste, and paste infused with chips. The present review aims to summarize the properties of various kind of viscous carriers and their clinical use combined with DBM in commercially available products. Given DBM'mercially available products. Given DBM;s long clinical track record and commercial accessibility in standard forms, opportunities to further develop and validate DBM as a versatile bone biomaterial in orthopaedic repair and regenerative medicine contexts are attractive. [ABSTRACT FROM AUTHOR]

Objectives: To establish a dynamic three‐dimensional (3D) model of upper cervical spine instability and to analyze its biomechanical characteristics. Methods: A 3D geometrical model was established after CT scanning of the upper cervical spine specimen. The ligament of the specimen was fatigued to establish the upper cervical spine‐instability model. A 100‐N preloaded stress was applied to the upper surface of the occipital bone, and then a 1.5‐Nm moment was applied in the occipital‐sagittal direction to simulate upper cervical spine flexion and extension. Subsequently, the 3D dynamic model was established based on trajectory data that were measured using a motion‐capture system. The stress on the main ligament and the relative motion angle of the joint were analyzed. Results: The shape of the model grid was regular and the total number of its units was 627 000. After finite‐element analysis was conducted, results of the ligament stress and relative movement angle were obtained. After the upper cervical spine instability, the pressure of the alar ligament during the upper cervical spine extension was increased from 2.85 to 8.12 MPa. The pressure of the flavum ligament was increased during the upper‐cervical spine flexion, from 0.90 to 1.21 MPa. The pressure of the odontoid ligament was reduced during the upper cervical spine flexion and extension, from 10.46 to 6.67 MPa and 25.66 to 16.35 MPa, respectively. The pressure of the anterior longitudinal ligament and cruciate ligament was increased to a certain degree during upper cervical spine flexion and extension. The pressure of the anterior longitudinal ligament was increased during flexion and extension, from 7.70 to 10.10 MPa and 10.45 to 13.75 MPa, respectively. The pressure of the cruciate ligament was increased during flexion and extension, from 2.29 to 4.34 MPa and 2.32 to 4.40 MPa, respectively. In addition, after upper cervical spine instability, the articular‐surface relative‐movement angle of the atlanto‐occipital joint and atlanto‐axial joint had also changed. During upper cervical spine flexion, the angle of the atlanto‐occipital joint was increased from 3.49° to 5.51°, and the angle of the atlanto‐axial joint was increased from 8.84° to 13.70°. During upper cervical spine extension, the angle of the atlanto‐occipital joint was increased from 11.16° to 12.96°, and the angle of the atlanto‐axial joint was increased from 14.20° to 17.20°. Therefore, the movement angle of the atlanto‐axial joint was most obvious after induction of instability. Conclusion: The 3D dynamic finite‐element model of the upper cervical spine can be used to analyze and summarize the relationship between the change of ligament stress and the degree of instability in cervical instability. Frequent or prolonged flexion activities are more likely to lead to instability of the upper cervical spine. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between the number of metastases to the spine and survival in patients with metastatic spinal cord compression (MSCC), as well as the prognosis difference between patients with solitary spinal metastasis (SSM) and multiple spinal metastases (MSM). Methods: Three institutional databases were searched to identify all patients who had undergone spinal surgery for metastatic spinal tumors between March 2002 and June 2010. As well as age and gender, preoperative medical conditions were collected from medical records, including primary tumor, preoperative Frankel score, other bone metastases, preoperative Karnofsky performance status (KPS), number of involved vertebrae, pathological fracture metastasis site, serum albumin, sphincter dysfunction and the time of developing motor deficits before surgery. Survival data were obtained from medical records or via telephone follow‐ups. Univariate and multivariate predictors of overall survival for each group were assessed using the Cox proportional hazards model. Results: The median postoperative survival time was 6.0 ± 0.6 months (95% confidence interval [CI] 4.8–7.2) in patients with SSM and 7.0 ± 1.0 months (95% CI 5.1–8.9) in patients with MSM (P = 0.238). The difference in survival was not significant between groups. Furthermore, univariate analysis showed that the number of spinal metastases had no significant association with survival (P = 0.075). Primary tumor (P = 0.004) and preoperative KPS (P < 0.001) were independent prognostic factors in the whole cohort; primary tumor (P = 0.020), time of developing motor deficit (P = 0.041) and preoperative KPS (P = 0.038) were independent prognostic factors in patients with SSM; while preoperative KPS (P = 0.001) and serum album level (P < 0.001) were independent prognostic factors in patients with MSM. Conclusion: The number of spinal metastases has not proven to be useful in predicting the prognosis for patients with MSCC. Consequently, more aggressive operations should be considered for patients with multiple spinal metastases. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether visceral metastases have a significant impact on survival in patients with metastasis‐related spinal cord compression (MSCC), and to determine the difference in prognosis between patients with and without visceral metastases. Methods: Three institutional databases were searched to identify all patients who had undergone spinal surgery for spinal metastases between March 2002 and June 2010. Data on patient characteristics including pre‐ and post‐operative medical conditions, were collected from medical records or by telephone follow‐up. Survival data were obtained either from medical records or by searching a governmental cancer registry. Results: The mean age of study patients was 59.6 ± 10.5 years (range, 18–84 years), of whom 102 were male and 67 female. The median and mean postoperative survival times were 7.0 ± 0.5 (95% CI 6.0–8.0) months and 12.6 ± 1.2 (95% CI 10.1–15.0) months, respectively, in all patients, being 5.0 ± 0.5 (95% CI 4.0–6.0) months and 10.8 ± 2.4 (95% CI 6.1–15.5) months, respectively, for patients with visceral metastases and 7.0 ± 0.8 (95% CI 5.4–8.6) months and 13.0 ± 1.4 (95%CI 10.3–15.6) months, respectively, for patients without visceral metastases (P = 0.87). These survival times did not differ significantly between groups. Multivariate Cox proportional hazard regressions showed that visceral metastases had no statistically significant association with survival (P = 0.277), whereas rate of growth of primary tumor (P = 0.003), preoperative Karnofsky performance status (KPS) (P < 0.001), change in KPS (P < 0.001), and Frankel grade (P = 0.091) were independent prognostic factors in the whole cohort (P = 0.005). Changes in KPS (P = 0.001) and major complications (P = 0.003) were significantly associated with survival in patients with visceral metastases, whereas rate of growth of primary tumor (P = 0.016), change in KPS (P = 0.001), and preoperative KPS (P < 0.001) were significantly associated with survival in patients without visceral metastases. Conclusions: Visceral metastases do not appear to predict the prognosis of patients with MSCC; thus, more aggressive surgery should be considered in patients with MSCC who have visceral metastases. Additionally, prognostic factors differ according to visceral metastases status in these patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the biomechanical stabilities of less invasive stabilization system (LISS) plate and retrograde intramedullary nail (IMN) for the comminuted femoral supracondylar fracture fractures in the elderly. Methods: Sixteen pairs of embalmed cadaver femurs were obtained to simulate a comminuted supracondylar femur fracture (AO/OTA33‐A3) gap model. All left‐side specimens were fixed with LISS plate, and retrograde IMN were applied to the right‐side specimens. All specimens were tested in torsional, axial and cyclic load mode on an Instron testing machine. Results: The mean torsional stiffness for LISS plate group was 34.1% greater than retrograde IMN group (2.90 vs. 1.91 Nm/degree, P = 0.002), but the mean axial stiffness was greater for the retrograde IMN (199.16 vs. 303.93 N/mm, P < 0.001). The total deformation of LISS plate caused by cyclic axial loading was greater than retrograde IMN (4.17 vs. 3.57 mm, P = 0.014). Significantly less mean irreversible deformation was detected in LISS plate than in retrograde IMN (1.64 vs. 1.69 mm, P = 0.699). Failure loads of the constructs were significantly different between the two groups (LISS plate: 2941±128 N; retrograde IMN: 4022±176 N, P < 0.001). Conclusion: For comminuted femoral supracondylar fractures in the elderly, the tested instruments can both maintain sufficient biomechanical stabilities, but retrograde IMN is superior to LISS plate in deformation of fracture site. [ABSTRACT FROM AUTHOR]

Objective: Relatively few studies have reported on the morphology of the supracondylar femur, which is a fundamental factor affecting prosthetic reconstruction. The objectives of the present study were to measure the morphological parameters of the supracondylar femur, to classify the supracondylar femur, and to provide theoretical guidance for the development of distal femoral prostheses. Methods: The study consisted of 82 patients of Han Chinese nationality in North China. There were 57 men and 25 women included in the study, with an average age of 50.9 years (range, 18–87 years). Effective CT data should include a range of more than 10 cm for the distal femur. CT data for the right distal supracondylar femurs was obtained from DICOM files. Results for the cancellous bone and marrow cavity were retained, and information for the cortical bone was erased to obtain information of the lumen. Measurements of the intracortical cavity have not been reported previously. Lumen models were reconstructed with Mimics 17.0 software. The surfaces of the lumen models were smoothed with Geomagic studio 12.0 software. Using the Solidworks 2014 software, we established a 3‐D coordinate system, where variables of the lumen were examined. Correlations between the various measurements were calculated. Results: The supracondylar region of the femur was divided into five levels, and the length, breadth, height, and angle values were measured at each level. There were strong correlations between the length indexes (transverse diameter [EF], medial anteroposterior diameter [AC], middle anteroposterior diameter [GH], and lateral anteroposterior diameter [BD]) and the volume index (V). There were also strong correlations among the length indicators (EF, AC, GH, and BD) in each layer. Angle γ was correlated with the lateral anteroposterior diameter (BD) at L2–L6 layers (r = −0.383, −0.385, −0.296, −0.258, −0.24; all P < 0.05) and with the height index (h) at L4–L6 layers (r = −0.244, −0.385, −0.506; all P < 0.05). The most representative parameters were the medial anteroposterior diameter (AC2R2 = 0.865; AC6R2 = 0.932), the coronal width ratio, and the sagittal width ratio with volume. The analysis found that the lumen shape of flower–top hat accounted for 81% at most. Conclusions: The supracondylar femur has an asymmetrical structural area. The coronal plane is dominated by a flowerpot‐like morphology, and the sagittal plane is narrowest in the lateral 1/3 and resembles a top‐hat‐like morphology. Our results provide theoretical guidance for developing distal femoral prostheses and for their clinical application. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of Jintiange capsules and Jintiange combined with other therapies in the treatment of osteoporosis. Methods: A systematic review of the literature was conducted through databases including China National Knowledge Infrastructure (CNKI), the VIP Database for Chinese Technical Periodicals (VIP), Wanfang, and PubMed from inception to April 2018. Network meta‐analysis was used to determine the relative efficacy of related treatments on osteoporosis. The primary outcome measures are the bone mineral density (BMD) of the lumbar and femoral neck, and the secondary outcome measures are visual analog pain score (VAS) and adverse events. Two reviewers independently selected the studies, extracted information, and assessed the quality of included trials. Data extracted from eligible studies was pooled and meta‐analyzed, and the mean differences (MD) with their 95% confidence intervals were estimated as the effect size between treatments. Results: Thirty‐one studies were included in this study, containing 28 randomized controlled trials (RCT) and 3 non‐randomized controlled trials (non‐RCT), with a total of 14 regimens treating osteoporosis. According to the surface under the cumulative ranking (SUCRA) curves, Jintiange capsules combined with atorvastatin (89.9%) and Jintiange combined with bisphosphonates (88.2%) have the best efficacy in terms of the BMD of the lumbar and femoral neck, respectively. Based on the VAS, Jintiange combined with calcium has the best analgesic effect (83.4%). Conclusion: Jintiange capsules alone and combined with other therapies is a good choice for treating patients with osteoporosis in terms of improving BMD, relieving pain, and reducing adverse events. More large‐scale and well‐designed RCT are warranted to confirm the results of this study. [ABSTRACT FROM AUTHOR]

China is a great country, and history teaches us that it was the largest producer and provider of goods and tools, as well as being a nation that developed many concepts and ideas in different fields of activity, including medical science. Many shoulder and elbow schools have Chinese fellows and colleagues who are actively contributing to the scientific development of shoulder and elbow surgery in China. The current special issue of I Orthopaedic Surgery i includes scientific papers from different shoulder, elbow, and orthopaedic departments that specialize in articular surgery and quality modern treatment. Reverse shoulder arthroplasty became very popular in the last 20 years, and currently China is developing this chapter for better patient care, offering new solutions in shoulder reconstruction for orthopaedic and traumatic conditions. [Extracted from the article]

This study was conducted to identify the influence of ambulatory status prior to treatment on survival of patients with spinal metastases. Two investigators independently retrieved relevant electronic literature in PubMed, Embase, and Cochrane Library databases, to identify eligible studies. Effect estimates for hazard risk (HR) were extracted and synthesized through fixed‐effects or random‐effects models as appropriate. A total of 17 eligible studies were identified, with an accumulated number of 3962 participants. HR from 14 studies regarding comparison between ambulatory versus non‐ambulatory groups were pooled using a random‐effects model, and statistical significance was presented for the pooled HR (HR = 1.96; 95% confidence interval [CI], 1.65–2.34). In subgroups of mixed primary tumor and lung cancer, ambulatory status was considered to be a significant prognostic factor (P < 0.05), while in the subgroup of prostate cancer it was not (HR = 1.72; 95% CI, 0.79–3.74). HR from 4 studies related to comparison between Frankel E versus Frankel C–D were pooled using a fixed‐effects model, which revealed statistical significance (HR = 1.73; 95% CI, 1.27–2.36). Ambulatory status is a significant prognostic factor in patients with spinal metastases. However, in patients with primary prostate cancer, the prognostic effect of ambulatory status has not yet been confirmed to be significant. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the correlation between features of knee joint rheumatoid arthritis (RA) identified on MRI and histological examination as a means of elucidating the pathogenesis of joint destruction in RA. Methods: This is a prospective analysis of 26 knee joints of 22 patients who underwent total knee arthroplasty (TKA) for the treatment of RA. Based on the degree of destruction of articular cartilage and the menisci, the occurrence of bone marrow edema and bone erosion, and synovial thickening, the stage of the knee joints were classified using MRI by two radiologists. Differences in the severity of destruction of the articular cartilage of the medial and lateral femoral condyles and medial and lateral tibial plateaus, the medial and lateral menisci, and bone were compared using analysis of variance with a post‐hoc test, and the Mann–Whitney U‐test. Samples of cartilage, subchondral bone, menisci, and synovium were obtained from the resected knee specimens during TKA and analyzed semiquantitatively using microscopy and immunohistochemistry. Histological differences between areas of bone erosion and bone marrow edema were evaluated using a Mann–Whitney U‐test. Results: The extent of articular destruction was classified as grade 4 for the medial and lateral femoral condyles and the medial and lateral tibial plateaus for most patients, with an average destruction grade of 3.6 (F = 5.455, P = 0.002), with the least amount of destruction identified on the lateral femoral condyle. The majority of knee joints in the RA patients were at stage 3 (21/26, 80.8%), followed by stage 4 (4/26, 15.4%). Fibrosis, thinning and destruction, and hyperplasia were the most severe pathological changes in cartilage. In a total of 26 specimens, 36 areas of bone marrow edema and 68 areas of bone erosion were identified, with fibrosis, a mosaic structure of bone, and lymphocyte infiltration being the most severe changes in these areas. The degree of meniscus destruction was classified as grade 4 in the majority patients for both the medial and lateral meniscus, with an average degree of meniscal destruction over all specimens of 3.85, and greater destruction of the medial meniscus than of the lateral meniscus (Z = 2.062, P = 0.039). Fibrosis and engulfing calcified debris were the most severe pathological manifestations. Synovitis was also identified in all 26 specimens, with hyperplasia of intima cells and lymphocyte and plasma cell infiltration being the most severe pathological manifestations. Conclusions: Severe destruction of the articular cartilage and menisci is a characteristic feature of RA. Bone marrow edema and bone erosion can both also be found, but are less characteristic. Synovial infiltration may be the triggering mechanism of the destruction of the cartilage, menisci, and bone marrow. However, the origin of bone marrow edema requires further investigation. [ABSTRACT FROM AUTHOR]

Diaphyseal defects in long bones of extremities following segmental resection are very common in the clinic, and reconstruction remains a great challenge. Although there are many treatments for diaphyseal defects at present, reconstruction with an intercalary endoprosthesis may be an optimal method. We demonstrate a surgical technique for reconstruction of a humeral shaft defect with an intercalary endoprosthesis following tumor resection, and achieve a good clinical outcome. We conclude that in comparison with other methods, reconstruction with an intercalary endoprosthesis is simple, effective, and allows for earlier weight bearing and more rapid restoration of function. [ABSTRACT FROM AUTHOR]

Gorham–Stout disease (GSD) is an extremely rare bone condition of unknown etiology characterized by spontaneous and progressive resorption of bones. GSD can occur at any age and is not related to gender, genetic inheritance, or race. Any part of the skeleton can be affected and the symptoms correlate with the sites involved. The diagnosis of GSD is established based on the combination of clinical, radiologic, and histologic features after excluding other diseases. Because of its rarity, current knowledge is limited to case reports and there is no agreement on the best strategy for treatment. The following case report describes a successfully treated case of GSD in a 26‐year‐old male patient with the left scapula and the 7th–9th left ribs involved. The patient was diagnosed with osteoporosis‐related pleural effusion at a local hospital. In our institution, the patient was diagnosed with GSD and treated with radiotherapy and bisphosphonate. The disease was controlled and there was no evidence of disease progression during follow‐up. Genetic sequencing was performed to investigate the etiology of GSD. In addition, the present study reviews the theories regarding the etiology, the clinical manifestations, the diagnostic approaches, and treatment options for this rare disease. [ABSTRACT FROM AUTHOR]

Objective: To study the biomechanical properties of a novel modular intercalary prosthesis for humeral diaphyseal segmental defect reconstruction, to establish valid finite element humerus and prosthesis models, and to analyze the biomechanical differences in modular intercalary prostheses with or without plate fixation. Methods: Three groups were set up to compare the performance of the prosthesis: intact humerus, humerus–prosthesis and humerus–prosthesis–plate. The models of the three groups were transferred to finite element software. Boundary conditions, material properties, and mesh generation were set up for both the prosthesis and the humerus. In addition, 100 N or 2 N.m torsion was loaded to the elbow joint surface with the glenohumeral joint surface fixed. Humeral finite element models were established according to CT scans of the cadaveric bone; reverse engineering software Geomagic was used in this procedure. Components of prosthetic models were established using 3‐D modeling software Solidworks. To verify the finite element models, the in vitro tests were simulated using a mechanical testing machine (Bionix; MTS Systems Corporation, USA). Starting with a 50 N preload, the specimen was subjected to 5 times tensile (300 N) and torsional (5 N.m) strength; interval time was 30 min to allow full recovery for the next specimen load. Axial tensile and torsional loads were applied to the elbow joint surface to simulate lifting heavy objects or twisting something, with the glenohumeral joint surface fixed. Results: Stress distribution on the humerus did not change its tendency notably after reconstruction by intercalary prosthesis whether with or without a plate. The special design which included a plate and prosthesis effectively diminished stress on the stem where aseptic loosening often takes place. Stress distribution major concentrate upon two stems without plate addition, maximum stress on proximal and distal stem respectively diminish 27.37% and 13.23% under tension, 10.66% and 11.16% under torsion after plate allied. Conclusion: The novel intercalary prosthesis has excellent ability to reconstruct humeral diaphyseal defects. The accessory fixation system, which included a plate and prosthesis, improved the rigidity of anti‐tension and anti‐torsion, and diminished the risk of prosthetic loosening and dislocation. A finite element analysis is a kind of convenient and practicable method to be used as the confirmation of experimental biomechanics study. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical effect of the minimally invasive transforaminal lumbar interbody fusion combined with posterolateral fusion and unilateral fixation using a tubular retractor in the management of degenerative lumbar disease. Methods A retrospective analysis was conducted to analyze the clinical outcome of 58 degenerative lumbar disease patients who were treated with minimally invasive transforaminal lumbar interbody fusion combined with posterolateral fusion and unilateral fixation during December 2012 to January 2015. The spine was unilaterally approached through a 3.0-cm skin incision centered on the disc space, located 2.5 cm lateral to the midline, and the multifidus muscles and longissimus dorsi were stripped off. After transforaminal lumbar interbody fusion and posterolateral fusion the unilateral pedicle screw fixation was performed. The visual analogue scale ( VAS) for back and leg pain, the Oswestry disability index ( ODI), and the MacNab score were applied to evaluate clinical effects. The operation time, peri-operative bleeding, postoperative time in bed, hospitalization costs, and the change in the intervertebral height were analyzed. Radiological fusion based on the Bridwell grading system was also assessed at the last follow-up. The quality of life of the patients before and after the operation was assessed using the short form-36 scale ( SF-36). Results Fifty-eight operations were successfully performed, and no nerve root injury or dural tear occurred. The average operation time was 138 ± 33 min, intraoperative blood loss was 126 ± 50 mL, the duration from surgery to getting out of bed was 46 ± 8 h, and hospitalization cost was 1.6 ± 0.2 ten thousand yuan. All of the 58 patients were followed up for 7-31 months, with an average of 14.6 months. The postoperative VAS scores and ODI score were significantly improved compared with preoperative data ( P < 0.05). The evaluation of the MacNab score was excellent in 41 patients, good in 15, and fair in 2, suggesting an effective rate of 96.6%. The intervertebral height had reduced 0.2 ± 1.2 mm by the last follow-up, and there were 55 Grade I and II cases based on the Bridwell evaluation criterion. The fusion rate was 94.8%, and no screw breakage and loosening occurred. The scores of physical pain, general health, social, and emotional functioning were significantly increased at the last follow-up. Conclusion Minimally invasive transforaminal lumbar interbody fusion combined with posterolateral fusion and unilateral fixation provide a new choice for degenerative lumbar disease, and the short-term clinical outcome is satisfactory. [ABSTRACT FROM AUTHOR]

Objective To introduce and analyze the feasibility of a new surgical strategy for circumferential reconstruction of subaxial cervical and cervicothoracic spine by simultaneously combined anterior-posterior approach in the sitting position. Methods A retrospective review was performed for seven patients who underwent the above surgical procedure between July 2011 and January 2015. Among the seven patients, there were six men and one woman, with an average age of 52 years (range, 36-79 years). Six patients were confirmed to have a lower subaxial cervical fracture and dislocation with a locked facet joint, and the other patient had an invasive tumor involving both anterior and posterior parts of vertebrae and lamina, detected by radiological examination. The levels involved for all patients were from C4 to T2. According to American Spinal Injury Association ( ASIA) classification, one case was class A, four were class B, and two were class D. The patients were restricted in the sitting position with traction and a halo in extension to immobilize the head during the operation. The simultaneously combined anterior-posterior operation for reduction, decompression or tumor resection and circumferential reconstruction was carried out. Results Both anterior and posterior procedures were successfully completed simultaneously in the sitting position in all cases. There were no perioperative complications. The average operative time was 175 ± 32 min (range, 120-240 min), and the mean blood loss was 430 ± 85 mL (range, 200-1100 mL). The patients were followed up for 35.8 months (range, 18-60 months). The symptom of neck pain improved distinctly and no evidence of implant failure was noted in any patients. Neurological status improvement was confirmed in six patients, who had suffered incomplete paralysis. The ASIA grade improved in five patients, and two cases had no change in grade. Conclusions The 'sitting position' simultaneously combined anterior-posterior approach is safe and is superior to the traditional prone position and supine position, and the surgical results are satisfactory. [ABSTRACT FROM AUTHOR]

Objective: To report the results of the posterior approach for thoracic ossification of posterior longitudinal ligament (TOPLL) by using a special "L" osteotome. Methods: The present study enrolled 16 consecutive patients (9 men and 7 women) between May 2009 and September 2013. All patients underwent a posterior circumferential decompression osteotomy and segmental instrumentation with interbody fusion. The mean age at surgery was 57.3 years (range, 37-68 years). Patients' data, clinical manifestation, blood loss, length of surgery, complications, visual analog scale (VAS), Japanese Orthopedic Association (JOA), and Frankel grading system before and after surgery were collected and evaluated, retrospectively. Results: The average follow-up period was 30 ± 19 months (range, 12-50 months). All patients were successfully treated with posterior compression and segmental instrumentation with interbody fusion. The average operation time was 261.6 ± 51.3 min (range, 190-310 min). The mean blood loss was 980.3 ± 370.5 mL (range, 600-2100 mL). All patients had subjective improvement of motor power and gait. Average preoperative and postoperative JOA scores were 4.2 ± 1.7 and 7.8 ± 2.5 points, respectively. Differences in the overall JOA scores showed significant postoperative improvement. At the last follow-up, all patients improved either by one or two Frankel grades. There was a significant difference between preoperative VAS scores and those 3 months after surgery (P < 0.05). No significant difference was observed between the 3-month and 12-month results (P > 0.05). Cerebrospinal fluid (CSF) leakage occurred in 3 patients. Acute neurological deterioration was encountered postoperatively in 1 patient. Conclusion: Treatment with posterior transpedicular osteotomy and circumferential decompression was found to be safe, effective, reliable, and technically feasible, and keeping the thoracic cavity intact avoids many shortcomings of anterior surgery and results in a satisfactory spinal decompression. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical outcomes and complications of segmental prosthetic reconstruction for pathological diaphyseal femoral fractures secondary to metastatic tumors. Methods: Between 2011 and 2015, we retrospectively evaluated 16 patients (6 men and 10 women; 64.5 ± 11.4 years old at diagnosis) who underwent prosthetic reconstruction after segmental resection of diaphyseal femoral fractures due to metastatic lesions. Visual analog scale (VAS), functional outcomes, implant-related complications, and Mean postoperative Musculoskeletal Tumor Society (MSTS) score for each patient were collected. Results: The mean length of bone defect was 10.2 ± 2.6 cm (range, 8-16 cm); follow-up was 9 ± 6.8 months (range, 2-25 months) for all patients, and 24 months (23 and 25 months) for the 2 patients still alive. At final followup, 14 patients were dead, indicating a mean survival of 6.9 ± 3.6 months (range, 2-14 months). Mean preoperative VAS score was 8.5 ± 1.0, which decreased to 2.5 ± 1.3 at day 2 postoperatively, indicating significant pain relief (P < 0.05). The MSTS score for lower extremities was 84.6% (range, 73%-90%). The range of motion and function of adjacent joints was within the normal limits in all cases. Three patients (33%) developed complications, including aseptic loosening because of disease progression (1), infection (1), and peri-prosthesis fracture (1). Conclusion: These findings demonstrated that this approach greatly relieves pain, and yields satisfactory functional outcomes with fewer complications in patients with pathological femoral fractures secondary to metastatic tumors; however, survival was not significantly improved. [ABSTRACT FROM AUTHOR]

Giant cell tumor (GCT) is a benign, locally aggressive tumor that rarely occurs in the spine. They usually occur in patients between 20 and 40 years of age; some patients with GCT present in hospital with pregnancy. The management of these patients can be challenging. The current study reports a case of GCT located in the sixth thoracic vertebra of a 31-yearold female at 34 weeks of gestation. An osteolytic lesion, 3.5 cm × 3.5 cm in diameter, was identified on CT. An MRI test of the lesion revealed a soft tissue mass involving the T6-7 vertebrae, extending to the right pedicle of the T6 vertebra and causing significant spinal cord compression. The patient delivered a healthy boy by cesarean at 35 weeks of gestation. One week later, she underwent a T6-T7 laminectomy, posterior spinal decompression, and instrument fusion. Ultimately, the patient was discharged to inpatient rehabilitation with improved lower extremity strength and returned bowel and bladder function. At the 2-year follow-up, there is no evidence of local reoccurrence and the patient has no constitutional symptoms. The present study also reviews eight similar previously reported cases of GCT in the mobile spine, with a discussion of the demographic characteristics, treatment, and prognosis of pregnant patients. This report adds to the existing literature, making the reader aware that clinical symptoms of GCT in the mobile spine can be misinterpreted as a symptom of pregnancy. For spinal GCT in pregnant women, continued pregnancy and definitive surgery after the baby is born are recommended without any serious nerve damage. [ABSTRACT FROM AUTHOR]

The purpose of this article is to evaluate the efficacy and feasibility of preoperative surgery with 3D printing-assisted internal fixation of complicated acetabular fractures. A retrospective case review was performed for the above surgical procedure. A 23-year-old man was confirmed by radiological examination to have fractures of multiple ribs, with hemopneumothorax and communicated fractures of the left acetabulum. According to the Letounel and Judet classification, T-shaped fracture involving posterior wall was diagnosed. A 3D printing pelvic model was established using CT digital imaging and communications in medicine (DICOM) data preoperatively, with which surgical procedures were simulated in preoperative surgery to confirm the sequence of the reduction and fixation as well as the position and length of the implants. Open reduction with internal fixation (ORIF) of the acetabular fracture using modified ilioinguinal and Kocher-Langenbeck approaches was performed 25 days after injury. Plates that had been pre-bent in the preoperative surgery were positioned and screws were tightened in the directions determined in the preoperative planning following satisfactory reduction. The duration of the operation was 170 min and blood loss was 900 mL. Postoperative X-rays showed that anatomical reduction of the acetabulum was achieved and the hip joint was congruous. The position and length of the implants were not different when compared with those in preoperative surgery on 3D printing models. We believe that preoperative surgery using 3D printing models is beneficial for confirming the reduction and fixation sequence, determining the reduction quality, shortening the operative time, minimizing preoperative difficulties, and predicting the prognosis for complicated fractures of acetabulam. [ABSTRACT FROM AUTHOR]

Objective To provide useful insights of multidisciplinary surgical treatment for vertebral hemangioma with spinal cord compression. Methods From 2009 to 2014, data on six patients who were diagnosed with cord compression vertebral hemangioma were reviewed and analyzed retrospectively. There were five women and one man with a mean age of 48.6 years (range, 26-68 years). All the patients were treated by multidisciplinary approach, including use of gelfoam, pedicle screw instrumentation, vertebroplasty, and decompression laminectomy. Neurological status and Frankel grades were documented, CT scan and MRI were performed after surgery. Results The follow-up period ranged from 8 to 54 months. Mean blood loss was around 367 mL, and the mean surgical time was 2.30 h. All patients had uneventful intraoperative and postoperative courses and reported symptomatic and neurological relief to varying degrees, at an average follow-up period of 23 months. Bone cement distribution was disseminated homogeneously over the affected vertebra and no leakage was observed. All the patients had a complete restoration to Frankel grade E. The postoperative and follow-up imaging showed that the implant was in perfect position, and no recurrence occurred in all patients. Conclusion The vertebral hemangioma with cord compression is a challenge to surgeons for therapeutic improvement, and an active involvement of several disciplines as well as performance of multidisciplinary surgical treatment can be crucial in achieving favorable results. [ABSTRACT FROM AUTHOR]

Objective Japanese Orthopaedic Association ( JOA) scoring systems were developed to evaluate the neurological function of patients with cervical or lumbar degeneration. As patient-based and multi-dimensional clinical evaluation tools, these systems should be capable of reflecting the walking disability of patients. The association between JOA scores and gait parameters, however, are not well characterized. The purpose of this study was to determine the correlations between JOA scores and gait parameters of patients with cervical spondylotic myelopathy ( CSM) and lumbar intervertebral disc herniation ( LDH). Methods A total of 32 CSM and 30 LDH patients with gait dysfunction were recruited for the present study. All patients were diagnosed by two senior orthopaedic doctors and evaluated with JOA scoring systems. A body-mounted motion analyzer, the Intelligent Device for Energy Expenditure and Activity ( IDEEA), was applied to measure gait parameters of patients across 30 m of flat floor in an orthopaedic ward. A linear regression model was used to determine the correlations between JOA scores and gait parameters. Multiple linear regressions were used to identify the relationships between subsections of the JOA systems and gait parameters. Results Japanese Orthopaedic Association scores of LDH patients from the JOA lumbar scoring system are significantly correlated with gait speed ( R2 = 0.557, P < 0.001) and stride length ( R2 = 0.544, P < 0.001). JOA scores are also correlated with double support duration, step duration, cycle duration and cadence, and weakly correlated with single support duration. For the four subsections of the JOA lumbar scoring system, 'restriction of activities of daily living' is the significant predictor of all gait parameters, especially gait speed ( R2 = 0.573, P < 0.001) and stride length ( R2 = 0.553, P < 0.001). However, JOA scores of CSM patients from the JOA cervical scoring system are only weakly correlated with these measures (all R2 < 0.3). For the four subsections of the JOA cervical scoring system, 'motor function of the lower extremity' is a weak predictor of gait parameters (all R2 < 0.3). Conclusions There is a significant correlation between gait parameters and functional disability as measured by the JOA lumbar scoring system, which indicates that the JOA lumbar scoring system can reflect gait impairment. The JOA cervical scoring system, however, may need to be improved for efficiently evaluating the walking ability of CSM patients in the assessment of motor function of the lower extremity. [ABSTRACT FROM AUTHOR]

Under the effective chemotherapy protocol, physeal distraction could be used as an effective limb salvage in the growing children with lower-limb malignant metaphyseal bone tumours and could actively prevent leg length discrepancy or malalignment that profoundly affects function. In this paper, we report a 7-year-old boy with right distal tibial osteosarcoma but not yet invaded the epiphysis, which underwent surgical treatment after effective chemotherapy. The surgical procedure included two phases: epiphysiolysis (physeal distraction) and en-bloc resection of tumor and distraction osteogenesis. In the first phase, after osteotomy of the proximal fibula was performed, two Ilizarov rings were attached to the proximal tibia and one Ilizarov ring was applied to the distal tibia. At same time, U-shape ring as an important external fixator was been used in the axis of rotation of the ankle joint in order to balance the stress from the surrounding tissues, increase distracting stabilization and prevent the deformity or contracture of ankle joint. In the second phase, the tumor bone (5.7 cm) was en bloc resected by diaphyseal osteotomy. Distraction osteogenesis was commenced 1 week postoperatively at a rate of 1 mm twice a day. The patient was reviewed by X-ray intermittently. The new bone was formed and the entire bone defect was covered in four months after the operation. Doxorubicin and cisplatin as the neoadjuvant chemotherapy protocol are effective to osteosarcoma and chemotherapy process did not adversely affect the union. Through this technique, the right distal tibial epiphysis was reserved successfully. At the last follow-up, there are no local recurrence or metastasis and we achieve to prevent leg length discrepancy or malalignment that profoundly affects function. [ABSTRACT FROM AUTHOR]

Objective To evaluate the result of en bloc resection and reconstruction of the distal radius with a non-vascularized fibular autograft for giant cell tumor ( GCT) of bone. Methods Between 2005 and 2015, 12 eligible patients (seven males, five females, mean age 31.3 years) with grade III GCT of the distal radius were treated by en bloc resection and reconstruction with non-vascularized proximal fibular autografts in four Chinese institutions (members of Giant Cell Tumor Team of China). The patients had a clinical and radiographic review every 6 months for the first 2 years then annually thereafter. The functional, oncologic and radiological outcomes of the patients were analyzed. Results The mean duration of follow-up was 39.6 months. Bony union was achieved in all cases. None of the patients were dissatisfied with the shape and appearance of the wrist. The mean MSTS score was 25.23 ± 2.38 (range, 22-29). The mean DASH score was 13.0 (range, 6.7-33.3). The average range of motion of the wrist was: 35.8° ± 14.5° of extension, 14.0° ± 8.4° of flexion, 15.5° ± 6.7° of radial deviation, 19.4° ± 10.1° of ulnar deviation, 57.2° ±18.9° of pronation and 44.0° ± 24.8° of supination. The average percentage of grip strength was 55.2% ± 29.0% compared with that of the contralateral side. One localized soft tissue recurrence occurred; it was successfully managed by excision. Lung metastases developed postoperatively in one case and were treated by gamma knife radiotherapy. There was radiographic evidence of radiocarpal arthritis in eleven patients, bone resorption in ten, distal radioulnar joint diastasis in six, ulnar deviation of the wrist in seven, subluxation of the carpal bone in three and dislocation of the carpal bone in one patient. Conclusions Reconstruction with a non-vascularized proximal fibular autograft is a reasonable option after en bloc resection of the distal radius for giant cell tumor of bone. [ABSTRACT FROM AUTHOR]

Objectives To demonstrate the functional results and emotional acceptance after scapulectomy for various malignant shoulder tumors. Methods Eight patients with malignant shoulder tumors who had undergone scapulectomy between April 2004 and March 2014 were retrospectively reviewed. They comprised seven men and one woman their mean age was 54 years (range, 24-69 years). All patients were diagnosed by pathological examination of biopsy specimens. The tumors were metastatic in four cases, having originated from a primary carcinoma of the liver in one patient, the lung in one patient and the kidney in two patients. The other four patients had primary malignant tumors in their scapulae, specifically, two scapular malignant fibrous histiocytomas, one scapular Ewing sarcoma and one soft tissue synovial sarcoma. The four patients with metastases were staged as III, and other four were staged as IIB. Six patients underwent total and two subtotal scapulectomy. The remaining soft tissues were sutured together directly in seven of the patients. The remaining patient, who had soft tissue synovial sarcoma, required transfer of a pedicle latissimus dorsi muscle flap. The functional results and emotional acceptance were evaluated by clinician using the Musculoskeletal Tumor Society ( MSTS) scoring system. Results The average duration of follow-up was 22.8 months. Four patients were continuously disease-free, three patients developed metastases and died of disease within 12 months of surgery and one patient with a scapular metastasis from the kidney survived with pulmonary nodules. No major complications, including infection or dislocation, occurred during or after surgery. The mean MSTS score was 16.3 (54%), which is similar to that previously reported in other studies of scapulectomy. There were no local tumor recurrences and only one patient developed pulmonary metastases. These outcomes are similar to those reported for scapular prostheses and there were fewer complications than in patients treated with allografts. The mean emotional acceptance score was 3.6 (72.5%). Conclusions Performing scapulectomies on patients with malignant shoulder tumors without prostheses or allograft reconstruction achieves good functional results and emotional acceptance with a low rate of complications. [ABSTRACT FROM AUTHOR]

The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy ( MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion. [ABSTRACT FROM AUTHOR]

The purpose of this article is to introduce and analyze the feasibility of simultaneously combined anterior-posterior approaches for subaxial cervical circumferential reconstruction in sitting position. A retrospective case review was performed for above surgery procedure. A 79-year-old man was confirmed subaxial cervical fracture and dislocation with facet locked by radiological examination, and the involved levels were C5-6. According to American Spinal Injury Association ( ASIA) classification, the impairment scale was grade B. And the Subaxial Cervical Spine Injury and Severity Score (SLIC) were 9. The patient was restricted in sitting position with traction on a halo in extension to immobilize the head during the operation. A posterior laminectomy and pedicle screws insertion to the involved cervical spine was performed firstly. And then the anterior discectomy and strut graft were accomplished through an anterior cervical approach. The final fixation was finished by clamping the strut graft with pedicle screw system. Total blood loss was 600 ml and the total operating time was 150 min. The patient was followed up for 6 months. The symptom of neck pain improved distinctly and no evidence about implant failure was noted. Neurological status improvement was confirmed and the ASIA scale was improved to grade C. We believed that the simultaneously combined anterior-posterior approach in sitting position was safe and more advantageous for appropriate cases. [ABSTRACT FROM AUTHOR]

This is a systematic review of articles concerning the morbidity, recurrence rate, treatment and treatment complications of pelvic giant cell tumors ( GCTs). The key words 'giant cell tumor, pelvis' were used to identify articles which included data on patients with pelvic GCTs in English and Chinese databases of published reports from 1949-2012. The articles were filtered by title, abstract and full text. Thirty-eight articles and 165 patients were identified for this review. Data on all identified patients were studies; data in different articles on the same patients was not used repeatedly. The following patient data were collected where possible and subjected to systematic analysis; age, location of GCT, treatment, follow-up, complications, recurrence and whether alive or dead. The mean age of onset was 33.2 years (range, 14-73 years), the peak ages of onset being between 21 and 40 years. A pronounced sex difference was identified, the male : female ratio being 1:1.7. The acetabulum was the commonest area for pelvic GCTs. Forty-eight tumors were primarily located in the iliac, 60 in the acetabular and 31 in the ischiopubic area. Twenty-seven patients experienced complications of treatment. Patients who had been treated by wide resection had the most complications; these included incisional infection and delayed healing of incisions. Local recurrence was common, having occurred in 39/158 patients (24.6%), comprising 24/72 (33.3%) who had undergone intralesional surgery only; 9/20 (45.0%) who had undergone radiotherapy only; 1/51 (2.0%) who had undergone wide resection; and 5/14 patients (35.7%) who had undergone radiation therapy or cryotherapy plus intralesional surgery. Mortality was low (3.2%, 5/158). Pelvic GCT is not common, the acetabular area appears to the most frequent site and the peak age is the third and fourth decades. Although the recurrence rate is high for all pelvic GCTs, the mortality is low. Treatment has a critical influence on recurrence. In spite of the associated complications, the lower local recurrence rate makes wide resection a reasonable option for patients with extensive and/or aggressive GCTs. [ABSTRACT FROM AUTHOR]

The study of bone tissue regeneration in orthopaedic diseases has stimulated great interest among bone tissue engineering specialists and orthopaedic surgeons. Combinations of biomaterials, growth factors and stem cells for repairing bone have been much studied and researched, yet remain a challenge for both scientists and clinicians pursuing regenerative medicine. The purpose of this review was to elucidate the role of sequential release of bone morphogenetic protein-2 and vascular endothelial growth factor in producing better outcomes in the field of bone tissue regeneration. [ABSTRACT FROM AUTHOR]

An operative approach to the inferior pubic ramus that was utilized in four patients with various bone tumors in the inferior pubic ramus is described here. These patients were successfully managed though a femoribus internus (inner thigh)-perineal approach. Data concerning preoperative and postoperative symptoms, surgical procedures, and outcomes are presented. There was no recurrence in the four cases and the pain associated with an initial pelvic floor had completely resolved except one case. The slight limitation in range of motion of the left hip joint and pain were performed in the same case postoperatively. The Musculoskeletal Tumor Society scores were 28, 15, 25, and 18 at the final follow-up. A typical case is described in full and our experience concerning surgical indications, and intraoperative issues in tumor patients discussed. The purpose of this paper is to recommend that the femoribus internus-perineal approach be used to resect the inferior pubic ramus, whether affected by osteomyelitis, bone tumor, or tuberculosis, but especially in patients with tumors. [ABSTRACT FROM AUTHOR]

In recent years, limb-salvage surgery has gradually replaced amputations and become one of the main treatment strategies for patients with bone and soft tissue tumors of the extremities. The goals of tumor resection in limb-salvage surgery are to reduce the recurrence rate and preserve as much limb function as possible. However, depending on the size and specific location of the tumor, large neurovascular bundles may be involved. In addition, management of large nerves and vessels can make wide marginal resection more difficult. Sites where these problems commonly arise include the sciatic and tibial common peroneal nerve, artery and vein in the lower limbs. [ABSTRACT FROM AUTHOR]