CT-Based Calculation Model Assists Precise Treatment for Anterior and Posterior Ankle Bony Impingement.

OBJECTIVE: Ankle arthroscope is the preferred tool for ankle surgeons to treat ankle impingement. However, there is no relevant report on how to improve the accuracy of arthroscopic osteotomy through preoperative planning. The aims of this study were to investigate a novel method to obtain the bone morphology in anterior and posterior ankle bony impingement through computed tomography (CT) calculation model, use this method to guide surgical decision-making, and compare the postoperative efficacy and actual bone cutting volume with conventional surgery. METHODS: This retrospective cohort study includes 32 consecutive cases with anterior and posterior ankle bony impingement by arthroscopy from January 2017 to December 2019. Mimics software was utilized to calculate the bony morphology and measure the volume of the osteophytes by two trained software engineers. The patients were divided into the precise group (n = 15) and the conventional group (n = 17) according to whether obtain and quantify the osteophytes' morphology with CT based calculation model preoperative. All patients were evaluated clinically using visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, active dorsiflexion and plantarflexion angle before and after surgery at both 3 months and 12 months postoperatively. We obtained the shape and volume of bone cutting through Boolean calculation. Clinical outcomes and radiological data were compared between the two groups. RESULTS: The VAS score, AOFAS score, active dorsiflexion angle and plantarflexion angle were significantly improved in both groups postoperatively. In comparison of the VAS score, AOFAS score, and active dorsiflexion angle, the precise group were higher than the conventional group in the follow-up at 3 and 12 months postoperatively with statistical difference. The difference between the virtual bone cutting volume and the actual bone cutting volume of the anterior edge of distal tibia in the conventional group and precise group were 244.20 ± 147.66 mm3 and 76.53 ± 168.51 mm3 , respectively, there was statistical difference between the two groups (t = -2.927, p = 0.011). CONCLUSION: Using a novel method of obtaining and quantifying the bony morphology with CT-based calculation model for anterior and posterior ankle bony impingement can help guide surgical decision-making preoperatively and assist precise bone cutting during the operation, which can improve the efficacy and evaluate the accuracy of osteotomy postoperatively.

Investigation of acupuncture in improving sleep, cognitive and emotion based on attenuation of oxidative stress in prefrontal cortex in sleep-deprived rats / 针灸推拿医学（英文版）

Objective: To explore whether acupuncture can improve sleep disturbance, cognitive impairment and emotional disorders caused by sleep deprivation, and its association with the attenuation of oxidative stress injury in prefrontal cortex. Methods: Fifty-two male Sprague-Dawley rats were randomly divided into a control group (n=10), a model group (n=14), a manual acupuncture (MA) group (n=14), and a sham-MA group (n=14). All the groups were established as sleep deprivation models via the modified multiple platform method, except for the control group. Rats in both the MA group and the sham-MA group received corresponding intervention, respectively. After modeling and intervention, the four groups received three behavioral tests, namely sleep monitoring, by comprehensive lab animal monitoring system (CLAMS), Morris water maze (MWM) test and open-field test (OFT), followed by oxygen free radical level test and Western blot (WB) detection for the expression levels of Bax and Bcl-2. Results: The MA group derived more sleep time within 24 h than either the model group or the sham-MA group (both P<0.05). On MWM orientation navigation test day 1, there were no significant differences in escape latency among the control, MA and sham-MA groups (P>0.05), and the escape latency was significantly shorter in these three groups than that in the model group (all P<0.05). On test day 4, the escape latency was markedly shorter in the MA group than that in either the model group or the sham-MA group (both P<0.05); meanwhile, the MA group showed significantly better performance compared with these two groups in space probe test (both P<0.05). In OFT, compared with the control group, there was a significant decline in the horizontal movement score in the other three groups (all P<0.05), and the decrease was more significant in the model group and the sham-MA group than that in the MA group (both P<0.05). The superoxide dismutase (SOD) content was markedly higher and the malondialdehyde (MDA) content was markedly lower in the MA group than those in the model group and the sham-MA group (all P<0.05). Compared with the model group and the sham-MA group, the expression of Bax was significantly lower and the expression of Bcl-2 was significantly higher in the MA group (all P<0.05). Conclusion: MA therapy can lengthen the sleep time in sleep-deprived rats and improve learning and memory impairments induced by sleep deprivation, and the underlying mechanism may be associated with the enhancement of antioxidant capacity in the prefrontal cortex and the inhibition of hippocampal neuronal apoptosis.

Optimal Sagittal Insertion Depth and Direction of Femoral Intramedullary Rod in Total Knee Arthroplasty in Chinese Osteoarthritis Patients.

OBJECTIVE: To identify the optimal femoral intramedullary rod insertion depth and direction on the sagittal plane in total knee arthroplasty (TKA) of Chinese osteoarthritis (OA) patients. METHODS: From January to December 2019, CT data were collected for 85 consecutive entire lower extremity Chinese OA patients. A three-dimensional method was used to simulate intramedullary rod penetration. The intramedullary rods were inserted toward the anterior (TA), center (TC), and posterior (TP) of the femoral canal, respectively. Four penetration depths of 150, 200, 250, and 300 mm from the joint line were set. The intersection angle was measured between the simulated intramedullary rod and the mechanical axis of the femur (FMA) on the sagittal plane. RESULTS: Our study included 85 Chinese OA patients: 46 women, with a mean age of 65.7 ± 8.4 years (range, 51-85 years) and 39 men, with a mean age of 65.6 ± 8.1 years (range, 46-86 years). The intersection angle between the FMA and the femoral anatomical axis was smaller in men, 2.4° ± 1.6° (range, 0°-4.8°), than in women, 3.5° ± 2.3° (range, 0.7º-8.2°), with a significant statistical difference (P < 0.01). In the comparison of the intersection angle between the simulated intramedullary rod and the FMA, there was no statistical difference between TA200 and TC200 in women (P > 0.05). The proportions were up to 91% and 96% of TA200 at 0°-3° and 0°-5° intervals, respectively, but just 63% and 78% in TC200. In TA150, 76% of intersection angles were greater than 5°. Only approximately 60% in TA250 and TA300 were within the 0°-5° interval and 40% were less than 0°. Only 57% of intersection angles in TC150 were in the 0°-3° interval. TC250, TC300, and TP150 were mostly below 0°. In men, there were statistical differences between all groups. All intersection angles were greater than 5° in TA150. TA200 and TA250 were mostly greater than 5° (87% and 59%, respectively) and 72% of intersection angles were within 0°-5° interval in TA300. TC150 had 92% of intersection angles within the 0°-5° interval but only 62% between the 0° and 3° interval. In the TC200, up to 90% and 97% were within 0°-3° and 0°-5° intervals, respectively. TC300, TP150, and TP200 were mostly below 0°. CONCLUSION: We described an innovative method for rapidly, simply, and accurately identifying the sagittal insertion depth and direction of the femoral intramedullary rod in TKA, which can optimize the position of the femoral prosthetic component on the sagittal plane in TKA.

Biomechanics of single-tunnel double-bundle anterior cruciate ligament reconstruction using fixation with a unique expandable interference screw.

BACKGROUND: Single-tunnel double-bundle (STDB) anterior cruciate ligament (ACL) reconstruction can restore biomechanical function and anatomic structure, but existing methods of graft fixation are not adequate. The aims of this study are to examine knee biomechanics after STDB reconstruction using a unique expandable interference screw for fixation. METHODS: The biomechanical parameters of six pairs of human cadaveric knee specimens were measured with the ACL intact, after ACL removal, and after STDB reconstruction using the interference screw or single-tunnel single-bundle (STSB) reconstruction. Anterior tibial translation under 134 N anterior tibial load in a neutral position as well as in 15° and 30° internal and external knee rotation and the internal tibial rotation angle under the rotatory load (5 N·m internal tibial rotation) were measured. RESULTS: Anterior tibial translations at each degree of knee flexion in the STDB group were significantly less than in the STSB group (all, P<0.05). The internal rotation angles in the STSB group at five flexion angles were significantly higher than in the ACL intact group, whereas there were significantly less than those of the ACL absent group (P<0.05). Under rotatory loads in the neutral position, the tibial internal rotation angles of the STDB group were significantly lower than in the STSB group at all flexion angles (all, P<0.05). CONCLUSIONS: STDB ACL reconstruction with the expandable interference screw provides better anteroposterior and rotational stability than STSB reconstruction. CLINICAL RELEVANCE: The technique provides the advantages of double-bundle reconstruction using a single-tunnel technique.

[Impact of muscle strength on knee joint stability in static loading].

OBJECTIVE: To study the in vivo stability of normal and anterior cruciate ligament (ACL)-injured knee joint before and after epidural anesthesia under 134 N pre-loading and evaluate the influence of muscular tension on the knee stability. METHODS: Eight volunteers with unilateral ACL rupture and normal contralateral knee were enrolled in this study. CT (3D) images and 2 orthogonal images of the knee were captured at 0°, 30°, 60°, and 90° under 134 N pre-loading. The orthogonal images were used to recreate the in vivo knee positions at each of the targeted flexion angles by 2D/3D registration to analyze the tibial translation data. RESULTS: The anterior tibia translation of both the intact and ACL-injured knees after anesthesia was significantly different from that before anesthesia at all the angles (P<0.05). The anterior tibial translation of the intact knee after anesthesia increased by 1.7 mm at 0°, 2.7 mm at 30°, 2.6 mm at 60°, and 2.3 mm at 90°, as compare to the increase of ACL-injured knee by 4.2 mm, 2.6 mm, 1.2 mm, and 1.6 mm, respectively. CONCLUSION: The muscular tension has evident influence on the knee stability in static loading.

[Features of the dual energy technique with dual-source computed tomography for anterior cruciate ligament injuries].

OBJECTIVE: To explore the diagnostic value of the dual-energy technique with dual-source computed tomography (DSCT) for anterior cruciate ligament injuries. METHODS: The clinical data of 8 patients with arthroscopic results were retrospectively reviewed. All patients underwent two- and three-dimensional imaging by multiplanar reconstruction, volume rendering, and tendon mode on DSCT. Dual-energy characteristics were compared with arthroscopic results. RESULTS: Six patients who were arthroscopically diagnosed as anterior cruciate ligament injuries, all of them were also correctly diagnosed by DSCT. Two patients who were arthroscopically diagnosed as normal, one was also diagnosed as normal by DSCT and the other was misdiagnosed. The overall agreement rate was 87.5% (7/8) . Under the dual energy tendon mode, the dual energy staining of the injured anterior cruciate ligament was lower than that of the contralateral normal cruciate ligament of the patient. CONCLUSION: The staining diminution in DSCT imaging may be a new feature that can be used to effectively diagnose anterior cruciate ligament injury.