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Sun JY, Ma HY, Shen JM, Du YQ, Dong Y, Zhang YC, Zhou YG, Wang Y. Factors influencing knee valgus alignment in Crowe type IV hip dysplasia after total hip arthroplasty. J Orthop Traumatol 2021; 22:41. [PMID: 34655357 PMCID: PMC8520551 DOI: 10.1186/s10195-021-00601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background Valgus deformity of the knee remains a complaint after total hip arthroplasty (THA) among some patients with Crowe type IV hip dysplasia. We aimed to identify the knee alignment in these patients before and after surgery, and to explore the factors contributing to postoperative knee valgus alignment. Materials and methods We retrospectively reviewed a series of Crowe type IV patients who received THA between February 2010 and May 2019 in our hospital. The patients’ medical data were collected from the hospital information system. On both preoperative and postoperative full limb length standing radiographs, the following parameters were measured: hip–knee–ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, anatomical tibiofemoral angle, anatomical lateral distal femoral angle, femoral neck-shaft angle, pelvic obliquity, limb length, height and lateral distance of hip center, and femoral offset. Univariate and multivariate binary logistic regression were used to identify the factors influencing postoperative knee valgus alignment. Results A total of 64 Crowe type IV patients (87 hips) were included in the study. Overall, HKA improved from 176.54 ± 3.52° preoperatively to 179.45 ± 4.31° at the last follow-up. Those hips were subdivided into non-valgus group (≥ 177.0°, n = 65) and valgus group (< 177.0°, n = 22) according to postoperative HKA. Only postoperative mLDFA was a significant factor in the multivariate regression model. Conclusions The postoperative mLDFA is a major factor related to knee valgus alignment after THA, which combines the preoperative anatomy and surgical reconstruction. Other factors previously published were found to have no significance. Level of evidence III.
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Affiliation(s)
- Jing-Yang Sun
- Medical School of Chinese PLA, Beijing, 100853, China.,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hai-Yang Ma
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jun-Min Shen
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yin-Qiao Du
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yu Dong
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yan-Chao Zhang
- Medical School of Chinese PLA, Beijing, 100853, China.,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yong-Gang Zhou
- Medical School of Chinese PLA, Beijing, 100853, China. .,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Yan Wang
- Medical School of Chinese PLA, Beijing, 100853, China. .,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China.
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Pereiro-Buceta H, Calvo-Lobo C, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Romero-Morales C, López-López D, Martínez-Jiménez EM. Intra and intersession repeatability and reliability of dynamic parameters in pressure platform assessments on subjects with simulated leg length discrepancy. A cross-sectional research. SAO PAULO MED J 2021; 139:424-434. [PMID: 34190874 PMCID: PMC9632525 DOI: 10.1590/1516-3180.2020.0791.r1.110321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/11/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Leg length discrepancy (LLD) may play a key role in exercise biomechanics. Although the Podoprint platform has been used in dynamic pressure studies, there are no data regarding the reliability and repeatability of dynamic measurements under simulated LLD conditions. OBJECTIVES To determine the intra and intersession repeatability and reliability of dynamic parameters of the Podoprint pressure platform under simulated LLD conditions. DESIGN AND SETTING Observational cross-sectional study at a public university. METHODS Thirty-seven healthy volunteers participated in this study. LLD was simulated using ethyl vinyl acetate plantar lifts with heights of 5 mm, 10 mm, 15 mm and 20 mm located under the right shoe of each volunteer. The procedure was performed to capture the dynamic parameters of each participant under five different simulated LLD conditions. Stance time, mean pressure and peak pressure measurements were registered in three trials for each foot and each LLD level. Data were collected during two separate testing sessions, in order to establish intrasession and intersession reliability. RESULTS The intraclass correlation coefficients (ICCs) for intrasession reliability ranged from 0.775 to 0.983 in the first session and from 0.860 to 0.985 in the second session. The ICCs for intersession reliability ranged from 0.909 to 0.990. Bland-Altman plots showed absence of systematic measurement errors. CONCLUSIONS The results from this study indicate that the Podoprint platform is a reliable system for assessing dynamic parameters under simulated LLD conditions. Future studies should evaluate plantar pressures under LLD conditions, in association with exercise, biomechanics and musculoskeletal disorders.
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Affiliation(s)
- Héctor Pereiro-Buceta
- MSc, DPM. Doctoral Student, Researcher, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain.
| | - César Calvo-Lobo
- PT, MSc, PhD. Senior Professor, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid. Madrid, Spain.
| | - Ricardo Becerro-de-Bengoa-Vallejo
- RN, BSc, MLIS, DPM, DHL, PhD. Full Professor, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid. Madrid, Spain.
| | - Marta Elena Losa-Iglesias
- MSc, PhD, DPM. Full Professor, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Spain.
| | - Carlos Romero-Morales
- PT, MSc, PhD, Senior Lecturer, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Daniel López-López
- MSc, PhD, DPM. Senior Lecturer and Researcher, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain.
| | - Eva-María Martínez-Jiménez
- PT, MSc, PhD, DPM. Assistant Professor, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid. Madrid, Spain.
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The Effect of Simulated Leg-Length Discrepancy on the Dynamic Parameters of the Feet during Gait-Cross-Sectional Research. Healthcare (Basel) 2021; 9:healthcare9080932. [PMID: 34442069 PMCID: PMC8393962 DOI: 10.3390/healthcare9080932] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The effect of Leg-Length Discrepancy (LLD) on dynamic gait parameters has been extensively discussed. Podobarography is the study of foot-to-ground pressure distribution. It has been used to test plantar footprint deviations that could reveal pathology. Purpose: The aim of this study is to determine the effects of simulated LLD on dynamic gait parameters measured with a pressure platform in healthy subjects. Methods: Thirty-seven healthy subjects participated in observational cross-sectional research. A procedure was performed to capture the dynamic parameters of each participant under five different simulated LLD conditions. Support time, mean pressure, and peak pressure measures were registered on three trials for each foot and LLD level per session. An analysis of variance (ANOVA) test for repeated measures was performed to check for differences between the different simulated LLD levels. Results: The stance time of the short leg had no significant changes. The stance time of the long leg increased by 3.51% (p < 0.001), mean pressure of the short leg increased by 1.23% (p = 0.005), and decreased by 5.89% in the long leg (p < 0.001). Peak pressure of the short leg decreased by 2.58% (p = 0.031) and the long leg decreased by 12.11% (p < 0.001). Conclusions: This study demonstrates that increasing LLD causes an asymmetrical foot-loading pattern, with decreased mean and peak pressure on the longer limb, and consequently an overload on the short side. Furthermore, an increasing LLD causes increased stance time on the long leg.
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Hu B, Sang L, Gao D, Wu Y, Zhang H, Luo D. Patella alignment abnormality in patients with developmental dysplasia of the hip. J Orthop Surg (Hong Kong) 2020; 27:2309499019854039. [PMID: 31204578 DOI: 10.1177/2309499019854039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the influence of developmental dysplasia of the hip (DDH) on patella alignment. METHODS The radiographic data of all the patients who met the inclusion criteria from January 2015 to July 2017 were reviewed, including the quadriceps angle (QA), patellar lateral tilt (PTA), sulcus angle (SA), lateral shift of patella (LSP), and lower limbs alignment. The patients were divided into three groups in accordance with lateral center-edge angle (LCE) and femoral neck torsion angle (FNTA): group A (LCE > 25° and FNTA < 40°), group B (LCE < 20° and FNTA < 40°), and group C (LCE < 20° and FNTA > 40°). RESULTS One hundred thirty-eight patients with 230 hips (115 females and 23 males) were recruited with an average age of 22 years. There were significant differences between group A and group C as well as group B and group C in QA, SA, PTA, LSP, and lower limbs alignment (p < 0.01). There were no differences in SA, PTA, LSP, and lower limbs alignment (p >0.05) and significant differences in QA (p < 0.01) between group B and group C. The "Pearson's" correlation analysis of the data in total of group B and group C showed that FNTA and LCE and QA and LCE were negatively correlated, whereas FNTA and QA, PTA, SA, and lower limbs alignment as well as SA, PTA, and lower limbs alignment were positively correlated. CONCLUSION Patients with DDH not only have hip joint change, but also have the patella alignment abnormality, which may lead to patella instability. In the clinic, we should pay attention to the hip development of the patella instability patients for excluding DDH. Level of Evidence: Prognostic level III.
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Affiliation(s)
- Baijun Hu
- 1 Division of Joint Surgery, Department of Orthopedics Surgery, the Affiliated Zhongshan Hospital of Guangzhou University of Traditional Chinese Medicine, Zhongshan, China.,2 Division of Joint Surgery, Department of Orthopedics Surgery, the First Affiliated Hospitalof Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lili Sang
- 1 Division of Joint Surgery, Department of Orthopedics Surgery, the Affiliated Zhongshan Hospital of Guangzhou University of Traditional Chinese Medicine, Zhongshan, China
| | - Dawei Gao
- 1 Division of Joint Surgery, Department of Orthopedics Surgery, the Affiliated Zhongshan Hospital of Guangzhou University of Traditional Chinese Medicine, Zhongshan, China
| | - Yufeng Wu
- 1 Division of Joint Surgery, Department of Orthopedics Surgery, the Affiliated Zhongshan Hospital of Guangzhou University of Traditional Chinese Medicine, Zhongshan, China
| | - Hong Zhang
- 2 Division of Joint Surgery, Department of Orthopedics Surgery, the First Affiliated Hospitalof Chinese People's Liberation Army General Hospital, Beijing, China
| | - Dianzhong Luo
- 2 Division of Joint Surgery, Department of Orthopedics Surgery, the First Affiliated Hospitalof Chinese People's Liberation Army General Hospital, Beijing, China
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Zhao HY, Kang PD, Shi XJ, Zhou ZK, Yang J, Shen B, Pei FX. Effects of Total Hip Arthroplasty on Axial Alignment of the Lower Limb in Patients with Unilateral Developmental Hip Dysplasia (Crowe type IV). J Arthroplasty 2019; 34:2406-2414. [PMID: 31103361 DOI: 10.1016/j.arth.2019.04.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/13/2019] [Accepted: 04/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the influence of total hip arthroplasty on axial alignment of the lower limb in adults with unilateral developmental hip dysplasia (Crowe type IV). METHODS We retrospectively reviewed medical records of 50 adults who underwent total hip arthroplasty, in which the acetabular cup was placed in the anatomical position. The following parameters were measured before surgery, immediately after surgery, and two years later: mechanical axis deviation (MAD), tibiofemoral angle (TFA), femoral offset, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (LDFA), mechanical medial proximal tibial angle, height of medial femoral condyle, height of lateral femoral condyle, and leg lengthening. Length of the resected femoral segment was also recorded from medical records. RESULTS Preoperative MAD, TFA, HKA, and LDFA of the ipsilateral lower limb showed significant valgus deformity. MAD of the ipsilateral lower limb and valgus inclination were significantly smaller immediately after surgery than before, while TFA, HKA, femoral offset, and LDFA were significantly larger (P < 0.05). These parameters did not differ significantly between immediately after surgery and two years later (P > 0.05). Ipsilateral extremities were extended by a mean of 2.54 cm (range, 0 to 5.35 cm). The mean length of the femoral resected segment was 3.56 cm (range, 2.03 to 5.74 cm). The contralateral lower limb showed marginally smaller MAD and medial proximal tibial angle after surgery than before, but larger LDFA, TAF, and HKA. CONCLUSIONS In patients with developmental hip dysplasia who underwent total hip arthroplasty with placement of the acetabular component at the level of the anatomic hip center, axial alignment of the ipsilateral lower limb was immediately altered, and valgus inclination was significantly reduced. The procedure only slightly altered the axial alignment of the contralateral lower limb.
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Affiliation(s)
- Hai-Yan Zhao
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, The First Hospital of Lanzhou University, Lanzhou, People's Republic of China
| | - Peng-De Kang
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Xiao-Jun Shi
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Zong-Ke Zhou
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Jing Yang
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Bing Shen
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Fu-Xing Pei
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
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Does increased femoral antetorsion predispose to cartilage lesions of the patellofemoral joint? Knee Surg Sports Traumatol Arthrosc 2017; 25:2695-2701. [PMID: 25957608 DOI: 10.1007/s00167-015-3625-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/28/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study was to investigate whether there was a relationship between femoral neck antetorsion and the presence and pattern of osteoarthritis of the patellofemoral joint. It was hypothesized that an increased femoral neck antetorsion (1) correlates with osteoarthritic changes of the lateral facet of the patellofemoral joint and (2) correlates with an increased lateral trochlear height and a decreased sulcus angle. METHODS Seventy-eight formalin-embedded cadaveric lower extremities from thirty-nine subjects with a median age of 74 years (range 60-88) were used. Surrounding soft tissues of the lower limb were removed. The femoral neck antetorsion was measured and referenced to the transepicondylar axis and the posterior condylar line. The height of the medial and lateral facet of the trochlea and the sulcus angle was measured. The location and the degree of patellofemoral cartilage degeneration were recorded. A Pearson's correlation analysis was performed to correlate the femoral neck antetorsion with the measured knee parameters. RESULTS No significant correlation could be found between the femoral antetorsion and cartilage degeneration of the lateral patellofemoral joint (n.s.), the height of the lateral trochlea (n.s.) and the sulcus angle (n.s.). CONCLUSION This study could not document that the femoral neck antetorsion and subsequent internal rotation of the distal femur correlated with the degree of degeneration of the lateral facet of the patellofemoral joint. Clinically, femoral internal rotation may play a minor role in the development of lateral patellofemoral joint degeneration.
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Liebensteiner MC, Ressler J, Seitlinger G, Djurdjevic T, El Attal R, Ferlic PW. High Femoral Anteversion Is Related to Femoral Trochlea Dysplasia. Arthroscopy 2016; 32:2295-2299. [PMID: 27209622 DOI: 10.1016/j.arthro.2016.03.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/25/2016] [Accepted: 03/15/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the possible relation between femoral anteversion (AV) and trochlear morphology. METHODS Among 560 available lower-limb computed tomography (CT) scans, those with previous fracture, arthroplasty, or osteotomy were excluded and 40 cases were randomly selected. The following 4 lines were determined from the CT scans: 1 through the center of the femoral head and neck; 1 through the lesser trochanter and the center of the femoral shaft; 1 as a tangent to the dorsal part of the distal femur, just above the gastrocnemius insertion; and 1 as a tangent to the posterior condyles. Between the respective lines, the following parameters of femoral AV were determined: (1) total AV, (2) proximal AV, (3) diaphyseal AV, and (4) distal AV. Trochlea parameters were determined from 2 separate axial CT slices (proximal trochlea and 5 mm farther distally): trochlea height (medial, central, lateral), transverse trochlea shift, trochlea depth, sulcus angle, lateral trochlea slope, and Dejour trochlea type. To prove or disprove our study hypothesis, a correlation analysis was performed between the variables of AV and trochlear morphology. RESULTS The total AV was significantly correlated with the trochlea parameters trochlea depth (P = .032), sulcus angle (P = .05), and lateral trochlea slope (P = .001). The diaphyseal AV was significantly correlated with the sulcus angle (P = .009). The distal AV showed significant correlations with medial, central, and lateral trochlea height (.005 <P < .032) and with Dejour trochlea type (P = .043). CONCLUSIONS The morphology of the trochlea is significantly related to femoral AV. Increased AV is associated with a flatter, more dysplastic trochlea. This was particularly true for AV located at the distal femur. LEVEL OF EVIDENCE Level III, diagnostic study of nonconsecutive patients.
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Affiliation(s)
| | | | - Gerd Seitlinger
- Department of Orthopaedic Surgery, Krankenhaus Oberndorf, Oberndorf bei Salzburg, Austria
| | - Tanja Djurdjevic
- Center of Diagnostic Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rene El Attal
- Department of Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Wilhelm Ferlic
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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Li Q, Kadhim M, Zhang L, Cheng X, Zhao Q, Li L. Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study. Knee 2014; 21:1072-6. [PMID: 25304860 DOI: 10.1016/j.knee.2014.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 08/07/2014] [Accepted: 08/13/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. METHODS Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6 years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. RESULTS In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. CONCLUSIONS Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Qiwei Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City 110004, Liaoning Province, PR China
| | - Muayad Kadhim
- Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Lijun Zhang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City 110004, Liaoning Province, PR China
| | - Xiangjun Cheng
- Department of Orthopedics, Red-Cross Children's Hospital of Qingfeng County, West Chaoyang Road, Qingfeng County, 457300 Henan Province, PR China
| | - Qun Zhao
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City 110004, Liaoning Province, PR China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City 110004, Liaoning Province, PR China.
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