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Tran TN, Baltaci Y, Winter P, Tschernig T, Landgraeber S. Optimal drilling at femoral head-neck junction for treatment of the femoral head necrosis: Experimental and numerical evaluation. Ann Anat 2023; 248:152081. [PMID: 36871868 DOI: 10.1016/j.aanat.2023.152081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/26/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Advanced core decompression (ACD) is a relative new technique for treatment of early stages of avascular femoral head necrosis. Although it is a promising treatment option, there is a need to modify this technique for achieving higher hip survival rates. An idea was to combine this technique with the lightbulb procedure in order to get a complete removal of the necrosis. This study aimed at evaluating the fracture risk of the femora treated by the combined Lightbulb-ACD technique as the basis for clinical application. METHODS Subject-specific models were generated from CT scan data of five intact femora. Several treated models were then created from each intact bone and simulated during normal walking activity. Biomechanical testing was additionally performed on 12 pairs of cadaver femora to confirm the simulation results. FINDINGS The finite element results revealed that the risk factor of the treated models with a 8 mm-drill increased, but was not significantly greater than that of their corresponding intact models. However, for the femur treated with a 10 mm-drill, the risk factor increased significantly. Fracture always initiated on the femoral neck, i.e. it was either subcapital or transcervical fracture. Our biomechanical testing results correlated well with the simulation data which confirmed the usefulness and effectiveness of the bone models. INTERPRETATION The combined Lightbulb-ACD technique using a 10 mm drill increased the fracture risk of femur postoperatively. A drill of up to 8 mm at the anterior head-neck junction did not however lead to the weakening of the femur so that full load bearing may be possible.
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Affiliation(s)
- Thanh Ngoc Tran
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany.
| | - Yeliz Baltaci
- Department of Pediatric Oncology and Hematology, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Philipp Winter
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Thomas Tschernig
- Institute of Anatomy, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Stefan Landgraeber
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
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Lou P, Deng X, Hou D. The effects of nano-hydroxyapatite/polyamide 66 scaffold on dog femoral head osteonecrosis model: a preclinical study. Biomed Mater 2023; 18. [PMID: 36720170 DOI: 10.1088/1748-605x/acb7be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 02/02/2023]
Abstract
The lack of mechanical support in the bone tunnel formed after CD often results in a poor therapeutic effect in ONFH. The n-HA/P66 has excellent biocompatibility and mechanical properties and has been widely used in bone regeneration. The present study aimed to evaluate the effects of n-HA/P66 scaffold treatment in a dog model of ONFH. A FEA was performed to analyze the mechanical changes in the femoral head after CD and n-HA/P66 scaffold or tantalum rod implantation. Fifteen male beagles were selected to establish the model of ONFH by liquid nitrogen freezing method, and the models were identified by x-ray and MRI 4 weeks after modeling and randomly divided into three groups. Nine weeks later, femoral head samples were taken for morphology, micro-CT, and histological examination. The FEA showed that the n-HA/P66 scaffold proved the structural support in the bone tunnel, similar to the tantalum rod. The morphology showed that the femoral head with n-HA/P66 implantation is intact, while the femoral heads in the model group and CD group are collapsing. Moreover, the micro-CT results of the n-HA/P66 scaffold group were better than the model group and the CD group, and the interface between the n-HA/P66 scaffold and bone tissue is blurred. Furthermore, the histological result also verifies the alterations in micro-CT, and bone tissue grows in the bone tunnel with n-HA/P66 scaffold implanted while few in the CD group. The CD results in a lack of mechanical support in the femoral head subchondral bone and bone tunnel high stress. The n-HA/P66 scaffold implantation can provide mechanical support and relieve high stress induced by CD. The n-HA/P66 scaffold can treat femoral head necrosis and provide the bone tissue growth scaffold for the femoral head after CD to promote bone tissue regeneration.
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Affiliation(s)
- Pengqiang Lou
- Liaoning University of Traditional Chinese Medicine, Shenyang 110032, People's Republic of China
| | - Xiaolei Deng
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, People's Republic of China
| | - Decai Hou
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, People's Republic of China
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Winter P, Landgraeber S. [The importance of removing osteonecrosis during treatment of femoral head osteonecrosis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:800-807. [PMID: 36136134 DOI: 10.1007/s00132-022-04302-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Atraumatic femoral head necrosis (aFHN) in adults is estimated to be the leading cause of approximately 10% of all hip prosthesis implantations. Due to the relatively frequent occurrence of aFHN at a young age, the possibility of a joint-preserving intervention should be examined. This includes the classic "core decompression" and modifications based on it. There are different data on the success rates of this method. Reasons for treatment failure could include a lack of clearance of the necrosis zone. The clearance of the necrosis zone is taken into account by alternative surgical procedures for the treatment of aFHN. These are the "trap-door procedure", the "light-bulb procedure" and "advanced core decompression". The current state of knowledge on these procedures is reviewed in this keynote article. It is shown that the extensive excision of femoral head necrosis is of particular importance. None of the procedures mentioned can currently be recommended in preference over the others.
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Affiliation(s)
- Philipp Winter
- Klinik für Orthopädie und Orthopädische Chirurgie, Universität des Saarlandes, Kirrberger Str. 100, 66421, Homburg, Deutschland.
| | - Stefan Landgraeber
- Klinik für Orthopädie und Orthopädische Chirurgie, Universität des Saarlandes, Kirrberger Str. 100, 66421, Homburg, Deutschland
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Tran TN, Wolf M, Winter P, Landgraeber S. Hip joint mechanics in patients with osteonecrosis of the femoral head following treatment by advanced core decompression. Clin Biomech (Bristol, Avon) 2022; 94:105635. [PMID: 35367817 DOI: 10.1016/j.clinbiomech.2022.105635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteonecrosis of the femoral head is a serious disease which, if left untreated, leads to destruction of the affected hip joint. For treatment of early stages of this disease, core decompression is the most common procedure. This study investigated the influence of the necrotic lesion and core decompression on the stress pattern in the hip joint using finite element analysis. METHODS Subject-specific models were generated from CT scan data of 5 intact hips. For each intact hip, twelve affected hip models were created by imposing a necrotic lesion in the femoral head, and four treated models were then created from four affected ones with central lesion, respectively. Treated models were created by supposing that the defect zone and the drill canal were filled with a bone substitute. Totally 105 hip models from three groups (intact, affected and treated) were simulated during normal walking activity. FINDINGS Necrotic lesion modified the stress distribution within the femoral head. Peak stress increased significantly up to 186% in mean in hips with a large lesion indicating an increased risk of femoral head collapse. Additionally, the presence of a medium to large necrosis altered significantly stress values (P < 0.05) and pattern in the articular cartilage. Our study revealed that advanced core decompression can recover normal cartilage stress values and pattern in treated joint. INTERPRETATION The presence of a large lesion increased the risk of femoral head collapse. Advanced core decompression with bone grafts can restore normal cartilage mechanics in hip postoperatively.
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Affiliation(s)
- Thanh Ngoc Tran
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, D-66421 Homburg, Germany.
| | - Milan Wolf
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, D-66421 Homburg, Germany
| | - Philipp Winter
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, D-66421 Homburg, Germany
| | - Stefan Landgraeber
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, D-66421 Homburg, Germany
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Xie P, Deng Y, Tan J, Wang M, Yang Y, Ouyang H, Huang W. The effect of rotational degree and routine activity on the risk of collapse in transtrochanteric rotational osteotomy for osteonecrosis of the femoral head-a finite element analysis. Med Biol Eng Comput 2020; 58:805-814. [PMID: 32016806 PMCID: PMC7156356 DOI: 10.1007/s11517-020-02137-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 01/22/2020] [Indexed: 11/24/2022]
Abstract
To explore the mechanical mechanism and provide preoperative planning basis for transtrochanteric rotational osteotomy (TRO) procedure, a joint-preserving procedure for osteonecrosis of the femoral head. Eleven TRO finite element femurs with the most common types of necrosis were analyzed under multi-loading conditions. Thereafter, we made a comprehensive evaluation by considering the anatomy characters, daily activities, and risk indicators contain necrosis expansion trend, necrotic blood supply pressure, and the risk of fracture. The risk of fracture (ROF) is the lowest when standing on feet and increases gradually during normal walking and walking upstairs and downstairs. Compared with posterior rotation, rotating forward keeps more elements at low risk. Additionally, the correlation analysis shows it has a strong negative correlation (R2 = 0.834) with the average modulus of the roof. TRO finally decreased the stress and energy effectively. However, the stress and strain energy arise when rotated posteriorly less than 120°. The comprehensive evaluation observed that rotating forward 90°could reduce the total risks to 64%. TRO is an effective technique to prevent collapse. For the anterior and superior large necrosis, we recommend to rotate forward 60° to 90° (more efficient) or backward 180°. The methodology followed in this study could provide accurate and personalize preoperative planning. Graphical Abstract A proximal femur was reconstructed and modified using Mimics from a series of computed tomography. The models were meshed after solidified and performed different osteotomy, and then assigned material based on the Hounsfield Unit from CT images. Finally, 44 different TRO finite element femurs were analyzed under multi-loading conditions and evaluated comprehensively.
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Affiliation(s)
- Pusheng Xie
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yuping Deng
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Jinchuan Tan
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Mian Wang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yang Yang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Hanbin Ouyang
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524002 People’s Republic of China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524002 People’s Republic of China
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Landgraeber S, Jäger M. [Modified advanced core decompression (mACD)]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:96-106. [PMID: 32157339 DOI: 10.1007/s00064-020-00653-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The modified advanced core decompression (mACD) combines the advantages of a low invasive core decompression with maximal removal of osteonecrotic bone and a biologic reconstruction of the resulting bone defect. INDICATIONS Avascular (atraumatic) osteonecrosis of the femoral head (ARCO stage II). CONTRAINDICATIONS Subchondral fractures (ARCO stage III); advanced osteoarthritis (e.g., ACRO stage IV); persisting risk factors such as high-dose corticoid therapy, chemotherapy, alcohol abuse; open growth plates; history of side effects or intolerance to components of the applied bone substitute; lack of patient compliance; osteomyelitis or other septic conditions. SURGICAL TECHNIQUE Supine positioning on the operation table, skin disinfection, and sterile draping. Skin incision and core decompression using a 3.2 mm guide wire. Removal of a bone cylinder from a nonaffected area of the femoral neck using a hollow trephine. Drilling of the osteonecrotic area over the applied wire up to 5 mm to the subchondral bone under fluoroscopy, insertion of an expandable bone knife and removal of the osteonecrotic bone supported by a curette. Bone grafting of the autologous bone into the subchondral defect zone and filling of the drill canal by resorbable bone substitute. POSTOPERATIVE MANAGEMENT Bed rest for 24 h, then partial weight bearing (20 kg) on crutches for 2-6 weeks depending on the bone quality in the defect zone and the applied bone substitute. RESULTS Midterm superiority (2 years) in hip survival of the mACD over advanced core depression and core depression, especially in ARCO stage II.
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Affiliation(s)
- Stefan Landgraeber
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr. 100, 66421, Homburg/Saar, Deutschland
| | - Marcus Jäger
- Lehrstuhl für Orthopädie & Unfallchirurgie, Universität Duisburg-Essen, Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim a.d.R., Kaiserstr. 50, 45468, Mülheim an der Ruhr, Deutschland.
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Landgraeber S, Warwas S, Claßen T, Jäger M. Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head. BMC Musculoskelet Disord 2017; 18:479. [PMID: 29162080 PMCID: PMC5698933 DOI: 10.1186/s12891-017-1811-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/06/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND "Advanced Core Decompression" (ACD) is a new technique for treatment of osteonecrosis of the femoral head (ONFH) that includes removal of the necrotic tissue using a percutaneous expandable reamer followed by refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO4)-calcium phosphate (CaPO4) bone graft substitute. As autologous bone has been shown to be superior to all other types of bone grafts, the aim of the study is to present and evaluate a modified technique of ACD with impaction of autologous bone derived from the femoral neck into the necrotic defect. METHODS A cohort of patients with an average follow-up of 30.06 months (minimum 12 months) was evaluated for potential collapse of the femoral head and any reasons that led to replacement of the operated hip. Only patients in stages 2a to 2c according to the Steinberg classification were included in the study. RESULTS In 75.9% the treatment was successful with no collapse of the femoral head or conversion to a total hip replacement. Analysis of the results of the different subgroups showed that the success rate was 100% for stage 2a lesions and 84.6% respectively 61.5% for stages 2b and 2c lesions. CONCLUSIONS Previous studies with a comparable follow-up reported less favourable results for ACD without autologous bone. Especially in stages 2b and 2c the additional use of autologous bone has a positive effect. In comparison to other hip-preserving techniques, the modified ACD technique is a very promising and minimally invasive method for treatment of ONFH. TRIAL REGISTRATION German clinical trials register ( DRKS00011269 , retrospectively registered).
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Affiliation(s)
- Stefan Landgraeber
- Department of Orthopaedics and Trauma surgery, University Hospital of Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Sebastian Warwas
- Department of Orthopaedics and Trauma surgery, University Hospital of Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tim Claßen
- Department of Orthopaedics and Trauma surgery, University Hospital of Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics and Trauma surgery, University Hospital of Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
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Li Z, Wang L, Wei J, Zhu L, Weng X, Jin J, Xiao H, Zhang J, Wang H, Shi G, Pei L, Zou F, Zhang W, Tao T, Dong X. Bone-strengthening pill (BSP) promotes bone cell and chondrocyte repair, and the clinical and experimental study of BSP in the treatment of osteonecrosis of the femoral head. Oncotarget 2017; 8:97079-97089. [PMID: 29228594 PMCID: PMC5722546 DOI: 10.18632/oncotarget.21226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/17/2017] [Indexed: 11/25/2022] Open
Abstract
About 1 in 3 people suffer from bone and joint disease, which is a disease of bone and cartilage cells. Osteonecrosis of the femoral head (ONFH) is a typical example of bone and joint disease involving bone cell necrosis. Osteonecrosis of the femoral head leads to the occurrence of premature osteoarthritis of the hip and collapse of the cartilage cells, and there is currently no effective drug treatment available. In order to study the effects of "bone-strengthening pill" (BSP) on the repair of bone and cartilage cells, we investigated the potential effects of the herbal mixture BSP in an animal model of avascular necrosis of the femoral head and in patients. Results showed that 90% of rats injected with prednisone developed ONFH, whereas BSP administration prevented ONFH development in 70% of prednisone-injected rats. We evaluated the constituents of BSP by HPLC fingerprinting. We also evaluated the clinical efficacy of BSP in a double-blind, randomized, controlled trial of 300 patients with ONFH. The response rate was found to be higher in the treatment group than in the control group, with a response rate of 82% in the treatment group. Treatment with BSP also significantly reduced pain, improved hip function, reduced lameness, and improved pathology by X-ray and MRI analysis, compared with patients who did not receive BSP. These results suggest that BSP treatment inhibits and reverses necrosis of the femoral head bone cells and cartilage cells to repair the femoral head, promote the repair of bone and cartilage diseases.
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Affiliation(s)
- Zheng Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Lulin Wang
- Department of Orthopedics, Beijing Jianxing Traditional Chinese Medicine Hospital, Beijing, 100007, China
| | - Jin Wei
- Department of Dermatology and Plastic Surgery, China Aerospace 731 Hospital, Beijing, 100074, China
| | - Liguo Zhu
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Jin Jin
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Hong Xiao
- Department of Orthopedics, Beijing Jianxing Traditional Chinese Medicine Hospital, Beijing, 100007, China
| | - Jun Zhang
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Heming Wang
- Fujian Provincial Institute of Traditional Chinese Medicine, Fuzhou, 350003, China
| | - Guantong Shi
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, China
| | - Lingpeng Pei
- Traditional Chinese Medicine, University of MINZU, Beijing, 100081, China
| | - Fangde Zou
- Patent Office, Tongliao Municipal Science and Technology Bureau, Tongliao, 028000, China
| | - Wanqiang Zhang
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Tianzun Tao
- Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xin Dong
- Department of Radiology, Beijing Zhongguancun Hospital, Beijing, 100190, China
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