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Chen Y, Sun Y, Xu Y, Lin WW, Luo Z, Han Z, Liu S, Qi B, Sun C, Go K, Kang XR, Chen J. Single-Cell Integration Analysis of Heterotopic Ossification and Fibrocartilage Developmental Lineage: Endoplasmic Reticulum Stress Effector Xbp1 Transcriptionally Regulates the Notch Signaling Pathway to Mediate Fibrocartilage Differentiation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:7663366. [PMID: 34737845 PMCID: PMC8563124 DOI: 10.1155/2021/7663366] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Regeneration of fibrochondrocytes is essential for the healing of the tendon-bone interface (TBI), which is similar to the formation of neurogenic heterotopic ossification (HO). Through single-cell integrative analysis, this study explored the homogeneity of HO cells and fibrochondrocytes. METHODS This study integrated six datasets, namely, GSE94683, GSE144306, GSE168153, GSE138515, GSE102929, and GSE110993. The differentiation trajectory and key transcription factors (TFs) for HO occurrence were systematically analyzed by integrating single-cell RNA (scRNA) sequencing, bulk RNA sequencing, and assay of transposase accessible chromatin seq. The differential expression and enrichment pathways of TFs in heterotopically ossified tissues were identified. RESULTS HO that mimicked pathological cells was classified into HO1 and HO2 cell subsets. Results of the pseudo-temporal sequence analysis suggested that HO2 is a differentiated precursor cell of HO1. The analysis of integrated scRNA data revealed that ectopically ossified cells have similar transcriptional characteristics to cells in the fibrocartilaginous zone of tendons. The modified SCENIC method was used to identify specific transcriptional regulators associated with ectopic ossification. Xbp1 was defined as a common key transcriptional regulator of ectopically ossified tissues and the fibrocartilaginous zone of tendons. Subsequently, the CellPhoneDB database was completed for the cellular ligand-receptor analysis. With further pathway screening, this study is the first to propose that Xbp1 may upregulate the Notch signaling pathway through Jag1 transcription. Twenty-four microRNAs were screened and were found to be potentially associated with upregulation of XBP1 expression after acute ischemic stroke. CONCLUSION A systematic analysis of the differentiation landscape and cellular homogeneity facilitated a molecular understanding of the phenotypic similarities between cells in the fibrocartilaginous region of tendon and HO cells. Furthermore, by identifying Xbp1 as a hub regulator and by conducting a ligand-receptor analysis, we propose a potential Xbp1/Jag1/Notch signaling pathway.
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Affiliation(s)
- Yisheng Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaying Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong Province 271000, China
| | - Wei-Wei Lin
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009 Zhejiang, China
| | - Zhiwen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhihua Han
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Beijie Qi
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chenyu Sun
- Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, 60657 Illinois, USA
| | - Ken Go
- Department of Clinical Training Centre, St. Marianna Hospital, Tokyo, Japan
| | - x.-R. Kang
- Shanghai Jiao Tong University, Shanghai 200080, China
| | - Jiwu Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
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Aisaiding A, Wang J, Maimaiti R, Jialihasi A, Aibek R, Qianman B, Shawutali N, Badelihan A, Bahetiya W, Kubai A, Kelamu M, Nuerdoula Y, Makemutibieke E, Bakyt Y, Wuerliebieke J, Jielile J. A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture. Injury 2018; 49:712-719. [PMID: 29153451 DOI: 10.1016/j.injury.2017.10.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Acute closed spontaneous Achilles tendon rupture often occurs in elderly individuals and is usually accompanied with many complications. Conventional surgical approaches to remove the tendon lesions and enthesophytes are highly traumatic and cause complications. In this study, a previously established minimally invasive surgical approach was modified and combined with a Kazakh exercise therapy to reduce trauma, improve wound healing, and promote tendon regeneration in the management of acute closed spontaneous Achilles tendon rupture. METHODS Fifty-two patients with acute closed spontaneous Achilles tendon rupture were randomly classified into 2 groups. Group A included 23 patients that were treated with the novel approach. Group B included 29 patients that were treated with a continuous medial oblique surgical approach. Follow-up examinations were performed at post-operative weeks 12 and 24, and year 2. Outcomes were assessed by Achilles tendon rupture score (ATRS), a heel-rise endurance test, and ultrasonographic and multislice spiral computerized tomography. RESULTS Mean ATRS in Group A was 68.6 and 86.0 at post-operative week 12 and 24, respectively, significantly higher than that in Group B (55.9 and 72.0, respectively). Recovery of patients in Group A was significantly better compared to Group B (p < 0.01), allowing them to participate in early rehabilitating kinesiotherapy. Patients in Group A rarely experienced complications after surgery, such as infection and Achilles tendon exposure, while in Group B, the wound healing was slower, the inside flaps were prone to necrosis and infection, and Achilles tendon exposure occurred in 10% of patients. CONCLUSIONS The novel minimally invasive surgery is more advantageous in the treatment of acute closed spontaneous Achilles tendon rupture over previous approaches by promoting wound healing and tendon regeneration.
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Affiliation(s)
- Amuding Aisaiding
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Jianping Wang
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Rouziwanguli Maimaiti
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Ayidaer Jialihasi
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Rakimbaiev Aibek
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Bayixiati Qianman
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Nuerai Shawutali
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Ayinazi Badelihan
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Wulan Bahetiya
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Aliya Kubai
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Mailamuguli Kelamu
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Yeermike Nuerdoula
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Elihaer Makemutibieke
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Yerzat Bakyt
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Jianati Wuerliebieke
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Jiasharete Jielile
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China.
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Jielile J, Asilehan B, Wupuer A, Qianman B, Jialihasi A, Tangkejie W, Maimaitiaili A, Shawutali N, Badelhan A, Niyazebieke H, Aizezi A, Aisaiding A, Bakyt Y, Aibek R, Wuerliebieke J. Early Ankle Mobilization Promotes Healing in a Rabbit Model of Achilles Tendon Rupture. Orthopedics 2016; 39:e117-26. [PMID: 26821224 DOI: 10.3928/01477447-20160106-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/15/2015] [Indexed: 02/03/2023]
Abstract
The use of early mobilization of the ankle joint without orthosis in the treatment of Achilles tendon rupture has been advocated as the optimal management. The goal of this study was to compare outcomes in a postoperative rabbit model of Achilles tendon rupture between early mobilization and immobilized animals using a differential proteomics approach. In total, 135 rabbits were randomized into the control group (n=15), the postoperative cast immobilization (PCI) group (n=60), and the early mobilization (EM) group (n=60). A rupture of the Achilles tendon was created in each animal model and repaired microsurgically, and tendon samples were removed at 3, 7, 14, and 21 days postoperatively. Proteins were separated using 2-dimensional polyacrylamide gel electrophoresis and identified using peptide mass fingerprinting, tandem mass spectrometry, NCBI database searches, and bioinformatics analyses. A series of differentially expressed proteins were identified between groups, some of which may play an important role in Achilles tendon healing. Notable candidate proteins that were upregulated in the EM group were identified, such as CRMP-2, galactokinase 1, tropomyosin-4, and transthyretin. The healing of ruptured Achilles tendons appears to be affected at the level of protein expression with the use of early mobilization. The classic postoperative treatment of Achilles tendon rupture with an orthosis ignored the self-protecting instinct of humans. With a novel operative technique, the repaired tendon can persist the load that comes from traction in knee and ankle joint functional movement. In addition, kinesitherapy provided an excellent experimental outcome via a mechanobiological mechanism.
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Jielile J, Badalihan A, Qianman B, Satewalede T, Wuerliebieke J, Kelamu M, Jialihasi A. Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study. Knee Surg Sports Traumatol Arthrosc 2016; 24:2148-55. [PMID: 25894749 DOI: 10.1007/s00167-015-3598-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Treatment of neglected Achilles tendon rupture is very challenging. This randomized study aimed to compare the clinical outcome of early post-operative rehabilitation (EPR) with post-operative cast immobilization (PCI). METHODS Fifty-seven patients with neglected Achilles tendon rupture were randomized to receive EPR (n = 26) or PCI (n = 31) management following surgery. Clinical outcome was monitored by follow-up at weeks 8, 12, 18 and 26 and year 2. The significance of intergroup differences from the Leppilahti scoring system (LSS), ultrasonography, multislice spiral computerized tomography (MSCT) and electromyography was assessed. RESULTS Ultrasonography and MSCT revealed no occurrence of tendon elongation or adhesion. Four patients could perform sustained single-leg heel-raise exercise for 60 s at post-operative day 40. The PCI group also showed increased post-operative LSS score, but recovery was slower. Post-operative complications, such as ankle joint ankylosis and osteoporosis, only occurred in the PCI group. CONCLUSIONS Compared with cast immobilization, early post-operative rehabilitation results in better clinical outcome and faster overall tendon regeneration of neglected Achilles tendon rupture. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jiasharete Jielile
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Ayinazi Badalihan
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Bayixiati Qianman
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Tuerde Satewalede
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Jianati Wuerliebieke
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Mailamuguli Kelamu
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Ayidaer Jialihasi
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China.
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5
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Badalihan A, Aihemaiti A, Shawutali N, Jielile J, Jialihasi A, Tangkejie W, Nuerdoula Y, Satewalede T, Hunapiya B, Niyazebieke H, Hezibieke H, Zhao Q, Bahetijiang A, Kelamu M, Qianman B. Outcome of a one-stage tensile stress surgical technique and early postoperative rehabilitation in the treatment of neglected achilles tendon rupture. J Foot Ankle Surg 2015; 54:153-9. [PMID: 25703445 DOI: 10.1053/j.jfas.2014.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Indexed: 02/03/2023]
Abstract
The present study evaluated the effect of single-stage internal traction combined with early postoperative active rehabilitation and the yurt bone suture method, a new surgical technique, on the clinical outcomes after surgical repair of Achilles tendon. A total of 51 patients with neglected Achilles tendon rupture who underwent the yurt bone suture treatment also participated in an accelerated postoperative rehabilitation program. The clinical outcome was evaluated for 18 weeks using the Leppilahti scoring system, bilateral ultrasound examination, and computed tomography examination. The ultrasound and computed tomography examinations revealed that Achilles tendon elongation and adhesion occurred in none of the patients. All the patients could perform the single leg heel raise exercise for a mean of 30 ± 7.6 seconds at 12 weeks postoperatively. In addition, the patients could participate in sport exercises and heavy physical activities by around 13 weeks postoperatively. The mean Leppilahti score was 85.8 ± 3.7 at 8 weeks postoperatively, and it had increased to 96.1 ± 3.2 and 100.0 ± 0.0 at 12 and 18 weeks, respectively, after the operation. The 1-stage internal traction technique, combined with early postoperative active rehabilitation and the yurt bone surgical technique, resulted in good clinical outcomes for the treatment of neglected Achilles tendon rupture.
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Affiliation(s)
- Ayinazi Badalihan
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | | | - Nuerai Shawutali
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jiasharete Jielile
- Assistant Professor, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Ayidaer Jialihasi
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wulanbai Tangkejie
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yeermike Nuerdoula
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Turde Satewalede
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Beisen Hunapiya
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hadelebieke Niyazebieke
- Surgeon, Department of Orthopaedics, Kazakh Traditional Medical Hospital of Toli County, Tacheng Prefecture, Toli County, Xinjiang, China
| | - Hayilat Hezibieke
- Orthopedist, Department of Orthopaedics, People's Hospital of Shawan County, Shawan, Xinjiang, China
| | - Qin Zhao
- Associate Professor, Department of Ultrasonographic Examination, Institute of Medical Image Canter, First Teaching Hospital of Xinjiang Medical University, Urumqi, China
| | - Ahezhuoli Bahetijiang
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Mailamuguli Kelamu
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Bayixiati Qianman
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
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