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Ma L, Song JJ, Cui ZN, Niu ZY, Tian SB, Liu M, Wang M, Zhang RP. Application of flow-through flaps for replantation after traumatic limb amputation according to the angiosome concept. Clin Hemorheol Microcirc 2024:CH242179. [PMID: 39058441 DOI: 10.3233/ch-242179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVE This study was performed to explore the treatment of the injury caused by traumatic limb amputation. METHODS From October 2002 to October 2021, 30 cases were enrolled in the present study. The reasons for injury were as follows: 8 cases with single hydraulic column crush injury, 12 cases with gear and wire rope stranding, 6 cases with belt avulsion injury, and 4 cases with carbon block smash injury. The present study application of a free or small saphenous vein bypass to reconstruct the injured artery and vein according to the concept of the angiosome model. The defective vessels were bridged with the axial vessels of a flow-through flap, such as a medial calf flap or anterolateral femoral flap, to construct an additional blood supply and drainage vein for the severed limb. The clinical data of 30 cases with traumatic limb amputation of the lower leg and ankle were retrospectively analyzed. RESULTS In all 30 cases of traumatic limb amputation, the replantation via the adoption of a flow-through flap was successful, and 85.6% of the patients remained in good postoperative condition. There were no symptoms of ischemia in the marginal segment after blood supply reconstruction of the transected limb by axial vascular bridging within the flap. CONCLUSION Via the adoption of microsurgical techniques, the blood supply to the transected limb can be reconstructed by bridging the defective vessels with the adoption of the axial vessels of the flow-through flap is a feasible and advanced treatment option.
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Affiliation(s)
- Lin Ma
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Jun-Jie Song
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Zhong-Ning Cui
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Zhi-Yong Niu
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Shao-Bin Tian
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Ming Liu
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Min Wang
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Rong-Ping Zhang
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
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Yu G, Chen Y, Yang N, Zhang H, Zhang X, Geng Y, Zhao J, Chen Z, Dong C, Lin L, Qi J, Zhang X, Jiang X, Gao W, Cai Y, Wang X, Ding J, Xiao J, Zhou K. Apoptotic Bodies Derived from Fibroblast-Like Cells in Subcutaneous Connective Tissue Inhibit Ferroptosis in Ischaemic Flaps via the miR-339-5p/KEAP1/Nrf2 Axis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307238. [PMID: 38639443 PMCID: PMC11200024 DOI: 10.1002/advs.202307238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/29/2024] [Indexed: 04/20/2024]
Abstract
Preventing and treating avascular necrosis at the distal end of the flaps are critical to surgery success, but current treatments are not ideal. A recent study shows that apoptotic bodies (ABs) generated near the site of apoptosis can be taken up and promote cell proliferation. The study reveals that ABs derived from fibroblast-like cells in the subcutaneous connective tissue (FSCT cells) of skin flaps promoted ischaemic flap survival. It is also found that ABs inhibited cell death and oxidative stress and promoted M1-to-M2 polarization in macrophages. Transcriptome sequencing and protein level testing demonstrated that ABs promoted ischaemic flap survival in endothelial cells and macrophages by inhibiting ferroptosis via the KEAP1-Nrf2 axis. Furthermore, microRNA (miR) sequencing data and in vitro and in vivo experiments demonstrated that ABs inhibited KEAP1 by delivering miR-339-5p to exert therapeutic effects. In conclusion, FSCT cell-derived ABs inhibited ferroptosis, promoted the macrophage M1-to-M2 transition via the miR-339-5p/KEAP1/Nrf2 axis and promoted ischaemic flap survival. These results provide a potential therapeutic strategy to promote ischaemic flap survival by administering ABs.
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Sun N, Cao Z, Wu P, Qing L, Yu F, Pan D, Zeng L, Peng L, Pang X, Tang J. Individualized design program of multiple flaps for adapting different zones to repair large irregular wounds in children. Heliyon 2024; 10:e31179. [PMID: 38803926 PMCID: PMC11128512 DOI: 10.1016/j.heliyon.2024.e31179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 05/08/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
Objective Management of large irregular wounds in children had been confusing plastic and reconstructive surgeons. Herein, this study was aimed to propose a new treatment method based on the principle of adapting different recipient zones to overcome the intractable wounds, simplifying and programing the design process of targeted flaps for covering large irregular soft-tissue defects. Patients and methods From January 2009 to December 2020, 31 children (9 girls and 22 boys) aged 3-16 years (mean 9.8 years) underwent multiple modular flaps with edge to edge splicing reconstruction of the lower extremities. All the wounds were large with non-adjacent defects and with or without a dead space. Several variants of flaps were harvested according to the needs and reconstruction requirements of patients. Results A total of 71 flaps were harvested from 31 patients and all flaps donor sites received primary closure. Nine patients underwent split-thickness skin grafting, and three cases of flaps survived from vascular crisis by rebuilding the vessels and the rest accepting LD flap transplants. And five partial necrosis of the distal epidermis flaps recovered using skin grafting and dressing change. No major complication was encountered in other patients and donor sites, except one heel ulcer. During the follow-up (ranging from 16 to 38 months, mean 27.7 months), aesthetic and functional results of reconstructed limbs were satisfactory in all patients. Conclusions The Individualized design program of multiple flaps for adapting different recipient zones is an alternative for repairing large irregular soft-tissue defects in children, beneficial for plastic and reconstructive surgeons to simplify and program the process of designing and perform multiple flaps to achieve this goal. Level of evidence III, Retrospective.
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Affiliation(s)
- Nianzhe Sun
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zheming Cao
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Panfeng Wu
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Liming Qing
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Yu
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ding Pan
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lei Zeng
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lingli Peng
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyang Pang
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Juyu Tang
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Angelini A, Tiengo C, Cerchiaro MC, Soto F, Biz C, Messana F, Bassetto F, Ruggieri P. Ortho-oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft-tissue defects after oncologic resections. Microsurgery 2024; 44:e31168. [PMID: 38549392 DOI: 10.1002/micr.31168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 01/20/2024] [Accepted: 02/28/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Malignant tumors of the foot are rare, and treatment strategies are challenging considering the complex anatomy of this area. In recent years, dramatic advances in technology and collaborations between different specialties (such as orthopedic, oncology, radiology, plastic, and vascular surgery) significantly changed the approach to complex malignant tumors without resorting to limb removal. The combination of the strengths of both orthopedic surgery and plastic surgery constitutes the modern definition of "orthoplasty." The aim of this review article is to provide treatment strategies that are available for reconstruction of foot and ankle in limb-salvage surgery after tumor resection, with a specific focus on microsurgical techniques in plastic surgery. METHODS We conducted a comprehensive search for relevant papers across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with small and large soft tissue defects. Indications, pros and cons, and technique tips are discussed for each type of reconstructive technique. RESULTS The search was done using literature of the past 30 years (from 1990 to date), resulting in about 725 articles describing over 2000 cases. Cutaneous flaps included lateral supramalleolar flap, medial plantar flap, reverse sural neurocutaneous island flap, medial leg flap, and lateral leg flap. Free flaps included anterolateral thigh flap, radial forearm flap, latissimus dorsi flap, gracilis muscle flap, lateral arm flap, and rectus abdominis flap. CONCLUSIONS The orthoplastic approach in musculoskeletal oncology is a collaborative model of orthopedic and plastic surgeons working together, resulting in a higher rate of successful limb salvage in patients at risk for amputation. Protocols, biologic substitutes, and surgical techniques are largely improved in the last decades increasing the possibility of functional reconstruction. Microsurgical strategies represent the new frontiers in these demanding reconstructions.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | - Cesare Tiengo
- Department of Plastic surgery, University of Padua, Padova, Italy
| | | | - Fernando Soto
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | - Carlo Biz
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | | | - Franco Bassetto
- Department of Plastic surgery, University of Padua, Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
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Deng Z, Long ZS, Chen G. Mini-Review: Tendon-Exposed Wound Treatments. J INVEST SURG 2023; 36:2266758. [PMID: 37813390 DOI: 10.1080/08941939.2023.2266758] [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: 04/19/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Tendon-exposed wounds are complex injuries with challenging reconstructions and no unified treatment mode. Furthermore, insufficient tissue volume and blood circulation disorders affect healing, which increases pain for the patient and affects their families and caretakers. REVIEW As modern medicine advances, considerable progress has been made in understanding and treating tendon-exposed wounds, and current research encompasses both macro-and micro-studies. Additionally, new treatment methods have emerged alongside the classic surgical methods, such as new dressing therapies, vacuum sealing drainage combination therapy, platelet-rich plasma therapy, and live-cell bioengineering. CONCLUSIONS This review summarizes the latest treatment methods for tendon-exposed wounds to provide ideas and improve their treatment.
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Affiliation(s)
- Zhuan Deng
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhi-Sheng Long
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Gang Chen
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Liu Z, Liu S, Yang L, Cheng J, Zhang T, Gao Q, Yang C, Huang Y, Sun F, Ju J. Reconstruction of large-area wounds in limbs using two flow-through anterolateral thigh perforator flaps. Injury 2023; 54:110979. [PMID: 37598071 DOI: 10.1016/j.injury.2023.110979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Limb salvage in large wounds is difficult because the disrupted blood supply does not support a flap. This study evaluated the clinical efficacy of using two flow-through anterolateral thigh perforator flaps for reconstructing large-area limb wounds. METHODS This retrospective study included 45 patients who underwent reconstruction of large limb wounds using two flow-through anterolateral thigh perforator flaps at Ruihua Hospital between January 2015 and December 2020. Wound areas ranged from 15 cm × 13 cm to 46 cm × 18 cm. Single flap areas ranged from 16 cm × 8 cm to 46 cm × 9 cm. Blood supply locations were identified using color Doppler ultrasound or digital subtraction angiography (DSA) images. Primary outcomes were flap survival and complications at recipient or donor sites during at least 6-months follow-up. RESULTS The overall flap survival rate was 97% (87/90). All donor sites healed by first intention. Three cases developed vascular crises, which were alleviated by reoperation. One case had flexor contracture in left toes, relieved by cutting flexor tendons; 13 cases had flap bloat, relieved by flap thinning at 6 months. All cases showed properly healed wounds and functional reconstruction. CONCLUSIONS Reconstruction of large-area limb wounds using two flow-through anterolateral thigh perforator flaps provides safe and satisfactory effects without donor-site morbidity, and with proper healing and restored function.
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Affiliation(s)
- Zhijin Liu
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Shengzhe Liu
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Lin Yang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Junnan Cheng
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Tao Zhang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Qinfeng Gao
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Chengpeng Yang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Yongtao Huang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Fengwen Sun
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Jihui Ju
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China.
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Sui X, Khan UZ, Qing L, Yu F, Wu P, Tang J. The free chimeric medial sural artery perforator flap for individualised and three-dimensional reconstruction of complex soft-tissue defects in extremities. Int Wound J 2023; 20:2679-2687. [PMID: 37078236 PMCID: PMC10410352 DOI: 10.1111/iwj.14142] [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: 01/02/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 04/21/2023] Open
Abstract
Trauma or lesion resection often causes complex wounds with deep soft tissue defects in extremities. Simply covering with a skin flap will leave a deep dead space resulting in infection, non-healing wounds, and poor long-term outcomes. Thus, effectively reconstructing complex wounds with dead space leaves a clinical challenge. This manuscript presents our experience using chimeric medial sural artery perforator (cMSAP) flap, to reconstruct complex soft tissue defects of the extremities, thereby exploring broader analysis and indications for future reference. Between March 2016 and May 11, 2022, patients (8 males and 3 females) with a mean age of 41 years (range from 26 to 55 years) underwent reconstructive surgery with the cMSAP flap. The cMSAP flap consists of an MSAP skin paddle and a medial sural muscle paddle. The size of the MSAP skin paddle ranged between 9 × 5 cm and 20 × 6 cm, and the size of the medial sural muscle paddle ranged between 2 × 2 cm and 14 × 4 cm. Primary closure of the donor site was achieved in all cases. Of the 11 patients, the cMSAP flap survived in 10 cases. The vascular compromise occurred in one special case and was treated with surgical procedures. The mean follow-up duration was 16.5 months (range of 5-25 months). Most patients present satisfactory cosmetic and functional results. The free cMSAP flap is a good option for reconstructing complex soft tissue defects with deep dead space in extremities. The skin flap can cover the skin defect, and the muscle flap can fill the dead space against infection. In addition, three types of cMSAP flaps can be used in a broader range of complex wounds. This procedure can achieve an individualised and three-dimensional reconstruction of the defects and minimise the donor site morbidities.
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Affiliation(s)
- Xinlei Sui
- Department of Hand & MicrosurgeryXiangya Hospital of Central South UniversityChangshaChina
| | - Umar Zeb Khan
- Department of Hand & MicrosurgeryXiangya Hospital of Central South UniversityChangshaChina
| | - Liming Qing
- Department of Hand & MicrosurgeryXiangya Hospital of Central South UniversityChangshaChina
| | - Fang Yu
- Department of Hand & MicrosurgeryXiangya Hospital of Central South UniversityChangshaChina
| | - Panfeng Wu
- Department of Hand & MicrosurgeryXiangya Hospital of Central South UniversityChangshaChina
| | - Juyu Tang
- Department of Hand & MicrosurgeryXiangya Hospital of Central South UniversityChangshaChina
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Huang Q, Wang Q, Xu Y, Ren C, Lin H, Zhang C, Liu L, Li M, Lu Y, Li Z, Zhang K, Ma T. Dual-Perforator Flap With Wide Pedicle Versus Sural Neurocutaneous Flap With Peroneal Artery Perforator in the Treatment of Soft Tissue Defects of Foot and Ankle. J Foot Ankle Surg 2022; 62:150-155. [PMID: 35803886 DOI: 10.1053/j.jfas.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/29/2022] [Accepted: 06/04/2022] [Indexed: 02/03/2023]
Abstract
How to deal with large soft tissue defects around the foot and ankle is still controversial. The aim of this study was: (1) to display a new pedicled flap, also named the dual-perforator flap with wide pedicle (DPFWP), and (2) to compare it with the sural neurovascular flap with peroneal artery perforator (SNFPAP) in foot and ankle reconstruction. According to different surgical methods, 82 patients were divided into 2 groups: the DPFWP group (42 cases) and the SNFPAP group (40 cases). All cases underwent a flap surgery after radical debridement. The 2 groups were homogeneous in terms of age, sex, body mass index (BMI), etiology, location, and follow-up duration. Operation indexes were compared, including flap length, flap width, operation time and blood loss. Complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed. The DPFWP group had larger flap length (24.5 ± 4.6 cm vs 16.3 ± 3.8 cm), and flap width (10.5 ± 2.7 cm vs 7.8 ± 1.7 cm) than the SNFPAP group. In postoperative follow-up, DPFWP group showed a lower complication rate and better cosmetic, functional outcomes than SNFPAP group. In conclusion, this study showed that a DPFWP flap brought better results than a SNFPAP flap in terms of complications, cosmetic appearance, and functional outcomes for patients undergoing reconstruction of foot and ankle defects.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - Qian Wang
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - YiBo Xu
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - Cheng Ren
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - Hua Lin
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - ChengCheng Zhang
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - Lu Liu
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - Ming Li
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - Yao Lu
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - Zhong Li
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
| | - Kun Zhang
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China.
| | - Teng Ma
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shanxi, China
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