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Fulchignoni C, Pietramala S, Lopez I, Mazzella GG, Comisi C, Perisano C, Rocchi L, Greco T. Surgical Outcomes and Complications of Custom-Made Prostheses in Upper Limb Oncological Reconstruction: A Systematic Review. J Funct Morphol Kinesiol 2024; 9:72. [PMID: 38651430 PMCID: PMC11036263 DOI: 10.3390/jfmk9020072] [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: 03/15/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
Bone tumors of the upper limb are a common cause of bone pain and pathological fractures in both old and young populations. Surgical reconstruction and limb salvage have become valid options for these patients despite this kind of surgery being challenging due to the need for wide bone resection and the involvement of surrounding soft tissues. Computer-assisted technology helps the surgeon in pre-operative planning and in designing customized implants. The aim of this study was to investigate the surgical outcomes and complications of custom-made prostheses in oncologic reconstruction of the upper limb and if they are reliable options for patients suffering from aggressive tumors. An electronic search on PubMed, Google Scholar, and Web of Knowledge was conducted to identify all available articles on the use of custom-made prostheses in oncological resections of the upper limb. Twenty-one studies were included in the review, comprising a total of 145 patients with a mean age of 33.68 years. The bone involved was the humerus in 93 patients, and the radius was involved in 36 patients. There were only six cases involving proximal ulna, three cases involving the scapula, and seven cases involving the elbow as well as soft tissues around it. The most frequent primary tumor was the giant cell tumor, with 36 cases, followed by osteosarcoma with 25 cases, Ewing Sarcoma with 17 cases, and Chondrosarcoma with 7 total cases. Forty patients were affected by bone metastases (such as renal cell cancer, breast cancer, melanoma, and rectal cancer) or hematologic diseases involving bone (lymphoma, myeloma, or non-Hodgkin disease). Custom-made prostheses are a viable option for patients who suffer from malignant tumors in their upper limbs. They are a reliable aid for surgeons in cases of extensive resections.
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Affiliation(s)
| | | | | | | | | | | | | | - Tommaso Greco
- Hand Surgery and Orthopedics Unit, Department of Orthopaedics and Traumatology, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.F.); (S.P.); (I.L.); (G.G.M.); (C.C.); (C.P.); (L.R.)
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Büyükceran İ, Aydın Şimşek Ş, Bayar E, Cengiz T, Coşkun HS, Dabak N. Evaluation of Bone and Soft Tissue Tumors of the Shoulder Girdle. Cureus 2023; 15:e46162. [PMID: 37905248 PMCID: PMC10613316 DOI: 10.7759/cureus.46162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION The shoulder girdle comprises the scapula, clavicle, proximal humerus, and the soft tissues surrounding these structures. Bone and soft tissue tumors are notably more prevalent in the lower extremity than in the upper extremity. However, the shoulder ranks as the third most common site for primary tumors, following the hip-pelvis and knee. MATERIALS AND METHODS This study conducted a retrospective examination of patients who presented with pain and swelling in the shoulder and its vicinity. The evaluation was carried out using a multidisciplinary approach by the Bone and Soft Tissue Tumors Council. RESULTS The study included 224 patients diagnosed with a tumoral lesion in the shoulder girdle between 2004 and 2021. Among these patients, 22 were assessed to have lesions other than tumors, while 105 (51.98%) had benign lesions, and 97 had malignant lesions. The most prevalent benign lesions were cystic bone lesions (30) and soft tissue lipomas (10). The primary form of malignant lesion was metastatic tumors (49). CONCLUSION Pathologies in the shoulder girdle may manifest through pain, palpable swelling, pathological fractures, or may be incidentally detected via radiological imaging. Notably, pain, hypercalcemia, and pathological fractures are significant indicators, especially in cases of bone metastases, which often follow a highly fatal course when involving long bones. The musculoskeletal system is the third most common site for metastasis, following the lungs and liver. Hence, particular attention should be directed toward metastatic concerns in the shoulder and its surrounding area.
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Affiliation(s)
- İsmail Büyükceran
- Department of Orthopedics and Traumatology, Ondokuz Mayis University, Faculty of Medicine, Samsun, TUR
| | - Şafak Aydın Şimşek
- Department of Orthopedics and Traumatology, Ondokuz Mayis University, Faculty of Medicine, Samsun, TUR
| | - Ercan Bayar
- Department of Orthopedics and Traumatology, Ondokuz Mayis University, Faculty of Medicine, Samsun, TUR
| | - Tolgahan Cengiz
- Department of Orthopedics and Traumatology, Inebolu State Hospital, Kastamonu, TUR
| | - Hüseyin Sina Coşkun
- Department of Orthopedics and Traumatology, Ondokuz Mayis University, Faculty of Medicine, Samsun, TUR
| | - Nevzat Dabak
- Department of Orthopedics and Traumatology, Ondokuz Mayis University, Faculty of Medicine, Samsun, TUR
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Zeng Z, Liu M, Liu Y. Anatomy features of the shoulder joint in asymptomatic chinese Han adults. BMC Musculoskelet Disord 2023; 24:73. [PMID: 36709290 PMCID: PMC9883949 DOI: 10.1186/s12891-023-06172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 01/18/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To evaluate the shoulder anatomical characteristics in asymptomatic Chinese adults. METHODS The prospective study enrolled individuals without shoulder pain at Beijing Tiantan Hospital Affiliated to Capital Medical University between January 2019 and January 2020. Six radiographic parameters were measured and analyzed, including glenoid plane to the acromion (GA), glenoid plane to the lateral aspect of the humeral head (GH), acromion index (AI), lateral acromial angle (LAA), acromion-humeral interval (AHI), and critical shoulder angle (CSA). RESULTS 103 participants (51 males and 52 females) were enrolled. The mean values of GA, GH, AI, CSA, LAA, and AHI were 32.88 ± 5.68 mm, 47.16 ± 4.82 mm, 0.70 ± 0.11, 37.45 ± 6.00°, 6.32 ± 3.99°, and 9.611.86 mm, respectively. Females had lower GA (30.78 ± 5.06 vs. 35.01 ± 5.51 mm, P < 0.001) and GH (44.28 ± 3.67 vs. 50.11 ± 4.02 mm, P < 0.001) than males and LAA was significantly smaller in the Bigliani flat type compared with the curved type and the hooked type (5.07 ± 2.31° vs 12.33 ± 5.46°vs 10.00 ± 3.37, P = 0.001). CONCLUSIONS Females had lower GA and GH than males in asymptomatic Chinese Han adults. Asymptomatic Chinese Han subjects with Bigliani flat type had lower LAA. CSA appears lager in Chinese Han individuals. Curve type of acromion performed lager LAA. The results may help establish an anatomical model of the shoulder joint and elucidate the anatomy features of the shoulder joint in asymptomatic Chinese Han adults.
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Affiliation(s)
- Zheng Zeng
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Miaomiao Liu
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Arguello AM, Houdek MT, Barlow JD. Management of Proximal Humeral Oncologic Lesions. Orthop Clin North Am 2023; 54:89-100. [PMID: 36402514 DOI: 10.1016/j.ocl.2022.08.008] [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: 11/06/2022]
Abstract
The proximal humerus is a common location for primary tumors, benign lesions, and metastatic disease. Advances in neoadjuvant and adjuvant therapy have allowed for limb-salvage surgery in most of the cases. There are numerous of options for surgical management of proximal humerus lesions and the decision to pursue one over another depends on factors such as age, comorbidities, pathology, location within the proximal humerus, planned resection margins/size of defect, and bone quality. Long-term outcomes for these techniques tend to be retrospective comparative studies, with recent studies highlighting the improved outcomes of reverse total shoulders.
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Affiliation(s)
- Alexandra M Arguello
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Differential Diagnosis of Thoracoacromial Artery Pseudoaneurysm from Shoulder Inflammatory Pseudotumor: A Case Report. Diagnostics (Basel) 2022; 13:diagnostics13010082. [PMID: 36611374 PMCID: PMC9818345 DOI: 10.3390/diagnostics13010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/23/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Diagnosing shoulder tumors is a challenge because the joint is very complex, and a static examination can misdiagnose some tumors. However, we found that a pseudoaneurysm provides a differential diagnosis of a tumor, and to that end, we present a case that mimics shoulder infection. The patient was an 80-year-old female who had a history of coronary artery disease and end-stage renal disease under regular hemodialysis and complained of right shoulder swelling and progression. A magnetic resonance imaging (MRI) scan revealed an abscess, inflammatory pseudotumor (IPT), and osteomyelitis of the humerus. Computed tomography (CT)-guided pigtail drainage was performed twice without significant improvement. An angiogram revealed a right shoulder pseudoaneurysm fed by the acromial branch of the thoracoacromial artery. After endovascular coiling, the patient was discharged and outpatient follow-up was arranged. If aspiration of the abscess leads to only mild improvement in shoulder swelling, further evaluation should be arranged. An angiogram examination is a good method for diagnosing and designing operations, and endovascular treatment is good for preventing injury to the muscle, tendon, nerve, or blood vessels.
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Saccheri P, Sabbadini G, Travan L. Two paleopathological cases suggestive of paralabral cysts of the shoulder. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 39:109-114. [PMID: 36347173 DOI: 10.1016/j.ijpp.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To undertake differential diagnosis of scapular bone defects found in two medieval skeletons buried in different necropoles of Friuli Venezia Giulia (Italy) and to evaluate the clinical significance of paralabral cysts in the context of shoulder pathology. MATERIALS Individual JoT36 is an adult male exhumed from a necropolis belonging to a rural agricultural settlement dated to the 10th to 11th century A.D. Individual CIVT58 is an adult male from a Langobard necropolis dated to 630-670 A.D. METHODS Macroscopic examination of the skeletons was performed using standard osteological methods and review of pertinent clinical literature to assist differential diagnosis. RESULTS Between the glenoid cavity and the spinoglenoid notch of the right scapula of JoT36 there is a multilocular circular defect adjacent to the glenoid rim. On the neck of the left scapula of CIVT58, immediately above the spinoglenoid notch, there is a unilocular circular depression. In both cases, the cortical bone appears smooth without any evidence of erosion or sclerosis. CONCLUSIONS Skeletal findings and historical/archaeological contexts of both cases are compatible with the diagnosis of paralabral cysts. SIGNIFICANCE Paralabral cysts are relatively frequently observed in clinical settings but very few examples have been documented in paleopathological literature. This study seeks to improve recognition and interpretation of this pathology in historical/archaeological contexts. LIMITATIONS Findings from a case report can neither generate epidemiological information nor be generalized. SUGGESTIONS FOR FURTHER RESEARCH Identification of new cases may add valuable information about lifestyles and related shoulder pathologies in ancient times.
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Affiliation(s)
- Paola Saccheri
- Department of Medicine, Section of Anatomy and History of Medicine, University of Udine, P.le Kolbe 3, 33100 Udine, Italy.
| | - Gastone Sabbadini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy.
| | - Luciana Travan
- Department of Medicine, Section of Anatomy and History of Medicine, University of Udine, P.le Kolbe 3, 33100 Udine, Italy.
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Prabowo Y, Saleh RF. Pedicle screw system reconstruction in shoulder resection type IV-total scapulectomy: A case report and short term follow up. Int J Surg Case Rep 2021; 82:105899. [PMID: 33957397 PMCID: PMC8113707 DOI: 10.1016/j.ijscr.2021.105899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Shoulder resection remains a challenging procedure after scapulectomy for tumour resection. The results have various functional outcome, wound coverage, and cosmetic aspect. In this case report, we reported the outcome of pedicle screw application after scapulectomy procedure within 1 month follow up after surgical tumour excision. Case presentation A 74-year-old female presented with a painful lump on the left shoulder since nine months before admission. We performed physical examination, radiological evaluation using x-ray and MRI. We performed limb salvage surgery with shoulder girdle resection of tumour procedure using Malawer technique type IVB and applied pedicle and screw in proximal end clavicula and proximal end of humerus. We performed histopathological examination to ensure the tumour. We evaluated the patient one month after surgery using DASH score. Discussion MRI examination revealed that there was a solid mass with malignant characteristic destructing left scapular bone with the acromioclavicular and glenohumeral joint involvement. We used pedicle and screw to reconstruct the patient with efficient cost spending consideration. Clinical valuation showed there was no pain left and hand-free movement except the limitation of shoulder abduction. DASH score evaluation pre operative and post operative showed improvement from 70.8 to 45.0. Conclusion Limb salvage procedure using pedicle screw system may be one of treatment of choice for treating tumour of the shoulder affecting glenohumeral joint with excellent result of evaluation both clinical and functional outcome. Limb salvage surgery with shoulder girdle resection of tumour procedure using Malawer technique type IVB Pedicle screw application after scapulectomy procedure Excellent DASH score evaluation
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Affiliation(s)
- Yogi Prabowo
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Riky Febriansyah Saleh
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia.
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Mitrousias V, Fyllos A, Karantanas A, Hantes ME, Papachristou D, Zibis A. Atypical presentation of an intra-articular osteoid osteoma in the proximal humerus excised with arthroscopy: a case report. J ISAKOS 2021; 6:247-250. [PMID: 34272301 DOI: 10.1136/jisakos-2020-000598] [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: 11/16/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/03/2022]
Abstract
An adult man presented with a 5-month history of anterior right shoulder pain. He denied previous trauma or night pain. On the otherwise normal physical examination, pain was elicited in maximum abduction and external rotation. Radiographs were negative. The primary imaging findings were bone marrow oedema of the inferomedial proximal metaphysis of the humerus on MRI and cortical demineralisation on CT located posteromedially. A superficial elevation was also observed around the lesion. A provisional diagnosis of an osteoid osteoma was made based on these imaging findings. Arthroscopic excision of the lesion was performed, and histopathological examination confirmed the diagnosis of an osteoid osteoma. Diagnosis of intra-articular osteoid osteomas may be challenging due to atypical symptomatology and lack of pathognomonic imaging findings. Arthroscopic excision of such lesions in the shoulder is a safe and reliable option and should be considered as the treatment of choice.
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Affiliation(s)
- Vasileios Mitrousias
- Department of Orthopaedic Surgery, University of Thessaly School of Health Sciences, Larissa, Thessaly, Greece
| | - Apostolos Fyllos
- Department of Orthopaedic Surgery, University of Thessaly School of Health Sciences, Larissa, Thessaly, Greece
| | - Apostolos Karantanas
- Department of Medical Imaging, University General Hospital of Heraklion Medical Service, Heraklion, Crete, Greece
| | - Michael E Hantes
- Department of Orthopaedic Surgery, University of Thessaly School of Health Sciences, Larissa, Thessaly, Greece
| | - Dionysios Papachristou
- Department of Anatomy-Histology-Embryology, Unit of Bone and Soft Tissue Studies, University of Patras, Patra, Greece
| | - Aristeidis Zibis
- Department of Anatomy, University of Thessaly School of Health Sciences, Larissa, Thessaly, Greece
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Using Machine Learning to Unravel the Value of Radiographic Features for the Classification of Bone Tumors. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8811056. [PMID: 33791381 PMCID: PMC7984886 DOI: 10.1155/2021/8811056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/05/2020] [Accepted: 03/03/2021] [Indexed: 11/17/2022]
Abstract
Objectives To build and validate random forest (RF) models for the classification of bone tumors based on the conventional radiographic features of the lesion and patients' clinical characteristics, and identify the most essential features for the classification of bone tumors. Materials and Methods In this retrospective study, 796 patients (benign bone tumors: 412 cases, malignant bone tumors: 215 cases, intermediate bone tumors: 169 cases) with pathologically confirmed bone tumors from Nanfang Hospital of Southern Medical University, Foshan Hospital of TCM, and University of Hong Kong-Shenzhen Hospital were enrolled. RF models were built to classify tumors as benign, malignant, or intermediate based on conventional radiographic features and potentially relevant clinical characteristics extracted by three musculoskeletal radiologists with ten years of experience. SHapley Additive exPlanations (SHAP) was used to identify the most essential features for the classification of bone tumors. The diagnostic performance of the RF models was quantified using receiver operating characteristic (ROC) curves. Results The features extracted by the three radiologists had a satisfactory agreement and the minimum intraclass correlation coefficient (ICC) was 0.761 (CI: 0.686-0.824, P < .001). The binary and tertiary models were built to classify tumors as benign, malignant, or intermediate based on the imaging and clinical features from 627 and 796 patients. The AUC of the binary (19 variables) and tertiary (22 variables) models were 0.97 and 0.94, respectively. The accuracy of binary and tertiary models were 94.71% and 82.77%, respectively. In descending order, the most important features influencing classification in the binary model were margin, cortex involvement, and the pattern of bone destruction, and the most important features in the tertiary model were margin, high-density components, and cortex involvement. Conclusions This study developed interpretable models to classify bone tumors with great performance. These should allow radiographers to identify imaging features that are important for the classification of bone tumors in the clinical setting.
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Gao C, Qiu ZY, Hou JW, Tian W, Kou JM, Wang X. Clinical observation of mineralized collagen bone grafting after curettage of benign bone tumors. Regen Biomater 2020; 7:567-575. [PMID: 33365142 PMCID: PMC7748453 DOI: 10.1093/rb/rbaa031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/13/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022] Open
Abstract
Curettage of benign bone tumor is a common cause for bone defect. For such bone defect repair, autogenous bone, allogeneic bone and traditional artificial bone graft substitutes have many disadvantages. In recent years, a biomimetic mineralized collagen (MC) with similar composition and microstructures to the natural bone matrix was developed and used for treating various bone defects. In this work, a retrospective study analyzed clinical outcomes of patients treated with curettage of benign bone tumors and bone grafting with MC, in comparison to another group treated with the same surgical method and autogenous bone. Lane–Sandhu X-ray score of the autogenous bone group was superior to the MC group at 1 month after the operation, but the two groups had no statistical difference at 6 and 12 months. The MC group was better in Musculoskeletal Tumor Society scoring at 1 and 6 months after the operation, and the two groups had no statistical difference at 12 month. Therefore, the MC performed not as good as autogenous bone in early stage of bone healing but achieved comparable outcomes in long-term follow-ups. Moreover, the MC has advantages in function recovery and avoided potential complications induced by harvesting autogenous bone.
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Affiliation(s)
- Chong Gao
- Department of Orthopedics, The Second People's Hospital of Lianyungang, No. 41 Hailiandong Road, Xinpu District, Lianyungang, Jiangsu 222006, China
| | - Zhi-Ye Qiu
- School of Materials Science and Engineering, Tsinghua University, Haidian District, Beijing 100085, China.,R&D Department, Allgens Medical Science Corporation, No. 26 Yongwangxi Road, Daxing District, Beijing 102629, China
| | - Jian-Wen Hou
- Department of Orthopedics, The Second People's Hospital of Lianyungang, No. 41 Hailiandong Road, Xinpu District, Lianyungang, Jiangsu 222006, China
| | - Wei Tian
- Department of Orthopedics, The Second People's Hospital of Lianyungang, No. 41 Hailiandong Road, Xinpu District, Lianyungang, Jiangsu 222006, China
| | - Jian-Ming Kou
- Department of Orthopedics, The Second People's Hospital of Lianyungang, No. 41 Hailiandong Road, Xinpu District, Lianyungang, Jiangsu 222006, China
| | - Xi Wang
- Department of Orthopedics, The Second People's Hospital of Lianyungang, No. 41 Hailiandong Road, Xinpu District, Lianyungang, Jiangsu 222006, China
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