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Wang CS, Wang HW, Chen KC, Lin CL. Biomechanical analysis of tibial plateau posterolateral fracture fragment fixation and introduction of a lateral tibia plateau hook plate system. J Orthop Sci 2023:S0949-2658(23)00181-1. [PMID: 37393110 DOI: 10.1016/j.jos.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/10/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Fixing the posterolateral fragments of tibial plateau fractures has been challenging owing to potential neurovascular injuries and fibular head blocks. Several surgical approaches and fixation techniques have been reported, with distinct limitations. We propose a novel lateral tibia plateau hook plate system and compare its biomechanical stability with other fixation methods. METHODS Twenty-four synthetic tibia models were simulated to present posterolateral tibial plateau fractures. These models were randomly assigned to three groups. Group A models were fixed with the lateral tibia plateau hook plate system, Group B with variable-angle anterolateral locking compression plates, and Group C with direct posterior buttress plates. The models' biomechanical stability was evaluated using static (gradually increased axial compressive loads) and fatigue (cyclically loaded from 100 to 600 N for 2000 cycles each) tests. RESULTS Groups A and C models exhibited comparable axial stiffness, subsidence load, failure load, and displacement in the static test. Group A model exhibited higher subsidence and failure loads than Group B model. Groups A and C models exhibited comparable displacement at 100 N cyclic loading in the fatigue test. Group C model was more stable at higher loads. Group C model endured the highest subsidence cycle numbers, followed by Groups A and B models. CONCLUSIONS The lateral tibia plateau hook plate system provided similar static biomechanical stability as the direct posterior buttress plates and comparable dynamic stability under limited axial loading. This system is a potential posterolateral treatment choice owing to its convenience and safety, in treating tibia plateau fractures.
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Affiliation(s)
- Chien-Shun Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112201, Taiwan; Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112201, Taiwan
| | - Hsuan-Wen Wang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan; Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan
| | - Kun-Chun Chen
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan; Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan
| | - Chun-Li Lin
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan; Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan.
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Noktehsanj R, Movahedinia M, Jousheghan SS, Salehi B, Amini K, Kamrava S, Sajjadi MM. Clinical Outcomes of Fixation of Depressed Posterolateral Tibial Plateau Fractures Using a Direct Lateral Approach. Indian J Orthop 2023; 57:466-471. [PMID: 36825273 PMCID: PMC9941383 DOI: 10.1007/s43465-023-00825-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/15/2022] [Indexed: 01/28/2023]
Abstract
Introduction Fixation of plateau posterolateral fracture (PLF) is challenging because the fracture site is mostly covered by vital neurovascular structures. We operated on 15 cases of PLF using a direct lateral approach. This study aims to report on clinical results. Material and methods Between 2017 and 2019, 15 cases of PLFs were fixed with a direct lateral approach and a tricortical autologous bone graft from the iliac crest. A depression of more than 2 mm was indicated for the surgical treatment. Clinical evaluation included Lysholm score, International Knee Documentation Committee Score (IKDC) score, and Tegner activity scale after two years follow-up. Results The last follow-up was at 24 months after the operation. The mean postoperative Tegner activity scale did not change significantly compared to before the injury (6.5 (6-7) vs. 7 (6-8, p = 0.5)). The postoperative IKDC and Lysholm scores improved significantly compared to before the operation (p < 0.001). The full range of motion was seen in all patients except one who was manipulated after three months. Conclusions Surgical treatment using a direct lateral approach is a safe procedure for PLFs that results in good, short-term clinical and radiologic outcomes without fibular osteotomy or compromising the important neurovascular structures. Level of evidence IV.
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Affiliation(s)
- Reza Noktehsanj
- Department of Surgery and Orthopedics, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Saman Shakeri Jousheghan
- Clinical Research & Development Unit, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Keyvan Amini
- Department of Emergency, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Jiang WB, Sun SZ, Li C, Adds P, Tang W, Chen W, Yu SB, Sui HJ. Anatomical basis of the support of fibula to tibial plateau and its clinical significance. J Orthop Surg Res 2021; 16:346. [PMID: 34051797 PMCID: PMC8164332 DOI: 10.1186/s13018-021-02500-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background The fibula is only indirectly involved in the composition of the human knee joint and has therefore been neglected in the research on knee osteoarthritis. Nonuniform settlement of the proximal tibia plateau is clinically defined as when the height of the medial tibial plateau is lower than that of the lateral side in medial compartment knee osteoarthritis (KOA). The non-uniform settlement of the proximal tibia plateau may be caused by fibular support on the lateral side. Orthopedic surgeons practice partial fibulectomy based on the clinical manifestation of nonuniform settlement, and this technique has been shown to reduce pain and improve function in patients with medial compartment KOA. However, this hypothesis of the mechanism of nonuniform settlement lacks an anatomical basis. Methods The P45 polyester plastination technique was used to prepare sections of the proximal tibiofibular joint to investigate the distribution of the bone trabeculae in the region of the lateral tibial plateau. Results There was uneven distribution of trabeculae in the lateral condyle of the tibia and the head and neck of the fibula. The fibula and the posterolateral cortex of the shaft of the tibia united to form an arch beam via the tibiofibular joint. Many thick, dense trabeculae were present in a longitudinal direction above the tibiofibular arch. Conclusions The fibula supports the lateral tibial plateau, and the trabeculae were concentrated above the tibiofibular arch.
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Affiliation(s)
- Wen-Bin Jiang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Shi-Zhu Sun
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Chan Li
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Philip Adds
- Institute of Medical and Biomedical Education (Anatomy), St George's, University of London, London, UK
| | - Wei Tang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Heibei, Shijiazhuang, 050051, China
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China.
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Goyal T, Paul S, Choudhury AK, Abdusamad V. Use of Osteochondral and Meniscal Allografts from Bone Cuts of Total Knee Arthroplasty for the Treatment of Tibial Plateau Malunions: A Case Series of Four Patients Showing Early Results. Indian J Orthop 2021; 55:375-383. [PMID: 33927816 PMCID: PMC8046859 DOI: 10.1007/s43465-020-00347-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/31/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Intra-articular malunion of tibial plateau fracture is a complex problem to treat. We are presenting outcomes of our series of patients of malunited tibial plateau fractures treated with osteo-chondro-meniscal allograft from lateral tibial plateau harvested from patients undergoing total knee arthroplasty (TKA). METHODS The technique was used in four patients. Preoperative computed tomography (CT) scan was used to match donor and recipient graft dimensions and to measure any malalignment. Patients were evaluated for Visual analogue Scale (VAS) for pain (scale 1-10 cm), WOMAC (Western Ontario McMaster Osteo-Arthritis Index) score, knee range of motion, and limb alignment. RESULTS There were three medial tibial plateau malunions and one lateral tibial plateau malunion. Articular comminution with depression was seen in all of them. One patient underwent concurrent high tibial osteotomy for the elevation of the medial tibial plateau and posterior cruciate ligament reconstruction was performed concurrently in one patient. All patients showed improvement in knee range of motion, WOMAC score, and VAS score for knee pain. Limb alignment improved in all cases. Radiologically there was consolidation of the allograft in all the cases at 6 months. The mean follow-up was 15.2 months (range 12-18 months). CONCLUSION Osteochondral allograft can be a good choice for reconstructing large articular cartilage defects in tibial plateau malunions. Osteo-chondro-meniscal grafts obtained during TKA can be a viable alternative for reconstructing such defects with excellent early clinical, functional, and radiological outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab 151001 India
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - V. Abdusamad
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Keizer MNJ, Hijmans JM, Gokeler A, Otten E, Brouwer RW. Sagittal knee kinematics in relation with the posterior tibia slope during jump landing after an anterior cruciate ligament reconstruction. J Exp Orthop 2020; 7:69. [PMID: 32959098 PMCID: PMC7505908 DOI: 10.1186/s40634-020-00289-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose An increased posterior tibia plateau angle is associated with increased risk for anterior cruciate ligament injury and re-rupture after reconstruction. The aims of this study were to determine whether the tibia plateau angle correlates with dynamic anterior tibia translation (ATT) after an anterior cruciate ligament reconstruction and whether the tibia plateau angle correlates with aspects of knee kinematics and kinetics during jump landing. Methods Thirty-seven patients after anterior cruciate ligament reconstruction with autograft hamstring tendon were included. Knee flexion angle and knee extension moment during single leg hops for distance were determined using a motion capture system and the dynamic ATT with its embedded method. The medial and lateral posterior tibia plateau angle were measured using MRI. Moreover, passive ATT was measured using the KT-1000 arthrometer. Results A weak negative correlation was found between the maximal dynamic ATT and the medial tibia plateau angle (p = 0.028, r = − 0.36) and between the maximal knee flexion angle and the lateral tibia plateau angle (p = 0.025, r = − 0.37) during landing. Patients with a smaller lateral tibia plateau angle show larger maximal knee flexion angle during landing than the patients with larger lateral tibia plateau angle. Also, the lateral tibia plateau angle is associated the amount of with muscle activity. Conclusion The posterior medical tibia plateau angle is associated with dynamic ATT. The maximal knee flexion angle and muscle activity are associated with the posterior lateral tibia plateau angle. Level of evidence III
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Affiliation(s)
- Michèle N J Keizer
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, FA 23 - PO Box 219, Groningen, 9713, AV, The Netherlands.
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alli Gokeler
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, FA 23 - PO Box 219, Groningen, 9713, AV, The Netherlands.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg.,Department Exercise & Health, Exercise Science and Neuroscience, University of Paderborn, Paderborn, Germany
| | - Egbert Otten
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, FA 23 - PO Box 219, Groningen, 9713, AV, The Netherlands
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital Groningen, Groningen, The Netherlands
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Yahagi Y, Horaguchi T, Iriuchishima T, Suruga M, Iwama G, Aizawa S. Correlation between the mid-substance cross-sectional anterior cruciate ligament size and the knee osseous morphology. Eur J Orthop Surg Traumatol 2019; 30:291-296. [PMID: 31552484 DOI: 10.1007/s00590-019-02552-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION One of the final goals of anatomical anterior cruciate ligament (ACL) reconstruction is the restoration of native anatomy. It is essential to obtain more accurate predictors of mid-substance ACL size before surgery. However, to the best of our knowledge, no study has reported correlation between the mid-substance cross-sectional ACL size and the knee osseous morphology. The purpose of this study was to reveal correlation between the mid-substance cross-sectional ACL size and the knee osseous morphology. MATERIALS AND METHODS We used 39 non-paired formalin fixed Japanese cadaveric knees. All surrounding muscles, ligaments and soft tissues in the knee were resected. After soft tissue resection, the knee was flexed at 90°, and a tangential plane of the femoral posterior condyles was marked and cut the ACL. Femoral ACL footprint size, Blumensaat's line length, lateral wall of the femoral intercondylar notch size, lateral wall of the femoral intercondylar notch height, tibial ACL footprint size, tibia plateau size, the whole anterior-posterior (AP) length, the medial and the lateral AP length of the tibia plateau, and the medial-lateral (ML) length of the tibia plateau were measured. The Pearson's product movement correlation was calculated to reveal correlation between the mid-substance cross-sectional ACL size and the measured parameters of the knee osseous morphology. RESULTS The measured mid-substance cross-sectional ACL size was 49.9 ± 16.3 mm2. The tibial ACL footprint size, the tibia plateau size, the whole AP length of the tibia plateau, the lateral AP length of the tibia plateau and the ML length of the tibia plateau were significantly correlated with the mid-substance cross-sectional ACL size. CONCLUSIONS For clinical relevance, some tibial sides of the knee osseous morphology were significantly correlated with the mid-substance cross-sectional ACL size. It might be possible to predict the mid-substance ACL size measuring these parameters.
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Affiliation(s)
- Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Takashi Horaguchi
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, 198-2, Ishikura Minakami-cho, Tone-Gun, Gunma-ken, 379-1311, Japan.,Department of Functional Morphology, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Makoto Suruga
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Genki Iwama
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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Krettek C, Clausen J, Omar M, Noack S, Neunaber C. Two-stage late reconstruction with a fresh large osteochondral shell allograft transplantation (FLOCSAT) for a large ostechondral defect in a non-union after a lateral tibia plateau fracture 2-year follow up. Injury 2017; 48:1309-1318. [PMID: 28610776 DOI: 10.1016/j.injury.2017.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This is the description of a 58-year-old female patient presenting 8 months after a horse riding accident with significant pain and inability to walk independently. Imaging revealed a large osseous defect of the lateral tibia plateau which was not united posteriorly. The patient refused knee replacement and we developed a patient specific two-step procedure for her. Step 1: Filling of the defect with a large cortico-cancellous autograft from the posterior iliac crest; step 2: Transplantation of a fresh large osteochondral shell allograft (FLOCSAT). The postoperative protocol included continuous passive motion (CPM), partial weight bearing for three months, and physiotherapy. Based on the concept of immuno-privileged cartilage tissue, the patient did not get any immuno-suppressive therapy. Pain-, activity of daily living, Lysholm and Tegner scores were evaluated before defect filling surgery with autograft, before allograft transplantation, and at 12 and 24 months after allograft transplantation. There were no complications. Radiographic analyses with plain films and CT scans revealed solid osseous integration within 3 month. The patient regained excellent functionality in both, activities of daily living and sports (back to horse riding, trampolin jumping). Knee arthroscopy after 1year showed excellent condition of the lateral meniscus and the cartilage of the lateral tibia plateau. Chimerism/DNA analysis of a cartilage biopsy showed, that at 1year 32% of the donor cells have been already replaced by the patient's own cells. To our knowledge, this is the first case of a patient who sustained such a large defect during a tibia plateau fracture, and got successfully treated with a fresh large osteochondral shell allograft transplantation in a two-step procedure.
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Affiliation(s)
- C Krettek
- Director and Professor Trauma Department, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - J Clausen
- Unfallchirurgische Klinik der Medizinischen Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - M Omar
- Unfallchirurgische Klinik der Medizinischen Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - S Noack
- Unfallchirurgische Klinik der Medizinischen Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - C Neunaber
- Unfallchirurgische Klinik der Medizinischen Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Chen HW, Chen CQ, Yi XH. Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management. Int J Clin Exp Med 2015; 8:472-479. [PMID: 25785019 PMCID: PMC4358474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To establish a classification system for the different types of posterior tibial plateau fractures (PTPF), and to explore the fracture patterns and early results of treatment. METHODS 39 PTPFs patients who received surgeries through posteromedial or (and) posterolateral knee approaches were analyzed retrospectively. RESULTS There were 5 types of PTPFs identified in the new classification system: posteromedial split fracture (type I, 7 patients), posterolateral split fracture (type II, 5 patients), posterolateral depression fracture (type III, 11 patients), posterolateral split and depression fracture (type IV, 2 patients), and posteromedial split combined with posterolateral depression fracture (type V, 14 patients). All patients underwent surgeries safely without complications. The average follow up was 18.1 months (12-30 months). The average weight-bearing durations were 15.6 weeks (12-20 weeks). Based on Rasmussen functional scoring system, 20 cases were regarded as excellent, 14 were good, 5 were fair, and 0 was poor. There was significant change in the Rasmussen functional score before (8.38 ± 2.87) and after surgery (24.20 ± 3.44). According to Rasmussen radiology system, 28 cases were excellent, 8 cases were good, 3 were fair, and none was poor. There was also a significant difference detected between pre-operation (6.77 ± 2.27) and post-operation (16.41 ± 2.65). CONCLUSION This study presents a new classification system for the different types of PTPFs based on the treatment. The classification is clinically relevant and can be used to guide the surgical management.
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Affiliation(s)
- Hong-Wei Chen
- Department of Orthopedics, Central Hospital of Yiwu CityYiwu, Zhejiang Province, China
| | - Chang-Qing Chen
- Department of Orthopaedic Surgery, Affiliated Dongnan Hospital of Xiamen University, Orthopaedic Center of PLAZhangzhou 363000, China
| | - Xian-Hong Yi
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical UniversityWenzhou, Zhejiang Province, China
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