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Li KH, Li ZG, Xiong HL, Liu XN, Ma XL. Biomechanical Study of Minimally Invasive Nonfusion Surgery for Treatment of Disc Herniation Associated with Adjacent Segment Disease: A Finite Element Analysis. World Neurosurg 2023; 179:e305-e313. [PMID: 37634668 DOI: 10.1016/j.wneu.2023.08.082] [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: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE We explored the biomechanical changes of 2 conventional minimally invasive nonfusion surgical methods for treating disc herniation in adjacent segment disease using 3-dimensional finite element analysis. METHODS A model comprising L3 to the sacrum was validated and used to establish an L4-L5 fusion model, and an adjacent segment disease (ASD) model was developed by modifying the material properties of the intervertebral discs. The ASD model was used to simulate 2 conventional minimally invasive nonfusion surgical methods, which resulted in the creation of 2 postoperative models (M1 and M2). The range of motion and the equivalent stress for each model were recorded under 6 different working conditions. The data are descriptive and were analyzed comparatively under a normal load. RESULTS Compared with the ASD group, the range of motion of the adjacent segment in the M1 and M2 groups remained unaffected. However, significant Von-Mises stress changes were found in the annulus fibrosus and nucleus pulposus (NP), especially during extension, ipsilateral bending, and rotation. Stress in the NP also shifted toward the surgical incision in the annulus fibrosus during these movements. The maximum Von-Mises stress in the NP of the cephalic segment increased more than did that of the caudal segment. CONCLUSIONS Minimal nonfusion surgery for ASD might not affect adjacent segment stability significantly. Nonetheless, it can lead to segmental degeneration deterioration and postoperative recurrence. The cephalic segment is affected more than the caudal segment. Therefore, consideration of disc degeneration and appropriate selection of surgical methods for ASD are crucial.
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Affiliation(s)
- Kai-Hua Li
- Graduate School of Tianjin Medical University, Tianjin, People's Republic of China; Institute of Orthopedics, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, People's Republic of China
| | - Zhi-Guo Li
- Institute of Orthopedics, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, People's Republic of China
| | - Hui-Ling Xiong
- Institute of Orthopedics, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, People's Republic of China
| | - Xiao-Ning Liu
- Institute of Orthopedics, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, People's Republic of China
| | - Xin-Long Ma
- Department of Orthopedics, Tianjin Hospital, Tianjin, People's Republic of China.
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Zhou LP, Zhang RJ, Wang JQ, Zhang HQ, Shang J, Gao Y, Jia CY, Ding JY, Zhang L, Shen CL. Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases. BMC Surg 2023; 23:46. [PMID: 36855117 PMCID: PMC9976523 DOI: 10.1186/s12893-023-01943-6] [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: 12/15/2022] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Dynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology in clinical practice. However, the advantages of DS method in medium and long-term follow-up remain controversial. OBJECTIVE To compare the radiographic and clinical outcomes between DS and instrumented fusion in the treatment of degenerative lumbar spine disease with or without grade I spondylolisthesis with a minimum follow-up period of 2 years. METHODS We conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases, Chinese National Knowledge Databases, and Wanfang Database for potentially eligible articles. Clinical outcomes were assessed in terms of VAS and ODI scores, screw loosening and breakage, and surgical revision. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated. RESULTS Seventeen studies with 1296 patients were included in the meta-analysis. The DS group was associated with significantly lower postoperative VAS scores for low-back and leg pain, and lower rate of surgical revision than the fusion group. Moreover, the Dynesys group showed significantly less ASDeg than the fusion group but showed no significant advantage over the fusion group in terms of preventing ASDis. Additionally, the ROM at the stabilized segments of the fusion group decreased significantly and that at the adjacent segments increased significantly compared with those of the DS group. CONCLUSION DS showed comparable clinical outcomes and provided benefits in preserving the motion at the stabilized segments, thus limiting the hypermobility at the adjacent segments and preventing ASDeg compared with the fusion method in degenerative disease with or without grade I spondylolisthesis.
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Affiliation(s)
- Lu-Ping Zhou
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Ren-Jie Zhang
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Jia-Qi Wang
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Hua-Qing Zhang
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Jin Shang
- grid.411395.b0000 0004 1757 0085Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, 107 Huanhudong Road, Hefei, 230031 Anhui China
| | - Yang Gao
- grid.488137.10000 0001 2267 2324Outpatient Department, The 55th Retired Cadres of the Beijing Garrison of PLA, 4 Wanshou Road, Beijing, 100036 China
| | - Chong-Yu Jia
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Jing-Yu Ding
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Lai Zhang
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Cai-Liang Shen
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, Anhui, China.
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Chen KJ, Lai CY, Chiu LT, Huang WS, Hsiao PH, Chang CC, Lin CJ, Lo YS, Chen YJ, Chen HT. Adjacent segment disease following Dynesys stabilization for lumbar disorders: A case series of mid- and long-term follow-ups. World J Clin Cases 2021; 9:10850-10860. [PMID: 35047596 PMCID: PMC8678859 DOI: 10.12998/wjcc.v9.i35.10850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/04/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiologic adjacent segment degeneration (ASDeg) can occur after spinal surgery. Adjacent segment disease (ASDis) is defined as the development of new clinical symptoms corresponding to radiographic changes adjacent to the level of previous spinal surgery. Greater pre-existing ASDeg is generally considered to result in more severe ASDis; nonetheless, whether the ASDeg status before index surgery influences the postoperative risk of revision surgery due to ASDis warrants investigation.
AIM To identify possible risk factors for ASDis and verify the concept that greater preexisting ASDeg leads to more severe ASDis.
METHODS Data from 212 patients who underwent posterior decompression with Dynesys stabilization from January 2006 to June 2016 were retrospectively analyzed. Patients who underwent surgery for ASDis were categorized as group A (n = 13), whereas those who did not were classified as group B (n = 199). Survival analysis and Cox proportional hazards models were used to compare the modified Pfirrmann grade, University of California-Los Angeles grade, body mass index, number of Dynesys-instrumented levels, and age.
RESULTS The mean time of reoperation was 7.22 (1.65–11.84) years in group A, and the mean follow-up period was 6.09 (0.10–12.76) years in group B. No significant difference in reoperation risk was observed: Modified Pfirrmann grade 3 vs 4 (P = 0.53) or 4 vs 5 (P = 0.46) for the upper adjacent disc, University of California-Los Angeles grade 2 vs 3 for the upper adjacent segment (P = 0.66), age of < 60 vs > 60 years (P = 0.9), body mass index < 25 vs > 25 kg/m2 (P = 0.3), and sex (P = 0.8).
CONCLUSION Greater preexisting upper ASDeg was not associated with a higher rate of reoperation for ASDis after Dynesys surgery. Being overweight tended to increase reoperation risk after Dynesys surgery for ASDis.
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Affiliation(s)
- Kuan-Ju Chen
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung City 404, Taiwan
| | - Chien-Ying Lai
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung City 404, Taiwan
- Spine Center, China Medical University Hospital, Taichung City 404, Taiwan
| | - Lu-Ting Chiu
- Management Office for Health Data, China Medical University Hospital, Taichung City 404, Taiwan
- College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Wei-Sheng Huang
- School of Chinese Medicine, China Medical University, Taichung City 404, Taiwan
| | - Pang-Hsuan Hsiao
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
| | - Chien-Chun Chang
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- Degree Program of Biomedical Science and Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - Cheng-Jyh Lin
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
| | - Yuan-Shun Lo
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- Department of Orthopedic Surgery, China Medical University Beigang Hospital, Yunlin County 651, Taiwan
- Graduate Institute of Precision Engineering, National Chung Hsing University, Taichung City 404, Taiwan
| | - Yen-Jen Chen
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- School of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- Department of Sport Medicine, College of Health Care, China Medical University, Taichung City 404, Taiwan
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Khalifé M, Devriese F, Ferrero E, Zadegan F, Ajavon L, Mazel C. Dynesys® dynamic stabilization outcomes in degenerative spine surgery. Acta Orthop Belg 2021; 87:795-803. [PMID: 35172450 DOI: 10.52628/87.4.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dynesys® is a dynamic device used for posterior stabilization of the lumbar spine. The objective of this study was to analyze the clinical and radiological outcomes at a 2-year minimum follow-up. In this retrospective study, patients operated between 2009 and 2016 with Dynesys® stabilization were included. 5 different etiologies were included: disc herniation, lumbar stenosis, revision for adjacent seg- ment disease (ASD), spondylolisthesis, and scoliosis. Clinical and radiological evaluations were performed. Postoperative complications and revisions were recorded. 136 patients were included: 34 for lumbar spinal stenosis, 19 for disc herniation, 29 degenerative spon- dylolisthesis, 41 revisions for ASD, and 13 scoliosis. Mean age was 64.8. Average clinical follow-up was 46 months. Postoperative clinical results showed a mean lumbar VAS of 3.07, a mean radicular VAS of 3.01 and an ODI score of 31.8%. The ASD rate was 16.2%, and overall revision rate was 11.8%. 2 cases (1.5%) of screw loosening were identified. Clinical outcomes, ASD rate and revision rate were more favorable in the spondylolisthesis and disc herniation groups. This study has one of the largest Dynesys® cohort in literature. Spinal dynamic stabilization by Dynesys® presents good long-term clinical and radiological out- comes with a lower rate of complications than pre- viously published cohorts and lumbar fusions. Best indications seem to be degenerative spondylolisthesis.
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Fu C, Chen T, Yang Y, Yang H, Diao M, Zhang G, Ji Z, Lin H. Clinical efficacy and radiographic K-rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis. BMC Musculoskelet Disord 2020; 21:437. [PMID: 32631336 PMCID: PMC7336485 DOI: 10.1186/s12891-020-03466-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background This study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS). Methods A total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n = 25) and rigid systems (n = 15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system. Results JOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system. Conclusions Compared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.
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Affiliation(s)
- Chaohua Fu
- Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.,Department of Orthopedics, the Jiangmen hospital of Sun Yat-Sen University, Jiangmen, China
| | - Tianjun Chen
- Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Yuhao Yang
- Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Hua Yang
- Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Maohui Diao
- Department of Orthopedics, Shenzhen Baoan Second People's hospital, Shenzhen, China
| | - Guowei Zhang
- Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Zhisheng Ji
- Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
| | - Hongsheng Lin
- Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
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Ko YJ, Lee E, Lee JW, Park CY, Cho J, Kang Y, Ahn JM. Clinical validity of two different grading systems for lumbar central canal stenosis: Schizas and Lee classification systems. PLoS One 2020; 15:e0233633. [PMID: 32459814 PMCID: PMC7252624 DOI: 10.1371/journal.pone.0233633] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To assess the learnability of two magnetic resonance imaging (MRI) grading systems for lumbar central canal stenosis based on inter-observer agreement and test-retest reliability of doctors with no prior knowledge of the two systems. MATERIALS AND METHODS Two clinical fellows, one novice radiology resident, one neurosurgeon, and one orthopedic surgeon, who were unaware of the two qualitative MRI grading systems prior to this study, acquainted themselves with the teaching files. All five observers independently assessed the LCCS grade of 70 patients using T2-weighted axial magnetic resonance images at the L2-3, L3-4, L3-4, and L5-S1 disc levels. Analysis was performed twice at an interval of two months. RESULTS The inter-observer agreement among all five readers was excellent and test-retest reliability was moderate to excellent for both the Schizas and Lee systems. Positive percentage agreements were found to be over 0.8 in almost all observers with relatively narrow 95% confidence limits. CONCLUSION Both Schizas and Lee MRI grading systems for LCCS are reliable grading systems, and can be used as a learnable method for both clinicians and radiologists.
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Affiliation(s)
- Yeon-jee Ko
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eugene Lee
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Joon Woo Lee
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chi Young Park
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jungheum Cho
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yusuhn Kang
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Mo Ahn
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Ji ZS, Yang H, Yang YH, Li SJ, Luo JX, Zhang GW, Lin HS. Analysis of clinical effect and radiographic outcomes of Isobar TTL system for two-segment lumbar degenerative disease: a retrospective study. BMC Surg 2020; 20:15. [PMID: 31952499 PMCID: PMC6969481 DOI: 10.1186/s12893-020-0680-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/07/2020] [Indexed: 01/29/2023] Open
Abstract
Background Nonfusion fixation is an effective way to treat lumbar degeneration. In the present study, we analyzed the clinical effects and radiographic outcomes of the Isobar TTL system used to treat two-segment lumbar degenerative disease. Method Forty-one patients diagnosed with two-segment lumbar degenerative disease underwent surgical implantation of the Isobar TTL dynamic stabilization system (n = 20) or a rigid system (n = 21) from January 2013 to June 2017. The mean follow-up time was 23.6 (range 15–37) months. Clinical results were evaluated with the Oswestry Disability Index (ODI), modified Macnab criteria, and the visual analog score (VAS). Radiographic evaluations included the height of the intervertebral space and the range of motion (ROM) of the treated and adjacent segments. The intervertebral disc signal was classified using the modified Pfirrmann grading system and the University of California at Los Angeles (UCLA) system. Results The clinical results, including the ODI and VAS, showed that there was significant improvement in the two groups after implantation and that the difference between the two groups was not significant. In addition, the clinical efficacy indicated by the modified Macnab criteria for the two groups was similar. Radiological outcomes included the height of the intervertebral space, lumbar mobility, and intervertebral disc signal. The height of the intervertebral space of the upper adjacent segment L2/3 in the rigid group was significantly lower than that in the Isobar TTL group at the last follow-up. Furthermore, the number of ROMs of the fixed-segment L3/4 in the Isobar TTL group was significantly less than that before implantation, suggesting that the fixed-segment ROMs in the Isobar TTL group were limited. In addition, the ROM of the upper adjacent segment L2/3 in the last follow-up of the rigid group increased significantly, while that of the Isobar TTL group did not change after implantation. Finally, the incidence of adjacent-segment degeneration (ASD) was significantly greater in the rigid group than in the Isobar TTL group according to the UCLA system. Conclusion The Isobar TTL system can be clinically effective for treating two-segment lumbar degenerative disease. Compared with rigid fixation, the Isobar TTL system yielded better radiographic outcomes and maintained the mobility of the treated segments with less impact on the proximal adjacent segment.
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Affiliation(s)
- Zhi-Sheng Ji
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Hua Yang
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yu-Hao Yang
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Shao-Jin Li
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Jian-Xian Luo
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Guo-Wei Zhang
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
| | - Hong-Sheng Lin
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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