objective To evaluate the biomechanical characteristics of Ni-ti barb wrist prosthesis.

Six cases of normal human fresh forearm were collected (provided by department of anatomy, Southern Medical University). Inclusion criteria: fresh frozen adult forearm; the wrists were free to move. Exclusion criteria: fracture, joint dislocation or bone tumor on the adult forears. In the Cortex motion capture system, the range of motion (ROM) of wrist prosthesis was compared in flexion, extension, ulnar deviation, and radial deviation before and after total wrist arthroplasty (TWA). The data were analysed by paired t test. In the Elector Force high precision biological material test system, the prostheses were loaded with an increasing pull-out force 2 N per second, until the prosthesis displacement was more than 2 mm. The prosthesis loosening pull-out force at the moment was recorded. Independent sample t test was used to compare the pull-out force of the radial component and wrist component .

ROM of wrist prosthesis in extension, ulnar deviation, and radial deviation showed no statistical difference (P>0.05) before and after TWA. For preoperative maximum flexion was (75.0±3.5) °, postoperative maximum flexion was (52.6±3.2) °, which showed significant difference (t=14.69, P<0.05). The pull-out force of radius prosthesis was (164±15) N, and the pull-out force of metacarpal prosthesis was (512±38) N, which was statistically different( t=-20.859, P< 0.05) .

Ni-ti barb wrist prosthesis can basically meet ROM and pull-out resistance of the daily biomechanics demands, which has some potential value of clinical application.

To compare adductor canal block (ACB) with femoral nerve block (FNB) for postoperative analgesic effect and early rehabilitation after total knee arthroplasty (TKA).

The Cochrane Library, PudMed, EMBASE, CNKI, VIP and Wan Fang were searched to identify randomized controlled trials (RCTs) articles comparing the ACB with the FNB in TKA up to August 2016. Study selection and assessment, data collection and analysis were undertaken by two authors independently. The meta-analysis was performed using Review Manager 5.2.0, and publication bias was evaluated through a funnel plot.

Twelve studies were included, involving nine English studies and three Chinese studies There was a total of 772 cases comparing ACB (n=382) with FNB (n=390). Meta-analysis suggested that the resting VAS scores[WMD=0.20, 95%CI(-0.33, 0.72); WMD=0.24, 95%CI(-0.12, 0.60); WMD=0.31, 95%CI(-0.07, 0.69); WMD=0.03, 95%CI(-0.29, 0.35)] and motion VSA scores[WMD=0.10, 95%CI(-0.41, 0.62); WMD=0.64, 95%CI(0.15, 1.12); WMD=0.17, 95%CI(-0.37, 0.70); WMD=0.03, 95%CI(-0.57, 0.62)]were similar to the ACB group and FNB group at 2-4 h, 6-8 h, 24 h and 48 h. The quadriceps strength in the ACB group was better than that in the FNB group at 4 to 8 h, 24 h and 48 h[WMD=0.45, 95%CI(0.25, 0.64); WMD=0.38, 95%CI(0.14, 0.61); WMD=0.41, 95%CI(0.18, 0.63)]. The range of motion in the ACB group was also better than that in the FNB group at 24 h, 48 h and 72 h[WMD=5.01, 95%CI(0.78, 0.92); WMD=8.74, 95%CI(3.54, 13.93); WMD=6.65, 95%CI(1.97, 11.33)]. Besides, ACB group had advantages in time-up-go test[WMD=-55.98, 95%CI(-109.60, -2.35)] and length of hospital stay[WMD=-0.049, 95%CI(-0.96, -0.03)]. There was no difference in opioid consumption and side effect of nausea and vomiting.

When comparing with FNB, the ACB shows similar postoperative analgesia effects and has advantages in quadriceps strength recovery and promoting early postoperative rehabilitation, but more high-quality RCTs are required for further investigation.

To compare the effection and safety of intra-articular injection for tranexamic acid(TXA) versus hemocoagulase(HCA) by reducing blood loss after total knee arthroplasty(TKA).

From February 2012 to June 2015, 120 patients suffered knee osteoarthritis accepted unilateral TKA. The patients with preoperative hemoglobin<95 g/L, blood system disease, combined history of myocardial infarction, atrial fibrillation, pacemaker installation, venous thrombosis, and renal insufficiency were excluded. The enrolled patients were divided into three groups: group A (TXA group) enrolled 40 cases (2g TXA with 100ml normal saline which was injected into the articular cavity through the drainage tube); group B (HCA group) enrolled 40 cases(four units HCA with 100ml normal saline injection using the same method); group C (NS group) enrolled 40 cases (100 ml normal saline injection by the same method). The blood routine, blood coagulation and D-dimer were rechecked on the 1^st , 3^rd and 5^th day postoperatively. The postoperative drainage volume, total blood loss, hemoglobin(Hb) values on 1^st , 3^rd and 5^th day postoperatively, blood transfusion, the rate of deep vein thrombosis and incision infection were recorded. F test was used to analyze the drainage volume, total blood loss, hidden blood loss and Hb values among the groups; χ² test was used to analyze the blood transfusion, the incidence of venous thrombosis and pulmonary embolism.

There were two cases of blood transfusions in the TXA group, three cases in the HCA group, 12 cases in the NS group, and significant differences were found between the HCA group/ NS group and the TXA group/ NS group (F=12.33, F=13.45 , P<0.01)while there was no significant differences between the HCA group and the TXA group (F=1.08 , P >0.05). HCA group and TXA group were compared with NS group for the drainage volume at 6 h (F=9.320)and 24 h (F=12.15)postoperatively, the hidden blood loss(F=9.450, F=8.650, F=7.885) and total blood loss(F=6.334, F=7.898, F=6.167) on the 1^st, 3^rd and 5^th day postoperatively showed significant difference (P<0.05)while no statistical difference was found between HCA group and TXA group (P>0.05). Hb values(F=6.300, F=8.470, F=10.56)and △Hb values(F=13.35, F=17.76, F=16.33)on the 1^st , 3^rd and 5^th day postoperatively in HCA group and TXA group compared with those in NS group showed significant difference(P<0.05); while no statistical difference was found between HCA group and TXA group (P>0.05). Two cases in TXA group , three cases in the HCA group and one case in the NS group occured calf muscular venous thrombosis; serious complications such as myocardial infarction, cerebral infarction, pulmonary infarction did not appear. No significant difference was observed among the groups in the thrombus incidence (F=1.4, P >0.05). The fat liquefaction of surgical incision occurred in all three groups, including three patients in the TXA group, two patients in the HCA group and four patients in the NS group.

Intra-articular injection of HCA or TXA and clipping the drainage tube for 3 h postoperatively can effectively reduce postoperative drainage volume, recessive blood loss and total blood loss on the postoperative first day and these managements would not increase the incidence of deep vein thrombosis and incision poor healing rate.

To evaluate the efficacy of adductor canal block(ACB) on pain management and early rehabilitation after total knee arthroplasty (TKA).

A total of 40 patients undergoing primary unilateral TKA in the first affilicated hospital of Harbin Medical University were randomly divided into two groups: ACB combined with parecoxib group (test group) and only parecoxib group (control group). Primary TKA patients were included, and the patients with severe infection or mental diseases were excluded. Adductor canal block was immediately performed. Perioperative data was calculated for statistical analysis.The data were analyzed with independent-samples t test, non-parameters Wilcoxon symbols test and chi-square test.

Comparing the test group with the control group, significant differences were found in rest pain, activity pain in early stage postoperatively (postoperative 6 h~72 h active VAS: Z= -3.124, -2.157, -2.044, -2.467, -2.471, all P < 0.05; postoperative 6 h~24 h rest VAS: Z=-2.310, -2.409, -2.208, P<0.05). No difference was found in knee function and length of hospital stay between two groups(P>0.05). The patients in the test group showed better compliance of rehabilitation. Further more, no ACB complication was found.

ACB can effectively alleviate postoperative pain in TKA patients, and it could be helpful for fast functional recovery.

To report the clinical results of the treatment of inferior polar fracture of the patella with patellar claw combined with tension band.

From August 2008 to October 2014, 53 cases of inferior polar fracture of the patella treated in the department of orthopedics, the 184th Hospital of PLA were enrolled in the study, and cases of fracture at patellar body were excluded. The treatment of 28 cases used only tension band (the Kirschner wire group) ; the treatment of the other 25 cases used patellar claw combining with tension band (the patellar claw group). The comparison of the healing time postoperative complications and the function of knee joint in the last follow-up between the Kirschner wire group and the patellar claw group was carried out. Statistical analysis was performed using SPSS 13.0 software for data analysis, which applied independent sample t test for fracture healing time, the postoperative complications, and chi-square test for the knee joint function.

All the cases were followed up for (12.5±2.9) months on average. The healing time of the patellar claw group [(9.7 ±0.9) weeks] was shorter than that of the kirschner wire group [(10.3±0.9) weeks]; the difference was significant(t=2.393, P <0.05). According to the Hospital of Special Surgery(HSS) scores, in the kirschner wire group, 10 patients recovered with excellent effect, nine patients with fine effect, seven patients with ordinary effect, and two patients obtained poor results; the fine rate was 67.9%. In the patellar claw group, 13 patients recovered with excellent effect, 10 patients with fine effect, one patients with ordinary effect, and one patients obtained poor results; the fine rate was 92%. The difference was significant (χ²=4.681 , P<0.05). In the Kirschner wire group, one case had traumatic arthritis, three cases occurred the internal fixation loosening, four cases occurred joint stiffness; in the patellar claw group, one case had traumatic arthritis, no internal fixation loosening was observed; the difference was significant (χ²=4.045, P<0.05).

The treatment of inferior polar fracture using the patellar claw combining tension band can achieve early knee joint function exercise and avoid joint stiffness, with satisfactory curative effect.

To observe advantages of simultaneous bilateral total knee arthroplasty (TKA) with three-dimentional(3D) printing osteotomy-guiding-plate and to analysis the actual significance of 3D printing technology in total knee arthroplasty.

From October 2014 to February 2015, the patients with osteoarthritis of knee joint were selected from inpatients of joint surgery department in Shenyang Orthopedic Hospital. The inclusion criteria were as follows: diagnosed as knee osteoarthritis(KOA); the symptoms were severe; classification of OA≥stage three; 60-75 years old without contraindication for surgery. Rheumatoid arthritis, traumatic arthritis, infection and cardiac or cerebrovascular diseases were excluded. Nineteen patients underwent bilateral total artificial knee arthroplasty with the help of personalized customized customized 3D printing mold(the 3D group), the other 20 patients who were selected by random number table underwent conventional total knee arthroplasty (the control group). The 3D group included 15 females and four males; the control group included 16 females and four males. The operation time, intraoperative blood loss, amount of post-operation drainage and occult bleeding volume were evaluated and compared between the 3D group and the control group with the same surgical approach. After the surgery, the two groups used the same rehabilitation program and medication regimen. A standardized follow-up was performed at three and six months postoperatively. The American Knee Society knee score(KSS) was used to evaluate the rehabilitation of knee joint function. Normalized lateral radiographs were taken to assess the angle between the femoral and tibial mechanical axes(MFTA), the angle between the anatomical axis of the femur and the tangent line of the femoral condyle in the coronal position(LDFA), the angle between the tibial anatomical axis and the tibial plateau tangent in the coronal position(MPTA), and the tibial posterior tilt angle in the sagittal plane(STCA). The differences between the two groups were compared by t test.

There was no significant difference in age and sex between the two groups, and there was no statistical significance(P>0.05). In the comparison of operation time, the 3D group was (170.6±26.5) min, slightly longer than the control group(165.3±24.6)min, but not statistically significant(P>0.05). In the comparison of intraoperative blood loss(t=7.1177), amount of post-operation drainage(t=7.2297) and occult bleeding volume(t=27.3163), the 3D group were less than the control group, there were significant differences(all P<0.05). Three months after the surgery, the KSS score difference between the two groups was statistically significant: the 3D group was (92.1± 2.3), while the control group was (89.4±3.6)(t=2.7797, P<0.05). There were significant differences between the two groups in the MFTA(t=7.1586) and the STCA(t=3.8190 )(all P<0.05). There was no significant difference between the two groups in the LDFA and the MPTA (P>0.05).

TKA with customized 3D printing osteotomy guides has the advantages of individualization, precision, digitization, and minimal trauma compared with TKA using conventional tools; in particular, the use of customized 3D printing osteotomy guides plays a good supporting role in bilateral simultaneous TKA.

To explore the application effect of the notion of fast-track surgery in treating rotator cuff tear under arthroscopy.

Thirty-seven patients with rotator cuff tear admitted by joint surgery department of Xianning Central Hospital, from February 2015 to August 2016 were analyzed retrospectively. All the patients were diagnosed with rotator cuff tear alone before operation and underwent rotator cuff suture repair under arthroscopy. These patients were randomly divided into fast-track surgery (FTS) group and traditional rehabilitation group (TRG): 19 cases in FTS group (10 males and nine females)with an average age of (43±9) years (22-60 years); 18 cases in TRG group(11 males and seven females) with an average age of (42±8) years old (19-63 years). These two groups were compared in terms of Constant score, the rating scale of American Shoulder and Elbow Surgeons (ASES), the University of California at Los Angeles Shoulder Rating Scale (UCLA), patients’ satisfaction and length of stay after operation at one week, one month and three months follow-ups, respectively.

The Constant-Murley score, ASES score, UCLA score and patient’s satisfaction at one week of FTS group were significantly higher than those in the TRG group(t=2.217, t=2.255, t=2.457, t=2.537, P<0. 05), The Constant-Murley score, ASES score, UCLA score and patient’s satisfaction at one month of FTS group were significantly higher than those in the TRG group(t=2.395, t=2.693, t=2.204, t=2.183, P<0.05). length of stay after operation, and total hospitalization expense of FTS were greatly lower than those of TRG (t=2.695, t=2.179, P<0.05). There was no statistically significant difference in the occurrence rate of undesirable incision healing between the two groups (F=0.717, P >0.05). The Constant-Murley score, ASES score, UCLA score and patient’s satisfaction at three months after operation of FTS group were much higher than those of TRG group (t=1.873, t=1.737, t=1.984, t=1.483, P<0.05).

The application of the notion of fast-track surgery in treating rotator cuff tear under arthroscopy can effectively promote patients’ early rehabilitation after operation, improve their shoulder joint scores, reduce their hospital stays and enhance their satisfaction.

To investigate the method and clinical effect of primary total knee arthroplasty(TKA) for the patients with severe later unstable knee.

A respective analysis was carried out. From January 2010 to June 2017, 17 patients (20 knees) with severe lateral instability underwent primary TKA in the joint department of the Lanzhou General Hospital of PLA. Among them, eight knees were from six males and 12 knees were from 11 females. Inclusion criteria: late stage of osteoarthritis or rheumatoid arthritis with medial-lateral instability of knee who underwent primary TKA. Exclusion cariteria: varus or valgus deformity of knee, extension subluxation of knee. In this group, osteoarthritis were nine cases (11 knees) and rheumatoid arthritis were eight cases (11 knees). The preoperative medial-lateral instability in the coronal plane was (12.0± 2.3) mm on anterior-posterior views. The functions of knee joint before and after the operation were evaluated with the American Knee Society score (KSS) and the range of motion (ROM). SPSS 18.0 statistic software was used to analyze the data, comparing the preoperative and postoperative data by paired t test.

All the patients were followed up for (31.5±0.3) months on average. KSS clinical score improved from preoperative (33±12)to( 89±7), and the KSS functional score improved from preoperative (36±9) to (86±6) at the final follow-up. The range of motion of the knee was improved from (69±29)° to (103±13)°. There was no complication such as infection, deep vein thrombosis, knee inst-ability or component loosening.

TKA for the knees with lateral instability demands precise evaluation for the structure and function of the ligaments of knee; good balance of soft tissues and correct prothesis selection of is the key to operation.

To compare the accuracy of three-dimensional(3D)patient-specific instrumentation(PSI) with conventional instrumentation concerning re-established lower limb alignment and prosthetic component positioning after total knee arthroplasty(TKA).

The randomized controlled trials that comparing 3D PSI with conventional osteotomy instrumentation concerning the lower limb alignment and clinical efficacy following TKA were searched through PubMed, Embase, CoChrane Library, CNKI, Chinainfo and other accessible electronic databases. The articles were precisely screened according to the inclusion criteria(the research types were randomized controlled studies, the research objects were end period osteoarthritis or rheumatoid arthritis patients who met primary TKA, the intervention and control measures were PSI or conventional instrumentation, the outcome measures included at least lower limb mechanical axis outliers) and exclusion criteria(the studies that did not meet the criteria mentioned above); the quality was assessed on the basis of the Jadad rating scale. Related data were extracted and analyzed by Review Manager 5.3, the relative risk (RR) and 95% confidence interval (CI) were evaluated for count data such as lower limb mechanical axis and prosthetic component outliers, the mean difference(MD) and 95% CI were calculate for continuous variables such as knee function score and operation time. The statistical results were reviewed in the end.

Eleven articles, including 12 trials were enrolled in this study. There was no statistically significant difference between PSI and conventional instrumentation in the post-operative hip-knee-ankle axis(lower limb mechanical axis) outliers[RR=0.88, 95%CI(0.65, 1.19), P>0.05]; the coronal femoral component outliers[RR=0.76, 95%CI(0.57, 1.02), P>0.05]; the coronal tibial component outliers[RR=1.19, 95%CI(0.68, 2.09), P>0.05]; the OKS scores at 3-month follow-up[MD=0.04, 95%CI(-1.63, 1.72), P>0.05] after TKA between PSI and conventional instrumentation. The post-operative femoral component rotation outliers indeed showed statistical difference [RR=0.55, 95%CI(0.33, 0.94), P<0.05].

PSI is more accurate than conventional osteotomy instrumentation in femoral component rotation after TKA.

To evaluate the efficacy and safety of radial extracorporeal shockwave therapy for treatment of supraspinatus tendinopathy in juvenile swimmers.

The study was designed as a prospective randomized controlled trial. After supraspinatus tear was excluded, 16 juvenile swimmers who were diagnosed supraspinatus tendinopathy by clinical examination and magnetic resonance imaging were enrolled in the study and were divided into control group and radial extracorporeal shockwave therapy (rESWT) group randomly.Ice compress, massage, modulated medium frequency electrotherapy were prescribed in the control group and meanwhile ice compress and rESWT were applied in the rESWT group. Visual analogue scale(VAS), simple shoulder test score, Constant score were used to evaluate before the treatment and at six weeks and 12 weeks after the last treatment. Independent t test was applied for comparing the results of both groups. P<0.05 was considered as significant difference.

Compared to the control group, the VAS score of rESWT group was significantly lower at six weeks(t=3.757, P<0.01) and 12 weeks(t=3.982, P<0.01) after the last rESWT. Compared to baseline, MRI scan after rESWT showed no significant change of supraspinatus. None of the complications related to rESWT was observed.

It shows a better short-term result of rESWT in releasing shoulder pain in juvenile swimmers with supraspinatus tendinopathy; the long term results are not clear.

Nowadays, with the rapid development and the continuous penetration of information technology to all fields, digital medicine arises at the historic moment. Medical research staff are continuing to study and explore new medical theories, new knowledge, new technologies and new methods with the help of digital technology, so that digital medicine has become very important and developmental direction of medical sciences in the 21st century , and has made great progress in the field of orthopedics. This review showed the development of digital medicine, the applications and prospects of digital medicine in orthopedics.

To explore the clinical effect of vitamin K2 combined with vitamin D3 on the young patients of early osteoarthritis of the knee.

From January 2016 to June 2017, 387 cases of young patient with pain of the knee were chosen in our hospital. And then according to the inclusive criteria, 132 cases were asked to take both vitamin K2(VK) and vitamin D3(VD) for 6 months. 25-OH-VD, procollagenⅠN-terminal peptide (P1NP) of the serum, VAS score and the muscle strength of four biceps femoris were the research objects before and after treatment.

After six months, 25-OH-VD, P1NP of the serum and the muscle strength of four biceps femoris were increased with statistical significance before treatment (P<0.05), while the VAS scores were decreased with statistical significance before treatment (P<0.05). And 33 cases were suggested with loss of cartilages and bone edema in the tibia and femur under X-ray and MRI before treatment.

VK2 combined with VD3 could release the pain and improve the activity of the young patients of early osteoarthritis of the knee properly through bone metabolism and osteogenesis. The young patients of early osteoarthritis of the knee should get enough intervention as soon as possible.

Total knee revision surgery is to reconstruct the joint structure. It’s an effective way to restore joint function. One of the problems in joint revision surgery is bone defects caused by loosening, infection, medical procedures and other factors. In recent years, with the widespread use of total knee arthroplasty (TKA) and the younger patients receiving arthroplasty, the number of TKA revision is also on the rise, and reports of treatment of bone defects in t TKA is more. The choice of prosthesis for revision surgery is very important for the outcome of the surgery. In recent years, the study of this issue has also deepened and diversified. The study on the treatment of bone defects not only lies in the traditional methods such as bone cement and bone grafting, but also the methods of metal pads and 3D printing developed based on the new concept. In clinical practice, appropriate methods should be used to rebuild joint lines, and restore joint function.

To evaluate the feasibility and safety of non-indwelling urinary catheter in the patients who receive unilateral primary hip or knee arthroplasty.

A retrospective study was carried out to analyze 109 patients who received unilateral primary hip or knee arthroplasty during Nov 2015 to Oct 2016 in China-Japan Friendship Hospital with non-indwelling catheter (NIC) and without obvious risk factors for urinary retention, preoperative urinary tract infection, urinary tract irritation or severe hepatorenal insufficiency. According to 1 ∶1 matching pair principle, they were paired with patients who received unilateral primary hip or knee arthroplasty with indwelling catheter (IC) during the same period. The feasibility and safety of non-indwelling urinary catheter was analyzed and evaluated by comparing the incidence of postoperative urinary retention, urinary retention recurrence, catheter-related bladder discomfort, urinary irritation symptoms, urinary tract infection, adverse events, postoperative hospitalization time and patient satisfaction between the NIC and IC groups. The SPSS19.0 statistics software was used to test the measurement data of normal distribution by paired t test, the measurement data of non-normal distribution by Wilcoxon signed rank sum test and the enumeration data by χ² test.

There was no significant difference (P>0.05) in terms of postoperative urinary retention, urinary retention recurrence or urinary tract infection between the two groups. The incidence of catheter-related bladder discomfort, urinary irritation symptoms, adverse events and postoperative hospitalization time in NIC group was significantly less and patient satisfaction was significantly higher than IC group (χ²=10.844, P<0.05). The rate of unnecessary catheterization in the patients who receive unilateral primary hip or knee arthroplasty was 81.7%.

Non-indwelling urinary catheter in patients who received primary hip or knee arthroplasty is safe and reliable, which could reduce the incidence of catheter-related bladder discomfort, urinary irritation symptoms and adverse events effectively, and shorten the postoperative hospitalization time, improve early patient satisfaction.

To explore the effect of rivaroxaban combined with local use of tranexamic acid in primary total hip arthroplasty(THA).

Inclusion criteria: age≥60 years, primary THA, no rivaroxaban and ammoniacal acid allergy. Exclusion criteria: deep venous thrombosis, pulmonary embolism or abnormal preoperative blood vessels, abnormal blood routine and blood coagulation dysfunction, cardiovascular and cerebrovascular diseases, severe cardiopulmonary renal insufficiency. A total of 146 patients undergoing primary total hip arthroplasty in the orthopedic department of the Second Affiliated Hospital of Xi’an Jiaotong University from January 2012 to January 2014 were selected and divided into the rivaroxaban + tranexamic acid group (the treatment group, n=73) and the rivaroxaban group(the control group, n=73). The following continuous variables were analyzed by t test: age, body mass index(BMI), operation time, total and intraoperative blood loss, drainage volume, preoperative hemoglobin(Hb), hematocrit(HCT) and coagulation index, as well as postoperative Hb, HCT, coagulation index on the 3^rd day and Harris hip function score in the 6th month. The following discrete variables were analyzed by Chi-square test: gender, disease types, transfusion cases.

There was no significant difference in age(t=0.657, P>0.05), gender(χ²=0.068, P>0.05), BMI(t=1.026, P>0.05), disease types(χ²=0.383, P>0.05) or operation time(t=0.193, P>0.05)between the two groups. The total blood loss(t=16.876, P<0.05), drainage volume(t=15.203, P<0.05), transfusion cases(χ²=6.032, P<0.05) in the experimental group were significantly less than those in the control group, the differences were statistically significant ; the postoperative Hb (t=4.874, P<0.05)and HCT(t=5.768, P<0.05)of the experimental group were significantly higher than those of the control group on the 3^rd day. The postoperative hrombosis events didn’t occur in the two groups.

Combined application of tranexamic acid and rivaroxaban in the primary THA of elderly patients does not affect the blood coagulation system, which can reduce the risk of postoperative thrombosis and the blood loss.

Osteoarthritis (OA), as characteristics are the loss of cartilage and concurrent changes in subchondral bone, is a common public health issue with Chinese people, resulting in joint pain and subsequent disability of the patients. Vitamin D plays an important role in calcium phosphorus metabolism, bone health and musculoskeletal function. However, the relationship between vitamin D and OA has not been clarified, and the goal of this literatures review is to determine relationship between vitamin D and OA.

To compare the clinical efficacy between the modified double Endobutton technique and the classical double Endobutton technique on the treatment of Rockwood type III acromioclavicular joint dislocation or greater.

Twenty-six patients with Rockwood type III injury and above this level were randomly treated with the modified double Endobutton technique (12 patients) or the classical double Endobutton technique (14 patients) from Jan 2015 to Jan 2017. The operation time, bleeding volume, the incision length, the incidence of post-operative compilations and recovery of the shoulder function of all patients were recorded and compared . The complications and postoperative joint functions were compared using chi-square test. The length of incision, intraoperative blood loss and operation time were measured by t-test.

Compared with the classic group, the length of the incision was similar in the modified group, and the incidence of complications were basically the same as those in the modified group. Although the function recovery of the shoulder joint was better in the classical group, the duration of surgery (t=6.18, P<0.01)and blood loss, which was(48.7±6.5)ml in the modified group were significantly less than (57.8±7.7)ml in the classic group (t=6.01, P<0.01). The differences were statistically significant between the two groups.

The improved double-button plate technique has less trauma, firm fixation, convenient operation, significantly reduced intraoperative blood loss, and significantly shorter operative time, but it does not improve shoulder function in the short term better than the classic group.