Chinese Journal of Tissue Engineering Research ›› 2016, Vol. 20 ›› Issue (31): 4700-4706.doi: 10.3969/j.issn.2095-4344.2016.31.020
Previous Articles Next Articles
Lang Yi, Rong Kai, Chen Ping-bo
Revised:
2016-05-16
Online:
2016-07-22
Published:
2016-07-22
Contact:
Chen Ping-bo, Chief physician, Fourth Department of Orthopedics, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
About author:
Lang Yi, Attending physician, Fourth Department of Orthopedics, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
CLC Number:
Lang Yi, Rong Kai, Chen Ping-bo. Internal and external fixation materials for the repair of pelvic fracture: reasonable choice and biocompatibility[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(31): 4700-4706.
2.1 骨盆骨折内固定和外固定生物力学研究 骨盆骨折是一种高能量损伤,而骨盆为不规则结构,个体差异大,其复杂的周围组织结构及损伤机制给诊断和治疗带来了困难。进行骨盆、骨盆骨折、骨盆治疗相关生物力学研究有助于解释骨盆骨折的发生机制、骨折分型并对最终的治疗方式选择有着非常重要的作用。骨盆生物力学研究是诊断和治疗骨盆骨折的基础[9]。利用人体骨盆做力学实验存在很多困难和问题,近年来,相关生物力学研究方法主要有轴向静态加载、有限元分析,有限元分析为之提供了新方向[10-12]。随着有限元分析有关软件和仪器的开发,改善了骨盆骨折的诊断和治疗。 由于骨盆结构的特殊性,现有的生物力学研究存在诸多分歧,如加载模式和边界值不具可比性。基于研究困境,周期性生理载荷的加载模式受到重视。通过骨盆生物力学的试验研究[13],揭示骨盆自身的结构特点,对固定前后的生物力学行为有着明显影响,松质骨在实验载荷下存在能量吸收,对循环加载的测量结果会产生影响。松质骨拉力螺钉固定骨盆在生物力学评价上有可行性,结合临床检查手段,对于严重创伤的早期救治有应用价值。此外,应用数字医学技术有助于直观地显示骨盆内部情况并明确分型,能实现骨折复位及内固定模拟等操作,实现复杂髋臼骨折的术前设计,提高了内固定治疗的精确性[14]。 越来越多研究证明,骨盆的稳定性主要依赖于后方承受体质量的骶髂复合体,但当骨盆环发生严重损伤(如TileC型)时,耻骨联合和耻骨支对整个骨盆环的稳定性将发挥近40%的作用[15]。单纯前方固定对前后环均有损伤的骨盆稳定性较差,认为应对骨盆后环同时进行固定[16]。生物力学测试表明,单一的器械固定难以获得满意的骨盆环稳定强度,骨盆环的稳定性有赖于前、后环完整性的恢复[17-19]。稳定的骨盆前环骨折通常采用保守治疗,传统的髂骨翼置钉内固定操作简便,但长期稳定性欠佳,对骨盆后方移位的控制较差。对于不稳定骨盆前环骨折,大多采用外固定或内固定治疗,如髋臼上方加压外固定的生物力学稳定性好,便于操作,是特定情况下不稳定型骨盆骨折临时和确定性治疗的良好选择。 2.2 外固定材料的应用 早期及时采用外固定支架材料对骨盆骨折的复位和有效的固定,控制了出血、减少了死亡率和致残率[20-21]。骨盆外固定架材料为骨盆骨折的早期修复提供了可行的解决方案。 若早期及时用外固定架固定,可使骨折块得以稳定,消除其活动,便于凝血、血栓形成。有利于控制出血,有利于提高骨盆骨折的抢救成功率。根据骨盆骨折稳定性的Tile创伤分类,对不同的创伤类型应用相对应的作用力进行外固定架固定,具有创伤小、操作简单、不增加损伤等优点[22]。周强等[23]公开了一种骨盆外固定支架万能导向器,该骨盆外固定支架万能导向器包括角度可调节的定位器、外固定针套筒、量角器;定位器安装在量角器的圆心位置,角度可以调节,外固定针套筒安装在定位器上,外固定针套筒指向量角器的径向。这种新型的骨盆外固定支架万能导向器,外固定前在患者CT片上测量出髂骨翼的倾斜角度,把定位器及外固定针套筒调整至所需角度,就能够准确快速地将外固定针置入骨盆,提高了外固定针置入的准确性,简化了治疗过程。 髋臼上方外固定的钉道位于髂前下棘至髂后上棘间髋臼上方致密骨质内髂嵴前缘自髂前上棘向下至髋臼边缘,熟悉股外侧皮神经解剖可避免损伤。李增炎等[24]生物力学研究表明,置钉于髋臼上方密质骨中可比传统置钉法获得更佳的骨盆稳定性,外固定针插入髋臼上方4.0-5.0 cm能提供足够稳定性。经髋臼上方通道的外固定针可获得更长的钉-骨界面,并实现对骨盆后环的加压,增加固定可靠性。骨盆骨折外固定材料的应用可降低出血率,迅速缓解疼痛,但不能保证充分的稳定,常用于临时固定[25-27]。 2.3 经皮空心螺钉内固定材料 骨盆骨折内固定是治疗骨盆前环骨折最稳定的固定方式,以往常采用切开复位内固定,创伤大、出血多,常见有髂外血管损伤、髂外血管血栓形成、股神经损伤、股外侧皮神经损伤、腹股沟疝、淋巴漏及感染等并发症。随着影像学设备的发展和骨科外科技术的进步,微创内固定以其独特的优点已成为骨盆骨折治疗的发展方向。近年来随着骨盆骨折解剖及生物力学方面研究的深入,针对不稳定的骨盆环骨折患者,普遍认为内固定治疗的优势在于可以达到解剖复位,符合生理力学要求,患者尽早负重行走,最大限度提高骨盆的稳定性,能取得良好的治疗效果。 耻骨联合分离是一种高能量损伤,占骨盆骨折的24%。耻骨联合作为骨盆前环的构成部分,对骨盆环的稳定起重要作用,内固定的目的在于恢复耻骨联合的解剖结构及维持骨盆环稳定[17]。目前临床上耻骨联合内固定的选择有很多,重建钢板、锁定钢板治疗耻骨联合分离是目前开展较多的内固定方式,它们能使骨盆的完整性和稳定性得到较大限度的恢复。但切开复位内固定存在损伤股血管、膀胱、精索及会阴部(诸如股外侧皮神经、髂腹下神经、髂 腹股沟神经及生殖股神经),而且需剥离腹直肌止点,内固定后功能恢复慢。近年来在传统普通钢板基础上,开始出现各种新的内固定形式[28-29]。 随着术中C型臂及导航技术的开展,经皮空心加压拉力螺钉内固定在骨盆骨折中得到广泛应用,经空心拉力螺钉内固定治疗耻骨联合分离具有固定时间短、治疗过程中出血少、治疗后并发症发生率低及内固定后骨盆稳定性高等优点[30]。临床研究发现,经皮螺钉固定治疗耻骨联合分离除了医源性损伤率较低及内固定后功能恢复较好外,其固定强度接近钢板内固定[31]。 尹成国[32]通过对人尸体骨盆标本的局部解剖及空心加压螺钉治疗耻骨联合分离的置钉实验,确定经皮固定耻骨联合分离空心拉力螺钉技术的安全进钉点、出钉点、进钉 角度、进钉长度及进出钉点与周围重要组织结构的距离,为该技术的临床应用提供理论基础。实验结果显示,模拟内固定标本拍片及CT检查证实空心螺钉钉道均位于骨质内,螺钉角度、长度均在所得实验数据范围内,说明经皮空心加压拉力螺钉技术治疗耻骨联合分离是可行的、安全的。 2.4 经皮骶髂螺钉内固定材料 骶髂关节复合体是指位于骨盆环后部的骨-韧带复合结构,是躯干向下肢传导负荷的枢纽,损伤后骶髂关节复合体修复效果的好坏对骨盆功能的恢复有重要意义。骶髂关节复合体是骨盆后环的主要组成部分,包括双侧髂骨、骶骨、骶髂关节及髂前后韧带等组织,将躯干的力传向下肢。临床和生物力学研究剖表明,骶髂复合体对骨盆环的稳定至关重要,其骨折脱位若得不到有效的复位和合理固定,则易并发创伤性关节炎、骨折畸形愈合或不愈合、腰痛和下肢功能受限,严重影响患者的生活质量[19,33]。高能损伤的骨盆骨折多合并骶髂关节复合体骨折脱位,破坏骶髂复合体的完整性,因此在不稳定骨盆骨折内固定时,必须强调治疗骶髂关节复合体损伤的重要性。 目前内固定技术已成为骶髂关节复合体损伤的首选治疗方案,主要的内固定措施包括经皮骶髂螺钉固定、横栓固定、骶髂前路钢板固定、后路钢板固定等。骶髂关节复合体部位较深,周围解剖结构复杂,对内固定装置的稳定性及安全性有较高要求。杨军等[34]通过临床研究得出,CT引导下经皮骶髂关节螺钉内固定骶髂关节复合体损伤定位准确,内固定稳定,操作安全可靠,联合早期功能锻炼,疗效肯定,是固定骨盆后环损伤的最佳治疗方法之一。临床上以往常采用前路钢板固定或直视复位骶髂关节螺钉固定治疗骶髂关节骨折脱位,且部分患者获得了良好的疗效。薛波等[35]对36例骶髂复合体损伤患者在CT引导下经皮置入骶髂关节螺钉成功,经近2年随访该方法固定牢靠,无并发症,功能恢复满意,说明CT引导下经皮置入骶髂关节螺钉是修复骶髂关节复合体损伤的最好方法之一。 骶骨骨折常合并严重的神经损伤,由于骶骨解剖位置和结构的特殊性,其骨折有时具有脊柱骨折的特征,有时则以骨盆后环骨折的特征为主,也有时二者兼具,因此其治疗的原则和方法也因其类型和机制而异,需要进行固定修复。骶骨骨折的垂直、旋转移位依靠传统的外固定支架进行复位是困难的,其固定稳定性差及可能损伤神经的缺点[36-37]。骶骨骨折内固定干预的意义在于使骨盆环的解剖得以恢复并稳定骨折部位,为早期功能锻炼,减少并发症并为神经功能的康复提供可能。 经皮骶髂螺钉内固定与经皮重建钢板内固定是近年来较流行的修复骶骨骨折的微创方法,但有研究通过相关临床资料进行回顾性分析,发现纵行骶骨骨折切开复位内固定以骨盆重建带钢板固定方便可靠[38],而对横行骨折则宜选择椎弓根钉棒系统固定效果肯定,因此应根据不同类型的骶骨骨折应选择相应的内固定方式[39]。 2.5 髓内拉力螺钉内固定材料 骨盆骨折合并髋臼骨折常伴严重并发症,如坐骨神经损伤、股骨头坏死、髋关节创伤性关节炎等并发症发生率高,致残率较高,一直是临床研究的热点。据统计髋臼骨折约占全身骨折的3%,长期随访发现内固定治疗的远期效果优于保守治疗,故内固定方式及内固定种类也越来越多[40]。复杂髋臼骨折具有创伤暴力大,骨折表现复杂,切开复位能最大限度地恢复髋关节的解剖结构,降低并发症的发生。以往临床上髋臼骨折内固定材料常用螺钉、可吸收螺钉、克氏针、骨盆重建钢板螺钉等,可明显改善关节功能,降低致残率,很大程度上改善患者的生活质量[41-42]。 目前髋臼骨折内固定类型包括髓外固定如髋臼钢板固定,髓内固定如拉力螺钉固定,髓内、外相结合固定等。研究人员将髋臼横断骨折3种常用的内固定方法进行生物力学比较,发现髋臼横断骨折,前柱单钢板内固定的稳定性高于后柱单钢板内固定[43]。而后柱双钢板内固定的稳定性最强,但髋臼后壁为较易发生骨折的部位,因其解剖厚度较薄,较难固定,而在生理活动时又易受到撞击,易导致固定失败。髋臼前柱钢板是沿着髋臼前柱表面放置,由于该处毗邻盆腔和闭孔区域,损伤周围重要结构的概率比较大。因此,在内固定的治疗上仍存在继续探讨的问题。髋臼螺钉内固定具有创伤小、固定强度大、治疗时间短、操作简单等优点,在某些髋臼骨折内固定治疗中的应用具有明显的优势。髋髋臼前柱髓内固定属于中心性固定,生物力学稳定性高,创伤小,取出方便,但要求的技术也高[44-45]。"
[1] McKee MD.Internal fixation in pelvic fractures and primary repairs of associated genitourinary disruptions: a team approach.J Trauma.1997;42(5):981. [2] Scheyerer MJ,Zimmermann SM,Osterhoff G,et al. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures.BMC Res Notes.2014;7:133. [3] Bramos A,Velmahos GC,Butt UM,et al.Predictors of bleeding from stable pelvic fractures.Arch Surg.2011; 146(4):407-411. [4] Mardanpour K,Rahbar M.The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation. J Inj Violence Res. 2013;5(2):77-83. [5] Leenen LP,van der Werken C,Schoots F,et al.Internal fixation of open unstable pelvic fractures.J Trauma. 1993;35(2):220-225. [6] Ji X,Bi C,Wang F,et al.Digital anatomical measurements of safe screw placement at superior border of the arcuate line for acetabular fractures.BMC Musculoskelet Disord.2015;16:55. [7] Simonian PT, Schwappach JR, Routt ML Jr,et al.Evaluation of new plate designs for symphysis pubis internal fixation.J Trauma.1996;41(3):498-502. [8] Vigdorchik JM,Esquivel AO,Jin X,et al.Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures.J Orthop Surg Res.2012;7:31. [9] Comstock CP,van der Meulen MC,Goodman SB.Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures.J Orthop Trauma. 1996;10(8):517-522. [10] Giráldez-Sánchez MA,Lázaro-Gonzálvez A,Martínez-Reina J,et al.Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis. Injury.2015;46(2):327-332. [11] Toogood P,McDonald E,Pekmezci M.A biomechanical comparison of ipsilateral and contralateral pedicle screw placement for modified triangular osteosynthesis in unstable pelvic fractures.J Orthop Trauma.2013;27(9):515-520 [12] Humphrey CA,Liu Q,Templeman DC,et al.Locked plates reduce displacement of vertically unstable pelvic fractures in a Mechanical Testing Model.J Trauma. 2010;69(5):1230-1234. [13] 赵俊伟.骨盆前环骨折经皮空心拉力螺钉固定的生物力学研究[D].广东省:广东医学院, 2010:1-50. [14] 宋军,梅益彰,吴增城,等.复杂髋臼骨折复位及内固定的数字技术模拟研究[J].中国临床解剖学杂志,2013,31(4): 248-251. [15] Angthong C,Wunnasinthop S,Sanpakit S.Complex lumbosacral fracture-dislocation with pelvic ring disruption and vertical shear sacral fracture: a case report of late presentation and review of the literature.Ulus Travma Acil Cerrahi Derg. 2010; 16(6): 561-566. [16] Sztrinkai G,Bodzay T,Pajor S,et al.Further development of our finite element pelvic model to compare fixation methods for pelvic fractures.Eklem Hastalik Cerrahisi. 2014;25(1):8-14. [17] Moed BR,O'Boynick CP,Bledsoe JG.Locked versus standard unlocked plating of the symphysis pubis in a Type-C pelvic injury:a cadaver biomechanical study. Injury. 2014;45(4):748-751. [18] Simonian PT,Routt ML Jr,Harrington RM,et al.Box plate fixation of the symphysis pubis: biomechanical evaluation of a new technique.J Orthop Trauma 1994; 8(6):483-489. [19] Zhao Y,Zhang S,Sun T,et al.Mechanical comparison between lengthened and short sacroiliac screws in sacral fracture fixation: a finite element analysis. Orthop Traumatol Surg Res.2013;99(5):601-606. [20] Hu SB,Xu H,Guo HB,et al. External fixation in early treatment of unstable pelvic fractures.Chin Med J (Engl).2012;125(8):1420-1424. [21] Burlew CC,Moore EE,Smith WR,et al.Preperitoneal pelvic packing/external fixation with secondary angioembolization: optimal care for life-threatening hemorrhage from unstable pelvic fractures.J Am Coll Surg.2011;212(4):628-635. [22] 张建新,徐展望,贾连顺,等.骨盆外固定支架治疗骨盆骨折[J].中国矫形外科杂志,2005,13(2):105-108. [23] 周强,王占朝,陆骅.一种骨盆外固定支架万能导向器[P].上海:CN201420463292.8, 2014年12月17日. [24] 李增炎,雷鸣,李静,等.髋臼上方骨盆外固定技术相关研究[J].国际骨科学杂志,2010,31(2):86-88. [25] Scaglione M,Parchi P,Digrandi G,et al.External fixation in pelvic fractures.Musculoskelet Surg.2010;94(2): 63-70. [26] Gardner MJ,Nork SE.Stabilization of unstable pelvic fractures with supraacetabular compression external fixation.J Orthop Trauma.2007;21(4):269-273. [27] Bellabarba C,Ricci WM,Bolhofner BR.Distraction external fixation in lateral compression pelvic fractures.J Orthop Trauma.2006;20(1 Suppl):S7-14. [28] Rommens PM.Internal fixation in postpartum symphysis pubis rupture: report of three cases.J Orthop Trauma.1997;11(4):273-276. [29] Bartlett CS,Ali A,Helfet DL.Bladder incarceration in a traumatic symphysis pubis diastasis treated with external fixation: a case report and review of the literature. J Orthop Trauma.1998;12(1):64-67. [30] 王亮.空心拉力螺钉与重建钢板治疗耻骨联合分离的疗效比较[J].中国伤残医学,2015,23(15):515-519. [31] 黄高,王金华,张军,等.经皮复位螺钉固定与切开复位内固定治疗耻骨联合分离的疗效比较[J].创伤外科杂志,2013, 15(1):36-40. [32] 尹成国.经皮空心拉力螺钉技术治疗耻骨联合分离的定量解剖学研究[D].山东省:山东大学, 2014:1-49. [33] Schildhauer TA,Bellabarba C,Nork SE,et al. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation.J Orthop Trauma.2006;20(7):447-457. [34] 杨军,周振东,李建军,等.CT引导下经皮空心钉内固定治疗骶髂关节复合体损伤[J].中华创伤杂志,2011,27(1): 44-48. [35] 薛波,胡勇,徐荣明,等.CT引导下空心拉力螺钉内固定治疗骶髂复合体损伤[J].中国骨与关节损伤杂志,2004, 19(7):445-447. [36] Bellabarba C,Schildhauer TA,Vaccaro AR,et al.Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability. Spine (Phila Pa 1976).2006; 31(11 Suppl):S80-88. [37] Choy WS,Kim KJ,Lee SK,et al.Anterior pelvic plating and sacroiliac joint fixation in unstable pelvic ring injuries.Yonsei Med J.2012;53(2):422-426. [38] 王晨,黄亚增.改良Stoppa入路治疗骨盆、髋臼骨折的临床疗效与优势分析[J].中国基层医药,2013,20(11): 1735-1736. [39] 吴小宝,樊志强,汤培.骶骨骨折内固定方式选择与临床意义[J].临床军医杂志,2013,41(7):736-739. [40] Xiaoxi J,Fang W,Dongmei W,et al.Superior border of the arcuate line: Three dimension reconstruction and digital measurements of the fixation route for pelvic and acetabular fractures.Int Orthop.2013;37(5):889-897. [41] Vikmanis A,Vikmanis A,Jakusonoka R,et al.Mid-term outcome of patients with pelvic and acetabular fractures following internal fixation through a modified Stoppa approach.Acta Orthop Belg.2013;79(6): 660-666. [42] Puchwein P,Enninghorst N,Sisak K,et al.Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion.Arch Orthop Trauma Surg.2012; 132(6):805-811. [43] 王庆贤,张英泽,潘进社,等.髋臼横断骨折不同内固定方式的生物力学研究[J].中华物理医学与康复杂志, 2004, 23(5):279-281. [44] Schwab JM,Zebrack J,Schmeling GJ,et al.The use of cervical vertebrae plates for cortical substitution in posterior wall acetabular fractures.J Orthop Trauma. 2011;25(9):577-580. [45] Sagi HC,Afsari A,Dziadosz D.The anterior intra-pelvic (modified rives-stoppa) approach for fixation of acetabular fractures.J Orthop Trauma.2010;24(5):263-270. |
[1] | Shi Bin, An Jing, Chen Long-gang, Zhang Nan, Tian Ye . Influencing factors for pain after total knee arthroplasty [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 993-997. |
[2] | Wang Xian-xun. Impact of local compression cryotherapy combined with continuous passive motion on the early functional recovery after total knee arthroplasty [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 998-1003. |
[3] | Yuan Wei, Zhao Hui, Ding Zhe-ru, Wu Yu-li, Wu Hai-shan, Qian Qi-rong. Association between psychological resilience and acute mental disorders after total knee arthroplasty [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1015-1019. |
[4] | Chen Qun-qun, Qiao Rong-qin, Duan Rui-qi, Hu Nian-hong, Li Zhao, Shao Min. Acu-Loc®2 volar distal radius bone plate system for repairing type C fracture of distal radius [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1025-1030. |
[5] | Huang Xiang-wang, Liu Hong-zhe. A new low elastic modulus of beta titanium alloy Ti2448 spinal pedicle screw fixation affects thoracic stability: biomechanical analysis [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1031-1035. |
[6] | Xie Qiang. Three-dimensional finite element model for biomechanical analysis of stress in knee inversion and external rotation after posterior cruciate ligament rupture [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1036-1040. |
[7] | He Ze-dong, Zhao Jing, Chen Liang-yu, Li Ke, Weng Jie. Multilevel finite element analysis on the biological tribology damage of water on bone tissue [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1041-1045. |
[8] | Jiang Zi-wei, Huang Feng, Cheng Si-yuan, Zheng Xiao-hui, Sun Shi-dong, Zhao Jing-tao, Cong Hai-chen,Sun Han-qiao, Dong Hang. Design and finite element analysis of digital splint [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1052-1056. |
[9] | Wang Fei, Liu Zhi-bin, Tao Hui-ren, Zhang Jian-hua, Li Chang-hong, Cao Qiang, Zheng Jun, Liu Yan-xiong, Qu Xiao-peng. Clinical efficacy of preoperative osteotomy designs using paper-cut technology versus photoshop software for ankylosing spondylitis with kyphosis [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1057-1063. |
[10] | Li Hui, Ma Jun-yi, Ma Yuan, Zhu Xu . Establishment of a three-dimensional finite element model of ankylosing spondylitis kyphosis [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1069-1073. |
[11] | Ling Guan-han, Ou Zhi-xue, Yao Lan, Wen Li-chun, Wang Guo-xiang, Lin Heng-feng. Establishment of simulating three-dimensional model of China-Japan Friendship Hospital Classification for L type osteonecrosis of the femoral head [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1074-1079. |
[12] | Fu Wei-min, Wang Ben-jie. Assessing the degree of necrotic femoral head, and association of blood supply with pathlogical changes: study protocol for a diagnostic animal trial [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1086-1091. |
[13] | Zhang Wen-qiang, Ding Qian, Zhang Na. Associations between alpha angle and herniation pit on oblique axial magnetic resonance imaging in asymptomatic hip joints of adults [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1098-1103. |
[14] | Sun Xiao-xin1, Zhou Wei2, Zuo Shu-ping3, Liu Hao1, Song Jing-feng1, Liang Chun-yu1. Morphological characteristics for the magnetic resonance imaging assessment of discoid lateral meniscal tears in children [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1104-1109. |
[15] | Lin Han-wen, Wen Jun-mao, Huang Chao-yuan, Zhou Chi, Tang Hong-yu. Correlation between the changes in lower limb power line and pain area in the knee osteoarthritis patients: imaging evaluation [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1110-1114. |
Viewed | ||||||
Full text |
|
|||||
Abstract |
|
|||||