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26 February 2013, Volume 17 Issue 9 Previous Issue    Next Issue

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Establishment of normal lumbar and osteoporosis three-dimensional finite element models Li Wei1, Zhang Hong, Cao Li-jun, Ren Guo-shan, Yan Zhan-ping, Zhao Chang-yi, Gao Zeng-min 2013, 17 (9):  1521-1526.  doi: 10.3969/j.issn.2095-4344.2013.09.001 Abstract ( 526 )   PDF   Save BACKGROUND: Establishment of a realistic finite element model is the important basis for the finite element mechanics analysis of the spine. The reports on the finite element model of osteoporosis are less. OBJECTIVE: To establish the main composition of the normal lumbar spine and osteoporosis lumbar vertebrae finite element digital model in order to lay the foundation for the finite element analysis of the normal lumbar spine and lumbar vertebrae of osteoporosis patients. METHODS: One healthy male volunteer received the spiral CT scan on the lumbar spine, then the pictures were separated and reconstructed in Mimics, optimized in Geomagic, assigned material and meshed in Ansys, and finally the three-dimensional finite element digital model was established. RESULTS AND CONCLUSION: The three-dimensional finite element digital models were established, including the lumbar spine, the intervertebral disc and the main ligament of normal and osteoporotic lumbar spine. This model was living with appearance, perfect with similarity. It could revolve arbitrary, so that the researchers could observe and collect the three-dimensional information from multiple perspectives, and the main structural and material properties were closed to the actual properties, which is suitable for biomechanical study. The CT data which is software (mimics, were geomagic and Ansys) can used to establish the normal lumbar spine and osteoporosis finite element digital models. Figures and Tables | References | Related Articles | Metrics

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Digital templating alleviates leg length discrepancy after total hip arthroplasty Zhang Xue-jun, Wang Chen 2013, 17 (9):  1527-1534.  doi: 10.3969/j.issn.2095-4344.2013.09.002 Abstract ( 731 )   PDF (446KB) ( 715 )   Save BACKGROUND: Digital templating before replacement is a very important step in pre-operative planning of total hip arthroplasty. Accurate pre-operative templating can help orthopedists to select the most appropriate prosthesis and control the lower limb length during replacement. Consequently, patients can get satisfactory lower limb length and offset. The incidence of complications after operation will be decreased. OBJECTIVE: To investigate the influence of pre-operative digital templating on leg length discrepancy after total hip arthroplasty. METHODS: We performed a retrospective analysis in 334 patients who received total hip arthroplasty from October 2004 to May 2012 in the Department of Orthopedics, Zhongda Hospital Southeast University. Patients were divided into two groups according to the willingness of digital templating: control group (n=124) and measurement group (n=210). The patients in the control group did not receive digital templating. Patients in the measurement group received digital templating on the anteroposterior pelvic with the NEUSOFT PACS/RIS3.0 imaging system. The incidence of leg length discrepancy after replacement was compared between two groups. RESULTS AND CONCLUSION: The absolute value of leg length discrepancy of the patients in the measurement group was less than that in the control group (Z=-3.638, P < 0.01), indicating that the severity of leg length discrepancy in the measurement group was lower than that in the control group, more inclining to lower limb equal length. The absolute value of leg length discrepancy > 10 mm was considered as the diagnostic standard. The incidence rate of leg length discrepancy of the patients in the measurement group was lower than that in the control group (X2=7.17, P=0.007 < 0.05). The results indicate that digital templating can reduce the incidence of leg length discrepancy after total hip arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Total knee arthroplasty for the treatment of severe knee disease Li Guang-wei, Wang Hong-jun, Sun Xiao-zhi 2013, 17 (9):  1535-1542.  doi: 10.3969/j.issn.2095-4344.2013.09.003 Abstract ( 981 )   PDF (501KB) ( 935 )   Save BACKGROUND: Total knee arthroplasty used for the treatment of knee joint deformity is difficult and involves multi-aspects, including the surgical approach, intraoperative osteotomy, order, method and extent of soft tissue release and soft tissue balance, There are a lot of controversies due to different scholarly opinions. OBJECTIVE: To explore the surgical methods and clinical efficacy of total knee arthroplasty for the treatment of severe knee disease. METHODS: A total of 42 cases (48 knees) with severe knee disease and knee joint deformity were selected, and all the patients were treated with total knee arthroplasty using posterior stabilized prosthesis. Through patellar medial approach and correct osteotomy, selective soft tissue release was performed to restore normal knee alignment and soft tissue balance to harvest knee stability. The targeted rehabilitation training was performed after replacement and the knee range of motion and maximum knee flex degree were detected regularly. The Hospital for Special Surgery score and the Western Ontario and Mcmaster Universities Arthritis Index score were performed. RESULTS AND CONCLUSION: All patients were followed-up for 25 to 84 months, 35.5 months in average. The knee range of motion, maximum knee flex degree, Hospital for Special Surgery score and the Western Ontario and Mcmaster Universities Arthritis Index score of all the patients were significantly increased after replacement compared with those before replacement (P < 0.01). The wound was in stage Ⅰ recovery. No knee joint rigidity, blood vessel and nerve injury, patella fracture, patella low-site and prosthesis loosening were observed after replacement. The lower limb alignment was restored to normal level. The adult severe knee deformity can be corrected through total knee arthroplasty, and the function is improved significantly with satisfactory clinical results. Figures and Tables | References | Related Articles | Metrics

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Therapeutic effect of early Tuina rehabilitation treatment after total knee arthroplasty Wang Nian-hong, Yan Jun-tao, Sun Wu-quan, Hu Yong-shan, Xia Jun, Wei Li-cheng, Wu Yi, Jia Jie, Ouyang Gui-lin, He Yong, Guo Yan-ming, Xu Jie 2013, 17 (9):  1543-1548.  doi: 10.3969/j.issn.2095-4344.2013.09.004 Abstract ( 557 )   PDF (449KB) ( 527 )   Save BACKGROUND: The present study investigated the efficacy of Tuina rehabilitation on the patients with rheumatoid arthritis after total knee arthroplasty and the mechanism underlying Tuina rehabilitation. OBJECTIVE: To observe the clinical effect of early Tuina comprehensive rehabilitation therapy on rheumatoid arthritis patients after total knee arthroplasty, in order to provide some objective evidences for clinical rehabilitation treatment. METHODS: Sixty-six rheumatoid arthritis patients after total knee arthroplasty were equally divided into two groups control group and Tuina group. The patients in the control group underwent continuous passive motion training after replacement, and the patients in the Tuina group underwent continuous passive motion training combined with Tuina rehabilitation. The effect of Tuina comprehensive rehabilitation was observed through Hospital for Special Surgery system and 36-Item Short-Form Health Survey. RESULTS AND CONCLUSION: Comparison of the Hospital for Special Surgery score among groups at 3 months after replacement found that the function (P=0.020), muscle strength (P=0.020), stability (P=0.011) and total scores (P=0.019) were improved, and there were significant differences when compared with those before treatment (P < 0.05). Comparison of the 36-Item Short-Form Health Survey scores among groups at 3 months after replacement found that the emotional health score (P=0.003) and total health score (P=0.008) were significantly improved, and there were significant differences when compared with those before treatment (P < 0.05). Early Tuina rehabilitation could facilitate function restoration and improve strength, stability, emotional health and total health for the rheumatoid arthritis patients after total knee arthroplasty． Figures and Tables | References | Related Articles | Metrics

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Intelligent prosthetic ankle based on the finite state machine control Yang Peng, Bai Jian, Wang Xin-ran, Geng Yan-li 2013, 17 (9):  1549-1554.  doi: 10.3969/j.issn.2095-4344.2013.09.005 Abstract ( 886 )   PDF (447KB) ( 718 )   Save BACKGROUND: At present, intelligent prosthesis only focuses on the function of knee joint, while ankle joint prosthesis is only used as the aid of prosthetic knee joint. So the normal gait cannot be realized according to the change of external environment and gait. OBJECTIVE: To develop a reliable intelligent prosthetic ankle in order to improve the gait of amputees effectively. METHODS: Based on the variable damping ankle-foot prosthesis, the control method of finite state machine was proposed. The ankle joint gait was planned in detail, and the relevant control strategy was developed. RESULTS AND CONCLUSION: Results indicate that the intelligent prosthetic ankle based on the finite state machine control can effectively follow health limb lateral movement, and can adapt to different paces, which lays an experimental basement for later knee ankle coordinated movement. Figures and Tables | References | Related Articles | Metrics

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Screw stress features of the posterior asymmetric or symmetric fixation of transforaminal lumbar fusion based on a three-dimensional finite element method Ao Jun, Wan Lei, Liao Wen-bo, Xue Zhong-lin, Yu Bo, Jin An-min 2013, 17 (9):  1555-1562.  doi: 10.3969/j.issn.2095-4344.2013.09.006 Abstract ( 620 )   PDF (796KB) ( 955 )   Save BACKGROUND: Biomechanical investigation had discovered that effectiveness of the posterior asymmetric fixation based on transforaminal lumbar fusion is similar to double side pedicle screws fixation, which can meet the clinical biomechanical requirement. How is the transfacetopedicular screw security in posterior asymmetric fixation after transforaminal lumbar fusion? OBJECTIVE: To develop three-dimensional finite element model of L4-5 segment treated with posterior ipsilateral pedicle screws supplemented with contralateral transfacetopedicular screw fixation, posterior ipsilateral pedicle screws supplemented with contralateral translaminarfacet screw fixation and posterior bilateral pedicle screws fixation after transforaminal lumbar fusion respectively and treated with the same load, in order to evaluate the stress of the screws under different kinestates and the stress of three kinds of screws combined fixation in transforaminal lumbar fusion. METHODS: The geometrical model was created by Mimics 11.1 based on CT data of L4/5 motion segment, fusion cage, pedicle screws and os integumentale screw from an adult man. Different fixation models after left transforaminal lumbar fusion including the following sequentially test configurations: ipsilateral pedicle screws+contralateral translaminarfacet screw; ipsilateral pedicle screws+contralateral transfacetopedicular screw; bilateral pedicle screws. Subsequently, the above models were imported into the Simpleware 3.1 in order to establish the three-dimensional finite element models. 500 N\6 Nm loading was loaded on the upper surface of L4 of transforaminal lumbar fusion supplement with three types of fixations to simulate lumbar flexion, extension, lateral bending and axial rotation. The three-dimensional finite element models were imported into Abaqus 6.8 to analyze the stress changes and stress distribution of screws. RESULTS AND CONCLUSION: Left facet joint was removed in transforaminal lumbar fusion procedure, leading to asymmetry stress attribution of internal implants. For rigid pedicle screws fixation, they were more influenced by asymmetry stress attribution, especially under left axial rotation. In asymmetry fixation, the stress of ipsilateral pedicle screws was increased accordingly due to the influence of transfacetopedicular screw, especially under left axial rotation. However, the breakage risk of screws remained lower under rotation controlled properly. For stepping down the risk of pedicle screws fatigue breakage, the axial rotation after three kinds of fixation based on transforaminal lumbar fusion should be restrict severely, especially the axial rotation on the side that facet joint was destroyed. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element analysis of in situ and reductive interbody fusion of lumbar spondylolisthesis Ni Wei-feng, Xu Jian-guang, Xue Feng 2013, 17 (9):  1563-1570.  doi: 10.3969/j.issn.2095-4344.2013.09.007 Abstract ( 517 )   PDF (733KB) ( 815 )   Save BACKGROUND: Due to the complexity of the spinal structure, it is difficult to conduct the exact biomechanical analysis on the changes of the stress distribution characteristics of the lumbar segment after in situ and reductive interbody fusion. OBJECTIVE: To compare the biomechanical changes of in situ and reductive interbody fusion of lumbar spondylolisthesis under mechanical loads and the effect of those changes on the lumbar stability through developing the three-dimensional finite element models of L4/5 degenerative spondylolisthesis treated with in situ and reductive interbody fusion pedicle screw internal fixation. METHODS: The three-dimensional finite element models of L4/5 segment of healthy male volunteers were established through analyzing the lower lumbar spine CT data and using the mimics, Catia, Patran and Marc softwares. Then the models were used to simulate the degenerative spondylolisthesis and to establish the L4/5 segment in situ and reductive interbody fusion and pedicle screw internal fixation models. The stress distribution characteristics of these two models under different mechanic loads were analyzed and the difference was compared. RESULTS AND CONCLUSION: Under the loads of flexion, extension, right rotation and left bending, there was no significant difference of the stress on the vertebral body, pedicle screw fixator and interbody fusion cage between the L4/5 segment degenerateive spondylolisthesis in situ and reductive interbody fusion and pedicle screw internal fixation models. Both the two models manifested that the pedicle screw fixator and interbody fusion cage take the majority of the loads. After the in situ and reductive interbody fusion internal fixation for the degenerative spondylolisthesis of the L4/5 segment, reduction or not has no great biomechanical influence on the fusion segment. Figures and Tables | References | Related Articles | Metrics

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Clinical outcomes of unilateral lumbar pedicle screw combined with translamina facet screw fixation versus bilateral fixation Xue Jian, Jin An-min, Sun Xiao-ping, Wang Yan-bin, Xie Wei-yong 2013, 17 (9):  1571-1578.  doi: 10.3969/j.issn.2095-4344.2013.09.008 Abstract ( 549 )   PDF (598KB) ( 823 )   Save BACKGROUND: The translaminar facet joint screw fixation and interbody fusion in the treatment of spinal disorders is a unique fixation method which can be used for degenerative lumbar spinal fusion. OBJECTIVE: To observe the clinical effect of the minimally invasive transforaminal lumbar interbody fusion combined with unilateral lumbar pedicle screw and translamina facet screw fixation versus conventional posterior lumbar interbody fusion combined with bilateral pedicle screw fixation for the treatment of low back pain. METHODS: Forty-nine patients had lumbar disc herniation with lumbar spinal mild instability were selected from Wu Jing Zong Dui Hospital of Guangdong Province between June 2010 and June 2012. All the patients were treated with posterior decompression and interbody fusion and internal fixation. Among the 49 patients, 24 patients were treated with minimally invasive transforaminal lumbar interbody fusion combined with unilateral lumbar pedicle screw and translamina facet screw fixation, and 25 patients were treated with conventional posterior lumbar interbody fusion combined with bilateral pedicle screws fixation. The clinical effects of the two methods above were compared. RESULTS AND CONCLUSION: There were no significant differences of vertebral fusion rate, Japanese Orthopedic Association score and visual analogue scale score between two groups (P > 0.05). These two approaches had similar clinical outcomes for single-level lumbar degenerative disorders with no instability. These two methods could effectively improve intervertebral fusion rate, make the small joint stability, relieve clinical symptoms and make outpatient follow-up satisfaction. In addition the incision length, operative time, intraoperative blood loss, postoperative incision drainage of minimally invasive transforaminal lumbar interbody fusion combined with unilateral lumbar pedicle screw and translamina facet screw fixation technology were significantly reduced (P < 0.05), and it indicated that the method had the advantages of small trauma and simple operation. Figures and Tables | References | Related Articles | Metrics

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Computer-assisted versus free-hand pedicle screw implantation Zhang Qi-wei, Zhang Yao-nan, Sun Chang-tai, Xu Hong-bing 2013, 17 (9):  1579-1585.  doi: 10.3969/j.issn.2095-4344.2013.09.009 Abstract ( 508 )   PDF (429KB) ( 861 )   Save BACKGROUND: Traditional pedicle screw placement technique relies on the anatomical landmark recognition and experience of the surgeons, even experienced spine surgeons may make the poor position of pedicle screw implantation. Computer navigation system can provide real-time multi-planar image and improve the placement accuracy for pedicle screw implantation. Lumbar vertebrae is the common position of pedicle screw implantation, and no literatures have reported the comparison of computer-assisted and free-hand lumber vertebral pedicle screw implantation at home and abroad. OBJECTIVE: To explore the accuracy and application of computer navigation in lumbar pedicle screw implantation in comparison with free-hand pedicle screw implantation. METHODS: 190 patients with lumbar disc herniation and lumbar spinal stenosis were selected, and all the patients were treated with posterior decompression pedicle screw implantation and intervertebral fusion or intertransverse fusion. The patients were randomly divided into two group, 90 patients in computer-assisted group and 100 patients in free-hand group. The implantation time, accuracy, piercing rate and incidence of neurovascular damage were compared between two groups. RESULTS AND CONCLUSION: A total of 480 pedicle screws were implanted into the computer-assisted group, the average implantation time was (8.0±2.5) minutes and the accuracy was 80.4% (386/480); a total of 514 pedicle screws were implanted into the free-hand group, the average implantation time was (3.0±1.0) minutes and the accuracy was 84.4% (430/514). Statistical analysis showed that the implantation time in the computer-assisted group was significantly longer than that in the free-hand group (P < 0.01). There were no significant differences in accuracy, piercing rate and incidence of neurovascular injury between two groups. The results suggest that during the lumber pedicle screw implantation, computer-assisted pedicle screw implantation has no significant advantages compared with free-hand pedicle screw implantation, and the implantation time of computer-assisted implantation is longer than that of free-hand implantation. Therefore, the computer-assistance has little help to the lumbar pedicle screw implantation. Figures and Tables | References | Related Articles | Metrics

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Biomechanical testing of adjacent double segment lumbar fractures treated with the spinal external fixator Yi Guo-liang, Song Xi-zheng, Wang Wen-jun, Yao Nü-zhao 2013, 17 (9):  1586-1591.  doi: 10.3969/j.issn.2095-4344.2013.09.010 Abstract ( 762 )   PDF (405KB) ( 812 )   Save BACKGROUND: Overactive adjacent motion segment is an important factor for adjacent segment degeneration after thoracolumbar fracture fixation, which can cause stress concentration on this segment, and the cephalad adjacent segment is more prone to degeneration than caudal adjacent segment. The more the fixed segments are, the higher the stress concentration of the adjacent segment, and the larger the degeneration rate. OBJECTIVE: To assess the biomechanical stability and range of motion degeneration of the upper adjacent vertebrae by the biomechanics testing of the pedicle screw external fixation for adjacent double segment lumbar burst fractures. METHODS: There were 14 vertebra samples (T14-S1) from six fresh adult pig spinal specimens. Each of them underwent a biomechanical test in the following order to minimize the inter-group interference, including normal group, fracture group (L3 and L4 vertebral specimens were made into the burst fracture models), external fixation group (L2 and L5 vertebral specimens were fixed with spine external fixtor) and internal fixation group (the L2 and L5 vertebral specimens received the traditional open posterior fixation after the spine external fixtor removed). The range of motion of L2-5 and the upper adjacent segment L1 were measured under flexion, extension, lateral bending and axial rotation angles before and after internal fixation and external fixation. RESULTS AND CONCLUSION: Range of motion in the fracture group, internal fixation group and external fixation group was significantly larger than that of the normal group (P < 0.05). Range of motion of L2-5 in the internal fixation group and external fixation group was significantly less than that of normal and fracture groups (P < 0.01). There was no significant difference in immediate stability index between the internal fixation group and external fixation group (P > 0.05). Compared with normal group, the range of motion of the upper vertebra L1 after internal and external fixation was increased; there was no significant difference in range of motion of upper vertebrae L1 under flexion and extension between external fixation group and normal group (P > 0.05), but there was significant difference under lateral bending and axial rotation (P < 0.01). There was significant difference in range of motion of the upper vertebra L1 under flexion, extension, lateral bending and axial rotation between internal fixation group and the normal group (P < 0.01). Compared with traditional internal fixation, the immediate stability index of the spinal external fixation in treating adjacent double segment burst fractures was equal. Both two fixation methods could increase the range of motion of the adjacent upper vertebra under lateral bending and rotation. But the spinal external fixation could not increase the range of motion of adjacent upper vertebrae under flexion and extension. Figures and Tables | References | Related Articles | Metrics

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Chemokin CXC motif receptor 4 expression in bone tissue surrounding anode-oxidized implants during early implantation Jia Ting-ting, Zhang Yun-tao, Liu Shun-zhen, Sun Xin, Hou Yu-dong 2013, 17 (9):  1592-1597.  doi: 10.3969/j.issn.2095-4344.2013.09.011 Abstract ( 588 )   PDF (628KB) ( 812 )   Save BACKGROUND: The anode-oxidized implants have shown high implant stability at early period compared to traditional implants. However, the cellular and molecular mechanisms are unknown. OBJECTIVE: To investigate the significance of chemokin CXC motif receptor 4 in bone tissue around anode-oxidized implant during early implantation. METHODS: Forty Wistar rats of 4 months old were selected and randomly divided into 6, 12 and 24 hours implantation groups and blank control group. Rats in experimental groups received anode-oxidized implant in one tibia and sand blast implant in the other one. Rats in the experimental groups were killed at 6, 12 and 24 hours accordingly after implantation, the implants were unscrewed, and the bone tissue around implants was prepared, 2 cm in diameter. For blank control group, proximal epiphysis bone tissue about 2 cm in diameter were prepared. Half bone tissues in the experimental groups were made into protein samples. The expression of chemokin CXC motif receptor 4 was detected by Western blot with β-actin as internal reference. The other half bone tissues were treated with neutral ethylene diamine tetraacetie acid, and then slides were made. The expression of chemokin CXC motif receptor 4 was detected by immunohistochemistry. The implants in the 24 hours implantation group were examined by scanning electron microscope. RESULTS AND CONCLUSION: The results of Western blot demonstrated that the expression of chemokin CXC motif receptor 4 in rat bone tissue of the experimental groups were significantly higher than that of the blank control group within 24 hours after implantation. At the same time point, the expression of chemokin CXC motif receptor 4 in rat bone tissue around the anode-oxidized implant was higher than that around the sand blast implant. The results of immunohistochemistry were consistent with those of Western blot. The observation results of scanning electron microscope showed that anode-oxidized surface showed more attached mesenchymal-like cells scattered all over the surfaces than the sand blast implant. The anode-oxidized implants can induce higher expression of chemokin CXC motif receptor 4 around bone tissue, and may promote the stability of implant at early time points. Figures and Tables | References | Related Articles | Metrics

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Femoral neck shortening after fracture fixation with cannulated screws Liu Yue, Zheng Shi-wei, Wu Liang, Zhang Yan, Yang Tie-yi 2013, 17 (9):  1598-1604.  doi: 10.3969/j.issn.2095-4344.2013.09.012 Abstract ( 1093 )   PDF (465KB) ( 807 )   Save BACKGROUND: Generally, 2 cm shortening of the femoral neck may influence the function of hip joint. But in recent years, many literatures demonstrate that 5 mm shortening of the femoral neck may impact the function and the life quality, and there are a lot of controversies. OBJECTIVE: To investigate the incidence, functional impact and related factors of femoral neck shortening after the treatment of femoral neck fractures with closed reduction and cannulated screw fixation. METHODS: Ninety-four patients with femoral neck fractures admitted during May 2003 to January 2011, who were treated with closed reduction and cannulated screws fixation, were selected for the retrospective analysis. The patients with fracture nonunion and femoral head necrosis were excluded and finally 86 patients were included for the analysis. Femoral neck fractures were fixed with three cannulated screws after satisfactory closed reduction. The shortening length ≥ 5 mm, ≥ 10 mm and ≥ 20 mm were considered as three reference points to investigate the incidence of shortening (by comparing bilateral femoral neck centerline), as well as the effect of several factors on femoral neck shortening. RESULTS AND CONCLUSION: The median of femoral neck shortening in 86 patients was 2.6 mm and averaged in (5.21±5.49) mm, including 36% (31/86) for shortening ≥ 5 mm, 19% (16/86) for shortening ≥ 10 mm and 3% (3/86) for shortening ≥ 20 mm. There was significant difference in Harris scores among three shortening groups, indicating that shortening ≥ 5 mm could influence the function of hip joint. Gender, age, singh index, Garden index and body mass index were the factors that affected the femoral neck shortening after fixation of femoral neck fractures. The results suggested that the incidence of femoral neck shortening is higher after closed reduction and cannulated screw fixation for femoral neck fractures, and the femoral neck shortening ≥ 5 mm could impact the function of hip joint. Figures and Tables | References | Related Articles | Metrics

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Absorbable screw internal fixation: Complications and prevention measures Xu Ke-lin, Yin Qu-dong, Gu San-jun, Sun Zhen-zhong, Shou Kui-shui 2013, 17 (9):  1605-1610.  doi: 10.3969/j.issn.2095-4344.2013.09.013 Abstract ( 2162 )   PDF (454KB) ( 664 )   Save BACKGROUND: In some special parts of limbs, absorbable screws instead of metal screws have obtained good fixation effects, but, a few complications also appear. The causes and prevention measures of complications of absorbable screws have been reported less in literature. OBJECTIVE: To analyze the incidence, causes and prevention measures of complications of absorbable screw internal fixation. METHODS: A total of 113 cases treated with 236 absorbable screw or rod internal fixation were studied retrospectively. Among the 113 cases, limb fractures occurred in 92 cases and ligament reconstructions in 21 cases. Excepted for four cases of tibial shaft fractures, the rest cases of limb fractures were cancellous bone fractures near the joints. RESULTS AND CONCLUSION: All the patients were followed-up for 12-48 months with an average of 20 months, the total incidence of complications was 10.6%.The fixation failure occurred in five cases (failure rate 4.4%), that was related with inappropriate choice of indications, osteoporosis, over-tapping and too early or excessive activity after operation. Among the five cases of fixation failure, displacement lighter in three cases and displacement significant in two cases. Local adverse reactions occurred in seven cases (6.2% incidence rate), that was mainly related with material composition, perforation of joint, too much outside exposure of screws. Among the seven cases of local adverse reactions, mild in two cases (1.8%) and severe in five cases (4.4%); early reactions in four cases (3.5%) and late phase reactions in three cases (2.7%). Complications of absorbable screws internal fixation are related with the material composition, poor choice of indication, failure to regulate the standard operation and too early or excessive activity after operation, as well as other factors. Figures and Tables | References | Related Articles | Metrics

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Mini double-thread hollow screw combined with osteotomy for the treatment of hallux valgus Xu Hai-dong, Chen Yong, Zhao Jian-ning 2013, 17 (9):  1611-1617.  doi: 10.3969/j.issn.2095-4344.2013.09.014 Abstract ( 641 )   PDF (454KB) ( 619 )   Save BACKGROUND: Treatments for hallux valgus are diverse. Mini double thread hollow screw combined with osteotomy surgery is a small invasive surgery, which can meet the orthopedic purpose of hallux valgus and can be considered as the new minimally invasive biological fixation material in clinic. OBJECTIVE: To retrospectively analyze the curative effect of mini double-thread hollow screw combined with osteotomy for the treatment of hallux valgus. METHODS: Thirty patients with hallux valgus (eight patients with bilateral orthopedic operation and 22 patients with unilateral orthopedic operation) were selected and treated with the first metatarsal osteotomy combined with mini double-thread hollow screw internal fixation according to the willingness of the patients. The X-ray films were taken before and after operation to compare the hallux valgus angle, intermetatarsal angle, sesamoides position and the American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale score. And the shortening length of first metatarsal bone was calculated. RESULTS AND CONCLUSION: Hallux valgus angle, intermetatarsal angle, sesamoides position and American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale score post-operation were improved obviously compared with those pre-operation. The shortening length of the first metatarsal bone was in orthopedic controllable scope, thereby avoiding deformity recurrence and metatarsus pain. Figures and Tables | References | Related Articles | Metrics

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Metal splint external fixation versus absorbable bone anchor system to treat closed mallet finger in early stage Ma Wen-ze, Liang Jing-feng, Li Wen-cheng 2013, 17 (9):  1618-1624.  doi: 10.3969/j.issn.2095-4344.2013.09.015 Abstract ( 761 )   PDF (465KB) ( 656 )   Save BACKGROUND: The absorbable bone anchor is a new internal fixation method. OBJECTIVE: To compare the clinical outcomes the metal splint external fixation and absorbable bone anchor system in treatment of closed mallet finger in early stage. METHODS: Forty cases of closed mallet fingers were selected, 24 cases were treated with the metal splint external fixation and 16 cases were treated with absorbable bone anchor system. The time from injury to treatment was less than 1 week. The clinical data and surgical outcomes of the patients were retrospectively analyzed, and the excellent and good rate of two groups was compared with statistical analysis. RESULTS AND CONCLUSION: All patients were followed-up for 4-14 months. Reference to the International Institute of Hand Surgery recommended TAM system, the excellent and good rate was 66.7% in the metal splint external fixation group and 93.8% in the absorbable bone anchor system group, exhibiting a significant difference between two groups (P < 0.05). There were two cases of recurrence in the metal splints external fixation group, one at 4 months and the other at 6 months after treatment. There was one case of local swelling and skin redness n the absorbable bone anchor system during functional training and these symptoms were improved after physical therapy. It indicated that the effect of the absorbable bone anchor system is significantly better than that of the metal splint external fixation. Absorbable bone anchor system is the first choice for the treatment of early closed mallet finger with the simple surgical procedure and the certain effect. However, the expensive price limits its wider application. Metal splint is easy to operate, but difficult to manage and the relapse rate is high during treatment. Figures and Tables | References | Related Articles | Metrics

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Geometry measurement of the proximal femur in the preoperative plan of hip fractures Cai Si-qing, Cai Dong-lu, Yan Li-sheng, Pan Yuan-cheng, Zhuang Hua-feng, Li Yi-zhong 2013, 17 (9):  1625-1632.  doi: 10.3969/j.issn.2095-4344.2013.09.016 Abstract ( 399 )   PDF (526KB) ( 918 )   Save BACKGROUND: Hip fracture is commonly seen, and frequently complicated with osteoporosis and deep vein thrombosis after treatment. Therefore, the careful preoperative plan is necessary. OBJECTIVE: To measure the geometric parameters of the proximal femur in the elderly female patients and to design the preoperative plan. METHODS: The pelvis radiographs of 204 female patients aged ≥ 50 years were collected between January 2010 and May 2012 from the Second Affiliated Hospital of Fujian Medical University. The geometric parameters, including femoral neck axis length, femoral neck width, medullary cavity width of femoral neck, femoral neck-shaft angle and canal flare index were measured with START-SOUTHERN medical software. The geometric parameters were measured in the contralateral hip for the patients with femoral neck fracture. Stratified analysis was done according to age. RESULTS AND CONCLUSION: The measurement results of hip plain films showed the femoral neck axis length of the old female patients was (97.14±6.16) mm, the femoral neck width was (33.76±3.03) mm, the medullary cavity width of femoral neck was (28.28±3.48) mm and the femoral neck-shaft angle was (127.05±3.43)°. The canal flare index was 3.50±0.55. Stratified analysis showed that, with aging, the canal flare index was reduced, and the canal flare index in the patients with femoral neck fracture was less than that in the non-fracture patients (P < 0.01). The measurement of the geometric parameters of the proximal femur was helpful to draw up the preoperative plan for patients with hip fracture and select the best placement of internal fixation. The canal flare index was beneficial for selecting the suitable prosthesis. Figures and Tables | References | Related Articles | Metrics

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Knee joint parameters are significant for anterior knee pain Sui Jin-po, Ge Bang-rong, Yang Wen-feng, Duan Guo-qing, Zhang Yuan-min, Zhao Xiao-wei, Xie Shi-cheng 2013, 17 (9):  1633-1640.  doi: 10.3969/j.issn.2095-4344.2013.09.017 Abstract ( 756 )   PDF (580KB) ( 730 )   Save BACKGROUND: The abnormality of some parameters such as congruence angle has statistical significance on anterior knee pain has been confirmed under CT measurement, but has not been confirmed through clinical operations. OBJECTIVE: To analyzes the relationship between the parameter of knee joint and anterior knee pain through measuring the parameters such as congruence angle, patellofemoral index, lateral patellofemoral angle and tilt angle. METHODS: Fifty patients with anterior knee pain caused by varying degrees of atellofemoral cartilage damage were included, and the parameters such as congruence angle, patellofemoral index, lateral patellofemoral angle and tilt angle were measured on the patellar X-ray axial film. The parameters were compared with those of the other 50 patients without anterior knee pain and only with meniscus injury. RESULTS AND CONCLUSION: There were significant differences in congruence angle, patellofemoral index and tilt angle on the patellar X-ray axial film, and there was no significant difference in lateral patellofemoral angle. The congruence angle and patellofemoral index have important diagnosis value for the patients with anterior knee pain caused by patellofemoral joint disorders and are considered as the most effective parameters which has clinical efficacy for the patients with patellofemoral joint disorders. Figures and Tables | References | Related Articles | Metrics

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Virtual knee arthroscopy system improves clinician surgical skills Chen Wei-jian, Xie Xiao-hui, Li Yun-gang, Liu Teng-fei, Sun Hong-tao, Li Gui-tao, Wang Fa-zheng 2013, 17 (9):  1641-1647.  doi: 10.3969/j.issn.2095-4344.2013.09.018 Abstract ( 573 )   PDF (593KB) ( 825 )   Save BACKGROUND: Virtual knee arthroscopy system has achieved some preliminary research results at home and abroad, but it is still unable to be popularized and applied widely because of the high cost. Therefore, we designed a set of simulation endoscopic equipment, which allows the surgeons to promote surgery skills during virtual surgery. OBJECTIVE: To evaluate the training effect of virtual knee arthroscopy system on surgical skills of the beginning students. METHODS: Twenty-four interns and orthopedists (16 interns with no arthroscopy operating experience; eight experts with arthroscopy operating experience) were selected from five different universities and different hospitals, and 16 interns were randomly divided into training group and control group, eight interns in each group. After system training, the training group was compared with the control group and expert group in the virtual knee arthroscopy system operation and clinical surgery operation, and the results were statistically processed. RESULTS AND CONCLUSION: In the virtual endoscope system operation, there was significant difference in the scores between the control and training groups (P < 0.001), and also between the control and expert groups (P < 0.001); however, there was no significant difference in the scores between the training and expert groups (P=0.115). In the clinical knee arthroscopy operation, there were significant differences between the training and control groups (P < 0.001), between the control and expert groups (P < 0.001), and between the training and expert groups (P=0.03). Virtual knee arthroscopy system can serve as beneficial surgery skill training for beginning students and the improvement of virtual operation technique may be related to clinical skills. Figures and Tables | References | Related Articles | Metrics

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Pillar implantation and percutaneous balloon kyphoplasty for the treatment of thoracolumbar vertebral compression fractures Yu Jin-he, Sun Xian-ze, Ren Liang, Liu Yan-bing, Gu Zhen-fang, Hou Shu-bing 2013, 17 (9):  1648-1654.  doi: 10.3969/j.issn.2095-4344.2013.09.019 Abstract ( 532 )   PDF (528KB) ( 711 )   Save BACKGROUND: Pillar implantation and percutaneous balloon kyphoplasty can overcome the drawbacks of “shell-like” vertebral after traditional posterior screw and rod system reset, make up the lack of traditional pedicle screw and rod system fixation, correct the deformity of the fractured vertebra with varying degrees, recover the carrying capacity and maintain the stability. But, which has the better efficacy has not been yet clear. OBJECTIVE: To compare the clinical effects of Pillar implantation and percutaneous balloon kyphoplasty for the elderly thoracolumbar vertebral compression fractures. METHODS: Pillar implantation was performed in 18 patients with elderly thoracolumbar vertebral compression fractures, percutaneous balloon kyphoplasty was performed in 76 patients with elderly thoracolumbar vertebral compression fractures. The operative time, blood loss, 24 hours visual analogue scale score, 7 days visual analogue scale score, anterior vertebral height and the Cobb angle were analyzed retrospectively. RESULTS AND CONCLUSION: Both Pillar implantation in 18 patients and percutaneous balloon kyphoplasty in 76 patients were successed. The visual analogue scale score and Cobb angle after Pillar implantation were decreased, but the anterior vertebral height was increased significantly, and there was significant difference of anterior vertebral height when compared with that before implantation (P < 0.05). Compared with percutaneous kyphoplasty, the Pillar implantation showed longer operative time, more blood loss and higher 24 hours visual balloon analogue scale score, and the differences were significant (P < 0.05). However, there were no significant differences in anterior vertebral height and 7 days visual analogue scale score between Pillar implantation group and percutaneous balloon kyphoplasty group (P > 0.05). There was no adverse reaction after Pillar implantation, and cement leakage could be observed in percutaneous balloon kyphoplasty group and no neurosis could be observed. Pillar implantation and percutaneous balloon kyphoplasty for the treatment of elderly thoracolumbar vertebral compression fractures have the advantages of simple operation, shorter operative time and less blood loss, and it can improve the anterior vertebral height and relieve the pain, which is considered as the effective method for the treatment of thoracolumbar vertebral compression fractures. Figures and Tables | References | Related Articles | Metrics

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Noise removal in electroencephalogram signal via independent component analysis approach based on the extended information maximization Huang Yan, Huang Hua 2013, 17 (9):  1655-1659.  doi: 10.3969/j.issn.2095-4344.2013.09.020 Abstract ( 728 )   PDF (477KB) ( 598 )   Save BACKGROUND: The electroencephalogram signal can reflect the different physiological and pathological activity of brain, many noises are interfused into electroencephalogram signals during the collecting and analyzing process, such as eye movements, eye blinks, heart beats and muscle activities, which affects people’s right to analysis and process the electroencephalogram signal. OBJECTIVE: To introduce an independent component analysis approach based on the extended information maximization in order to perform the noise removal in electroencephalogram signal. METHODS: The iteration of extended information maximization was performed to obtain the separation matrix, and the independent component after noise removal was used to reconstruct the electroencephalogram signal that need to be recorded. The electroencephalogram signal after noise removal with Matlab simulation was observed, and the correlation between electroencephalogram signal and electrooculogram signal was compared. RESULTS AND CONCLUSION: The independent component analysis approach based on extended information maximization could successfully remove the electrooculogram signal intervention from the electroencephalogram signal. The comparison of the power spectrum of the electroencephalogram signals before and after noise removal showed the independent component analysis approach based on extended information maximization could remove the frequency interference from the multi-channel electroencephalogram signals effectively and have no damage to other signals. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional reconstruction of pelvic arteries by laminagraphy of pipe cast specimens Hong Xia, Shi Xiao-tian, Wang Kun-ju, Lin Lin-ran 2013, 17 (9):  1660-1664.  doi: 10.3969/j.issn.2095-4344.2013.09.021 Abstract ( 564 )   PDF (472KB) ( 690 )   Save BACKGROUND: Two-dimensional images are observed in previous imaging diagnosis. With the development of medical technology and treatment equipment, the research on the distribution of small vessels of the human body in the three-dimensional space has become necessary. OBJECTIVE: To explore three-dimensional reconstruction of pelvic arterial by polyvinyl alcohol-cerium oxide angiography in order to provide anatomic basis for interventional therapy with blood vessel. METHODS: Tow specimens of cavitas pelvis from voluntary adult cadavers without gynecological disease were included. The specimens were pretreated through perfusing polyvinyl alcohol-cerium oxide contrast agent, and scanned consecutively with CT (QE Lights Speed VCT 64, USA). Three-dimensional reconstruction of the artery of cavitas pelvis was made by Mimics with the CT data. The occurrence of pelvic arterial branches and the clearness and satiation of the vessel wall were observed. RESULTS AND CONCLUSION: Cross-sectional images and three-dimensional reconstruction images were all satisfied. Three-dimensional reconstruction models could show the fourth-grade pelvic arterial branch clearly, and the models could rotate in every direction. It indicates that polyvinyl alcohol-cerium oxide angiography is an effective means for the three-dimensional reconstruction of pelvic arteries, which plays a guiding role in obstetrics and gynecology vascular interventional technology. Figures and Tables | References | Related Articles | Metrics

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Effect of hyperbaric oxygen on blood flow velocity of vertebro-basilar artery in sympathetic nerve type of cervical spondylosis Zhou Si-hua, Zheng Rui-lian, Yang Jun, Yu Ling-yun 2013, 17 (9):  1665-1672.  doi: 10.3969/j.issn.2095-4344.2013.09.022 Abstract ( 547 )   PDF (659KB) ( 727 )   Save BACKGROUND: The cause and the mechanism of sympathetic nerve type of cervical spondylosis are unclear, and there is no objective checking standard. Transcranial Doppler ultrasound apparatus can directly monitor the blood flow velocity of vertebro-basilar artery and can be considered as the significant indicator to diagnose the sympathetic nerve type of cervical spondylosis. However, reports on the effect of hyperbaric oxygen on blood flow velocity of vertebrobasilar artery in sympathetic nerve type of cervical spondylosis are rare. OBJECTIVE: To assess the efficacy of hyperbaric oxygen to blood flow velocity of vertebro-basilar artery in sympathetic nerve type of cervical spondylosis. METHODS: The patients with sympathetic nerve type of cervical spondylosis were randomly divided into two groups. The observation group took the computer-controlled pulse traction (Lueneburg health care company, Germany) and hyperbaric oxygen therapy. Control group barely using computer-controlled pulse traction (Lueneburg health care company, Germany). The bilateral vertebral artery and basilar artery were detected with Doppler examination before and after treatment. RESULTS AND CONCLUSION: The bilateral vertebral arteries and basilar artery blood flow in 41 patients with low blood flow velocity in the observation group were significantly increased (P < 0.01); the bilateral vertebral arteries and basilar artery blood flow in 22 patients with high blood flow velocity were decreased significantly (P < 0.01). In the control group, the blood flow velocity in systolic left vertebral artery and diastolic basilar artery was changed and others were not changed. The cure rate and the efficient rate in the observation group were significantly higher than those in the control group (P < 0.01). Hyperbaric oxygen can bilateral regulate the velocity of vertebro-basilar artery in sympathetic nerve type of cervical spondylosis. And the blood flow velocity motoring can be used as an objective basis to the diagnosis and treatment of sympathetic nerve type of cervical spondylosis, While, hyperbaric oxygen is a more effective therapy for sympathetic nerve type of cervical spondylosis. Figures and Tables | References | Related Articles | Metrics

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Effect of lumbar fusion and fixation on adjacent segment degeneration Gong Bing-nan, Xu Hao, Chen Jian-mei, Li Jin-quan 2013, 17 (9):  1673-1678.  doi: 10.3969/j.issn.2095-4344.2013.09.023 Abstract ( 1328 )   PDF (575KB) ( 1022 )   Save BACKGROUND: With the mature of the spinal surgery and the development of fixation instrument, spine fusion and fixation has become the main method for the treatment of spine diseases, but the long-term adjacent segment degeneration is more and more serious. OBJECTIVE: To retrospectively analyze the risk factors of adjacent segment degeneration after spinal fixation, which can help to improve spine fixation and reduce the long-term complications. METHODS: A computer-based search was performed on VIP database and PubMed database for the articles on the adjacent segment degeneration after spine fusion and fixation published from January 2005 to December 2012, the key words were “spine fusion, adjacent segment degeneration, unilateral single cage” in Chinese and English. All articles were selected firstly, and those related to adjacent segment degeneration after spine fusion were collected. Randomized controlled trials were included and the nonrandomized controlled trials were excluded. The duplicated investigations were eliminated. The articles explored the adjacent segment degeneration after spine fusion mainly dependent on the surgical method, fusion mode and damage of adjacent segment. RESULTS AND CONCLUSION: A total of 27 articles were coincident with the inclusion criteria. From the articles, we find that the fusion number, way, position and the damage to the adjacent segment were the main reasons for adjacent segment degeneration. The total disc replacement and unilateral single cage play important role in preventing and delaying the adjacent segment degeneration. The influence of the fixation materials and surgical way should be considered before fusion, in order to avoid and reduce the occurrence of adjacent segment degeneration. Figures and Tables | References | Related Articles | Metrics

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Appropriate metal implants for internal fixation of proximal femoral fractures Chen Jun-ming, Li Wen-cheng, Cai Yu, Ding Er-qin 2013, 17 (9):  1679-1686.  doi: 10.3969/j.issn.2095-4344.2013.09.024 Abstract ( 644 )   PDF (713KB) ( 675 )   Save BACKGROUND: Proximal femoral fracture often occurs in elderly population, and selecting the appropriate fixation implants is the key to guarantee the biocompatibility and treatment effect. OBJECTIVE: To analyze the selection and the biocompatibility of the metal implants for internal fixation for the treatment of proximal femoral fracture. METHODS: The relative databases at home and abroad were searched by the first author for the relative articles in December 2012. The Chinese key words were “proximal femoral fracture, dynamic hip screw, less invasive stabilization system, percutaneous compression plate, Gamma nail, intramedullary nail”, and the English key words were “proximal femoral fracture, dynamic hip screw, less invasive stabilization system, percutaneous compression plate, Gamma nail”. The literatures of the articles were Chinese and English. A total of 142 articles were screened out, and 17 articles were included for the final analysis according to the inclusion criteria. RESULTS AND CONCLUSION: The methods for the treatment of proximal femoral fracture included conservative treatment, metal implants internal fixation, external fixation, locking plate and prosthesis replacement therapy. At present, the domestic and international treatment points have abandoned the conservative treatments such as traction, and try best to perform the metal implants internal fixation. The clinical metal implants internal fixation can be divided into extramedullary fixation device and intramedullary fixation device, and the extramedullary fixation device included dynamic hip screw, inverted distal femoral less invasive stabilization system and percutaneous compression plate, while the intramedullary fixation device included the proximal femoral intramedullary nail, Gamma nail and reconstruction nail. Each treatment method and internal fixation device has their own advantages and limitations. We should propose a personalized treatment program and select the appropriate method according to the patient’s condition and treatment requirement during the clinical treatment. Figures and Tables | References | Related Articles | Metrics

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Positron emission tomography computed tomography/magnetic resonance imaging: A new progress of molecular imaging technique Zhang Min-yan, Wang Shu-yi, Yan Rong-guo, Ge Bin, Zhou Ying 2013, 17 (9):  1687-1694.  doi: 10.3969/j.issn.2095-4344.2013.09.025 Abstract ( 796 )   PDF (711KB) ( 1137 )   Save BACKGROUND: Positron emission tomography can reflect the cell metabolism and functional changes of cells at the molecular level. Magnetic resonance imaging can obtain images with higher soft-tissue contrast and better spatial resolution without ionizing radiation. With the fast development of multimodality molecular imaging techniques, positron emission tomography/magnetic resonance imaging as a multimodality molecular imaging technique can provide the molecular, morphological and functional information, so its clinical application is an anticipating focus of medical molecular imaging. OBJECTIVE: To overview the progress and problems meet in the development of positron emission tomography/magnetic resonance imaging and to get a clear prospect of its potential clinical and scientific application. METHODS: The CNKI database, SpringerLink database and PubMed database were searched by the first author for the related articles from January 2000 to June 2012. The English key words were “PET/MRI” and “multimodality molecular imaging or image fusion”, and the Chinese key words were “molecular imaging” and “image fusion”. The articles related to positron emission tomography/magnetic resonance imaging multimodality molecular imaging technique were selected, and for the articles in the same field, those published recently or in the authorized journals were selected. A total of 53 articles were included. RESULTS AND CONCLUSION: From the existing research results, positron emission tomography/magnetic resonance imaging have more advantages over traditional and other multimodality imaging techniques such as positron emission tomography/computed tomography and single-photon emission computed tomography/ computed tomography, as demonstrated by the pre-clinical studies and preliminary clinical experiences, and have broader development space. So it has capacity to bring the development of molecular imaging technique and clinical diagnosis into a new area. Figures and Tables | References | Related Articles | Metrics

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Correlation between lumbar disc degeneration and COL9A2 gene single nucleotide polymorphisms Chen Tao, Li Guan-bao, Liang Ke-you, Jia Shi-qing 2013, 17 (9):  1695-1702.  doi: 10.3969/j.issn.2095-4344.2013.09.026 Abstract ( 738 )   PDF (797KB) ( 823 )   Save BACKGROUND: Studies have shown that lumbar disc degeneration is closely related to genes. OBJECTIVE: To explore the relationship between COL9A2 gene single nucleotide polymorphisms (rsl2722877, rs3737820 and rs209914) and lumbar disc degeneration. METHODS: 280 patients with lumbar degenerative disc disease were selected, and 268 age- and sex-matched patients without lumbar degenerative disc disease were selected as control group. All the patients came from Guangxi Zhuang Autonomous Region. The blood samples were collected from the patients with lumbar degenerative disc disease and without lumbar degenerative disc disease to extract the genomic DNA and to design PCR primers and TaqMan probe for the rsl2722877 rs3737820 and rs209914 sites of COL9A2 gene. The allele frequency and genotype frequency were analyzed with SPSS17.0 software. RESULTS AND CONCLUSION: The differences of genotype and the allele frequency distribution of rsl2722877 rs3737820 and rs209914 sites were statistically significant (P < 0.05). The COL9A2 gene single nucleotide polymorphisms rsl2722877, rs3737820 and rs209914 were closely related with susceptibility of lumbar degenerative disc disease in Guangxi Zhuang population. Figures and Tables | References | Related Articles | Metrics

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Internal fixation with different implants for the treatment of old pelvic fractures Zhang Li-cheng, Lan Xia, Zhang Li-hai, Tao Sheng, Zhang Qun, Liang Xiang-dang, Guo Yi-zhu, Tang Pei-fu 2013, 17 (9):  1703-1710.  doi: 10.3969/j.issn.2095-4344.2013.09.027 Abstract ( 496 )   PDF (756KB) ( 565 )   Save BACKGROUND: The treatment not in time after pelvic fracture is the main reason for old pelvic fracture malunion which with higher morbidity. OBJECTIVE: To explore the effect of different implants internal fixation on old pelvic fracture malunion. METHODS: Nine patients with old pelvic fracture malunion were selected from the Department of Orthopedics, General Hospital of Chinese PLA between January 2008 and January 2011; the nine patients were treated with internal fixation at 87-165 days after injury, averaged 116.7 days. The pelvic rotational deformity of nine patients was more than 30°. Pre-treatment walking persistent pain occurred in five patients, two patients had serious pain and could not walk, mild intermittent pain in two patients. Four patients had lower limbs discrepancy, and the average ipsilateral shortening was 2.25 cm. The treatment was performed when the iliac artery completely temporary blocked by balloon catheter with expanded ilioinguinal approach. For the treatment of posterior pelvic ring deformity, five patients received iliac osteotomy, one patient received outer edge sacrum osteotomy (in 1.5 cm) and three patients received sacroiliac joint incision flip and fusion. RESULTS AND CONCLUSION: All the nine patients were followed-up for 12-48 months after implants internal fixation, and the average follow-up time was 24.8 months. The fracture healing time was 16-24 weeks, and the average healing time was 20.6 weeks. No sciatic nerve stretch injury occurred after treatment. According to the evaluation criteria reported by Mears DC after treatment, anatomic reduction was in six patients (6/9, 67%), satisfactory reduction in three patients (3/9, 33%). The follow-up of the nine patients showed that implants internal fracture combined with osteotomy for the treatment of old pelvic fracture through expanded ilioinguinal approach can effectively correct the deformity and reconstruct the pelvic stability. Figures and Tables | References | Related Articles | Metrics