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23 July 2013, Volume 17 Issue 30 Previous Issue    Next Issue

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Proteoglycan and collagen type Ⅱ in the adjacent intervertebral disc of the cervical instability models Wu Bin, Meng Chun-yang, Wang Hai-bin, Jia Cun-ling, Zhao Yi-feng 2013, 17 (30):  5421-5426.  doi: 10.3969/j.issn.2095-4344.2013.30.001 Abstract ( 340 )   PDF (2165KB) ( 519 )   Save BACKGROUND: Cervical decompression and fusion internal fixation will accelerate adjacent segment disc degeneration, and it is not clear whether single segment instaibility can increase the adjacent segment disc degeneration. OBJECTIVE: To study the changes of morphology, proteoglycan and collagen type Ⅱ in the adjacent intervertebral disc of the cervical instability models. METHODS: Sixteen New Zealand white rabbits were divided into two groups randomly, with eight rabbits in the control group and eight rabbits in the model group. The animal cervical instability models were made by destroyed partly annulus fibrosus and absorbed C5/6 nucleus pulposus through anterior cervical puncture. After 12 weeks, the animal models were tested by X-ray film. All rabbits were sacrificed and 10 mg nucleus pulposus of the intervertebral discs of C4/5 cut from sagittal plane were harvested and stored under 0 ℃. The content of proteoglycan in nucleus pulposus was tested with phloroglucinol method. Then, the paraffin sections of intervertebral disc tissues were taken for hematoxylin-eosin staining and SABC immunohistochemical staining.  RESULTS AND CONCLUSION: The notochord cells of C4/5 intervertebral discs in the experimental group was decreased, and being replaced by fibroblast-like cells. Round chondrocytes could be seen occasionally and intervertebral discs annulus fibrosus became rough and arranged disorderly, the hyaline degeneration and pigmentation were observed as well as the fibrochondrocytes, and there was a gap between inner and outer annulus fibrosus. The content of proteoglycan was decreased in the nucleus pulposus, and there was significant difference between two groups. The collagen type Ⅱ in the degenerative disc nucleus pulposus and annulus fibrosus of the experimental group was lower than that of the control group. Cervical instability can lead to adjacent intervertebral disc degeneration with the morphological changes and decreased content of proteoglycan and collagen type Ⅱ. Figures and Tables | References | Related Articles | Metrics

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Femoral head diameter and acetabular anteversion in hip prosthesis replacement Zhang Jiang-tao, Shang Yan-chun, Wu Fu-yuan, Qu Guang-yun 2013, 17 (30):  5427-5433.  doi: 10.3969/j.issn.2095-4344.2013.30.002 Abstract ( 867 )   PDF (757KB) ( 760 )   Save BACKGROUND: Posterior dislocation after total hip replacement is one of the most common complications that second only to loosen, and can affect the stability of the hip joint seriously. There is controversy on the effect of femoral head diameter and acetabular anteversion on the stability of hip joint in clinical study. OBJECTIVE: To investigate the effect of the femoral head diameter and acetabular anteversion on the stability of hip joint after hip prosthesis replacement. METHODS: The femoral head diameter and acetabular anteversion that affect the posterior instability after hip prosthesis replacement were measured on the cadaveric bone. The acetabular shell was inserted at 0°-20° of anteversion at five degree intervals. The femoral heads with different diameters (28, 32 and 36 mm) were used for experiment, the internal rotation degrees to dislocation caused by hip at 90° flexion and 0° adduction and at 90° flexion and 30° adduction were recorded. RESULTS AND CONCLUSION: When the cup anteversion varied from 0° to 15°, there was an increase in the degree of internal rotation angle that could cause hip dislocation with the increasing of femoral head diameter (P < 0.05). When the cup anteversion varied from 15° to 20°, the increasing trend was not significant. With the hip at 90° flexion and 0° adduction, and the cup anteversion varied from 15° to 20°, the stability of 36 mm group was significantly higher than that of the 28 mm and 32 mm groups (P < 0.01); the stability of 32 mm group was higher than that of 28 mm group when the acetabular anteversion in 10° or more (P < 0.05); there was no significant difference in stability between groups when the anteversion less than 10°. With the hip at 90° flexion and 30° adduction, the stability of 36 mm group was significantly higher than that of the 28 mm and 32 mm groups (P < 0.01); the stability of 32 mm group was higher than that of 28 mm group when the acetabular anteversion in 10° or more (P < 0.05); there was no significant difference in stability between groups when the anteversion less than 10°. The results indicate that the increasing of acetabular anteversion can reduce the occurrence of dip dislocation, but when it is difficult to choice the acetabular anteversion, large-diameter femoral head is preferred to increase the stability of hip joint.  Figures and Tables | References | Related Articles | Metrics

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Artificial total hip arthroplasty and hip-self procedure in the treatment of congenital dislocation of hip  Liu Yi, Yan Jian-jun, Cui Zhi-ming 2013, 17 (30):  5434-5439.  doi: 10.3969/j.issn.2095-4344.2013.30.003 Abstract ( 419 )   PDF (639KB) ( 501 )   Save BACKGROUND: The effects of artificial joint replacement, osteotomy and reconstruction in the treatment of Crown Ⅳ-type congenital dislocation of hip in adult are not very satisfied. OBJECTIVE: To evaluate the effect of artificial total hip arthroplasty and hip-self procedure in the treatment of Crown Ⅳ-type congenital dislocation of hip in adult patients. METHODS: Twenty-three adult patients with Crown Ⅳ-type congenital dislocation of hip were treated with artificial total hip arthroplasty and hip-self procedure. There were 2 males and 21 females with an average age of (24.26±3.56) years ranging 20 to 35 years. The effect was evaluated according to the Harrris evaluation standard, and the statistical analysis was performed. RESULTS AND CONCLUSION: All of the patients were followed-up for 12-60 months, averaged of (26.60±13.16) months. Statistical comparison with the SPSS 19.0 system showed there was significant difference of the Harrris scores between preoperation and postoperation period (P < 0.05). The artificial total hip arthroplasty and hip-self procedure can be used to reconstruct the normal function of hip joint, relieve pain and increase the joint stability, which is considered as the best method for the treatment of Crown Ⅳ-type congenital dislocation of hip in adult. Figures and Tables | References | Related Articles | Metrics

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Efficacy and safety of rivaroxaban in the prevention of deep vein thrombosis after hip arthroplasty Zhang Hui, Wang Dong, Sun Hai-yu, Li Shu-wei, Liu Liang 2013, 17 (30):  5440-5445.  doi: 10.3969/j.issn.2095-4344.2013.30.004 Abstract ( 453 )   PDF (613KB) ( 841 )   Save BACKGROUND: As an oral anticoagulant drug, many experiments have proved that rivaroxaban can prevent the deep venous thromboembolism after the hip arthroplasty. The foreign literatures indicate that it can significantly reduce the incidence of deep venous thromboembolism after extending the treatment course to 35 days. But there is no significant conclusion at home, and the safety of drugs after extentding the course has not been confirmed. OBJECTIVE: To analyze the efficacy and safety of rivaroxaban versus low-molecular-weight heparin for the prevention of deep venous thrombosis after the hip arthroplasty. METHODS: 106 patients with primary unilateral hip arthroplasty in the Second Clinical Medical College of Shanxi Medical University between March 2011 and September 2012 were selected. The patients were randomly divided into rivaroxaban group and low-molecular-weight heparin group. The patients in two groups were given drugs at 6 hours after replacement, the patients in the rivaroxaban group were given rivaroxaban 10 mg/d with the course of 5 weeks; the patients in the low-molecular-weight heparin group were given low-molecular-weight heparin 4 100 U/d with the course of 2 weeks. RESULTS AND CONCLUSION: The review and follow-up results showed there was no deep vein thrombosis or symptoms of deep vein thrombosis in patients of the rivaroxaban group after replacement, while seven cases (13%) of deep vein thrombosis were observed in the low-molecular-weight heparin group, and there was significant difference in the incidence rate of deep vein thrombosis between two groups (P < 0.05). There were no significant differences in venous blood hemoglobin level, platelet level and coagulation function before and after replacement, as well as the drainage volume and subcutaneous ecchymosis area after replacement of the patients received unilateral hip arthroplasty between two groups (P > 0.05). The results indicate that full course of rivaroxaban has clear effect and reliable security in the prevention of deep venous thrombosis after hip arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Lumbar lordosis after lumbar disc replacement Wang Long, Chu Ge, Zhang Hong-qi, Guo Chao-feng, Yan Tao, Qiao Wei-min 2013, 17 (30):  5446-5451.  doi: 10.3969/j.issn.2095-4344.2013.30.005 Abstract ( 454 )   PDF (595KB) ( 581 )   Save BACKGROUND: Artificial total disc replacement is one treatment of low back pain in recent years, but the report on the effect of disc replacement on lumbar sagittal plane is rare.   OBJECTIVE: To analyze the effect of lumbar disc replacement on lumbar lordosis. METHODS: Retrospective analysis of radiographic data of 17 patients who underwent lumbar disc replacement for single segment degenerative disc disease was carried out. Data measurement included preoperative and postoperative lumbar lordosis, diseased segmental lordosis and lumbar intervertebral angle. RESULTS AND CONCLUSION: All the 17 patients were followed-up for more than 12 months. Lumbar disc replacement was performed at L4-5 segment in three cases and L5-S1 segment in 14 cases. The average diseased segmental lordosis and lumbar lordosis were increased significantly after replacement when compared with those before replacement (P < 0.05); the lumbar intervertebral angle was increased after replacement when compared with that before replacement, but the difference was not significant. The results indicate that lumbar disc replacement for the treatment of single segment degenerative disc disease can increase the lumbar lordosis and diseased segmental lordosis, which can help to improve the lumbar sagittal balance. The postoperative lumbar intervertebral angle has no correlation with the implant angle of the prosthesis on the replace segment. Figures and Tables | References | Related Articles | Metrics

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Minimally invasive versus open transforaminal lumbar interbody fusion in the treatment of single-level lumbar disc herniation Ding Ru-hu, Liu Bo, Zhang Bo, Wang Yong-qing, Xiao Bin, Su Hai-tao 2013, 17 (30):  5452-5459.  doi: 10.3969/j.issn.2095-4344.2013.30.006 Abstract ( 564 )   PDF (801KB) ( 774 )   Save BACKGROUND: Navigation assisted minimally invasive posterior lumbar interbody fusion and pedicle screw fixation can precisely real-time guide a variety of operation under minimally invasive sleeve, and implant the pedicle screws and interbody fusion cage and other implants safely and accurately, thus can determine the decompression parts. Minimally invasive transforaminal lumbar interbody fusion is the typical approach in recent years for the successful application of minimally invasive spine surgery techniques with the advantages of small incision, less bleeding, slight tissue damage and faster recovery. OBJECTIVE: To evaluate the short-term effect of minimally invasive transforaminal lumbar interbody fusion with real-time three-dimensional navigation system and open posterior transforaminal lumbar interbody fusion. METHODS: Forty cases with single-level lumbar disc herniation were retrospectively analyzed. The patients were treated with minimally invasive transforaminal lumbar interbody fusion with real-time three-dimensional navigation system (20 cases) and open posterior transforaminal lumbar interbody fusion (20 cases) respectively for the comparative analysis. The fusion duration, intraoperative blood loss, postoperative drainage volume, the length of postoperative hospital stay and the length of hospital stay were compared between two groups. The wound pain and function were evaluated after treatment with visual analogue scale score and Japanese Orthopaedic Association score. RESULTS AND CONCLUSION: All patients were followed-up for 7.7 months. The operative duration in the minimally invasive transforaminal lumbar interbody fusion group was longer than that in the open posterior transforaminal lumbar interbody fusion group, and the difference was significant (P < 0.01); the length of hospital stay and length of postoperative hospital stay of the minimally invasive transforaminal lumbar interbody fusion group were shorter than the open posterior transforaminal lumbar interbody fusion group, and the differences were significant (P < 0.01); the intraoperative blood loss of the minimally invasive transforaminal lumbar interbody fusion group was less than the open posterior transforaminal lumbar interbody fusion group, and the difference was significant (P < 0.05); the postoperative drainage volume of the minimally invasive transforaminal lumbar interbody fusion group was less than the open posterior transforaminal lumbar interbody fusion group, and the difference was significant (P < 0.01). The visual analogue scale score was significantly decreased and the Japanese Orthopaedic Association score was significantly increased in the minimally invasive transforaminal lumbar interbody fusion group at 3 days after internal fixation compared with open posterior transforaminal lumbar interbody fusion group (P< 0.01), but there were no significant differences in the visual analogue scale score and Japanese Orthopaedic Association score between the two groups before operation and 6 months after operation (P > 0.05).The results indicate that minimally invasive transforaminal lumbar interbody fusion with real-time three-dimensional navigation system is an effective method for lumbar disc herniation with the advantages of less intraoperative blood loss, less postoperative drainage volume, small trauma, short hospital stay and short-term efficacy. Figures and Tables | References | Related Articles | Metrics

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Comparison of hidden blood loss in two kinds of internal fixation for femoral intertrochanteric fractures Long Qiu-ping, Liao Qian-de, Yin Ke, Zhong Da, Niu Bing, Ding Deng-feng 2013, 17 (30):  5460-5465.  doi: 10.3969/j.issn.2095-4344.2013.30.007 Abstract ( 504 )   PDF (585KB) ( 491 )   Save BACKGROUND: Hidden blood loss is an important risk for the intertrochanteric fracture patients, especially the elderly patients, which can cause anemia in patients after internal fixation and can affect wound healing and patient recovery.  OBJECTIVE: To compare the perioperative hidden blood loss and the risk factors of proximal femoral anti-rotation intramedullary nail internal fixation and dynamic hip screw fixation for the treatment of femoral intertrochanteric fracture. METHODS: We selected 70 cases of femoral intertrochanteric fracture patients who treated with proximal femoral anti-rotation intramedullary nail and dynamic hip screw fixation, including 21 patients with the age ≥ 80 years and 49 patients with the age < 80 years; 28 patients with the body mass index > 30 kg/m2 and 42 patients with the body mass index ≤ 30 kg/m2; 30 patients received anti-rotation intramedullary nail internal fixation and 40 patients received dynamic hip screw fixation. The perioperative blood loss was calculated with Gross formula according to the changes of height, body mass index and the hematocrit before and after fixation. RESULTS AND CONCLUSION: The mean total blood loss was 936 mL, the mean dominant blood loss was  237 mL and the mean hidden blood loss was 699 mL. The hidden blood loss was accounted for 74.7% in total blood loss. The dominant blood loss in the dynamic hip screw fixation group was higher than that in the anti-rotation intramedullary nail internal fixation group, and the hidden blood loss was lower than the anti-rotation intramedullary nail internal fixation group. The total blood loss and the hidden blood loss of the elderly patients were higher than those of the non-elderly patients; there was no significant difference between male and female patients, obesity and normal patients. The results indicate that hidden blood loss is the major reason for total blood loss of femoral intertrochanteric fracture after internal fixation. The hidden blood loss of anti-rotation intramedullary nail internal fixation is larger than that of dynamic hip screw fixation, and elder is the risk factor for hidden blood loss. Figures and Tables | References | Related Articles | Metrics

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Suture anchor fixation realizes the physiological reconstruction and repair of tibiofibular syndesmotic injury  Tang Feng, Wang Qin-ye, Xu Zhong-liang, Luo Ya-ping, Chang Xiao-bo, Wang Yi-jin 2013, 17 (30):  5466-5471.  doi: 10.3969/j.issn.2095-4344.2013.30.008 Abstract ( 882 )   PDF (778KB) ( 659 )   Save BACKGROUND: The traditional surgical method have large trauma in the treatment of tibiofibular syndesmosis injury, and cannot well complete the repair of ligament. But the suture anchor has clear effect for ligament repair, ligament reconstruction and bone connection. OBJECTIVE: To investigate the biomechanical properties of the suture anchor in the treatment of tibiofibular syndesmotic injury, and to compare with lag screw internal fixation. METHODS: Eight ankle joint specimens were collected, and the biomechanical experiment was performed for stress analysis. The suture anchor technology and lag screw internal fixation were used respectively to treat the tibiofibular syndesmotic injury. The biomechanical properties of the stress strength, stiffness and stability were compared. RESULTS AND CONCLUSION: The biomechanical properties of the stress strength, stiffness and stability of suture anchor technology for the treatment of tibiofibular syndesmotic injury were better than those of lag screw internal fixation, and there were significant differences in the strength and stiffness between two methods (P < 0.05); the stress shielding rate of suture anchor technology was lower than that of lag screw  internal fixation, and the difference was significant (P < 0.05); the tibiofibular syndesmosis separated displacement of suture anchor technology was lower than that of lag screw internal fixation, and the difference was significant (P < 0.05). The results indicate that the suture anchor technology is a minimal invasion and good method to realize physiological reconstruction and elastic fixation with stable fixation strength and less trauma, and without secondary operation. Figures and Tables | References | Related Articles | Metrics

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Construction and identification of humerus three-dimensional finite element model in children Ruan Shi-jie, Shen Cong, Li Hai-yan, He Li-juan, Zhai Guang-feng 2013, 17 (30):  5472-5476.  doi: 10.3969/j.issn.2095-4344.2013.30.009 Abstract ( 492 )   PDF (624KB) ( 471 )   Save BACKGROUND: Mechanical experiment of finite element numerical simulation is the effective method to research the biomechanical structure of human body. OBJECTIVE: To establish the three-dimensional finite element model of a normal 6-year-old child’s humerus. METHODS: CT images of a 6-year-old child volunteer were imported to the Mimics 10.01 software. The threshold segmentation method was used to rebuild the humerus three-dimensional model. The surface optimization treatment and surface patches dicision were performed on the surface of the model with Geomagic Studio 12.0 software. Then the mesh generation was completed in the software TrueGrid. Finally, the material properties were set and the finite element model was completed. The boundary conditions and constrains were exerted to simulate the three-point-bending test of humeurs. After the simulation, the results were outputted. RESULTS AND CONCLUSION: The humerus finite element model included 3 024 nodes and 18 758 nodes- hexahedron elements. The 0.01 m/s and 3 m/s dynamic loads were loaded respectively, then the central humerus fracture occurred and the load-displacement curve was close to the cadaver test results. The simulation results show that the simulation results of children humerus finite element model are close to the cadaver’s test, and the finite element simulation method can simulate the physical properties of the human skeleton very well. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element model of the new artificial lumbar disc replacement Zhang Lan-feng, Dong Li-min, Wang Yong-qing, Meng Li-na, Ye Jin-duo, Zhang Chun-qiu 2013, 17 (30):  5477-5482.  doi: 10.3969/j.issn.2095-4344.2013.30.010 Abstract ( 707 )   PDF (715KB) ( 754 )   Save BACKGROUND: As lumbar spine biomechanics research is unceasingly thorough and the constant development of related fusion and dynamic fixation device, the spine fusion technique which is represented by artificial disc replacement is a new choice to the spine surgeons. Therefore, it is particularly important to design reasonable artificial intervertebral disc. OBJECTIVE: To establish the finite element model of the new artificial disc replacement of the lumbar motion segment for further biomechanical study. METHODS: The L3-4 thin-section CT images of a healthy male volunteer was selected, combined with human anatomy data and applied the reverse engineering technology to rebuild the lumbar spine model with medical image software Mimics and tool software Geomagic Studio. The three-dimensional model of the silicone artificial disc was converted into a finite element model through software ANSYS12.0. RESULTS AND CONCLUSION: Through CT scanning, digital image processing and computer-aided design, the three-dimensional model of the lumbar motion segment and the finite element model of artificial disc replacement were successfully established. The finite element model contained 691 085 units and 1 008 913 nodes which could be applied constraint and load and could be used for spinal biomechanics and the further research of the new artificial intervertebral disc. Figures and Tables | References | Related Articles | Metrics

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Precise mechanical analysis on the femoral three-dimensional finite element model constructed based on DICOM data Li Feng, Wu Hua 2013, 17 (30):  5483-5489.  doi: 10.3969/j.issn.2095-4344.2013.30.011 Abstract ( 615 )   PDF (653KB) ( 970 )   Save BACKGROUND: The finite element model has been developed from two-dimensional model to three-dimensional model, from linear model to nonlinear model. As the advantage of this method in the analysis of mechanical characteristics of the irregular objects, the finite element model has been widely used in the research of orthopedic biomechanics, especially in the research of hip joint.  OBJECTIVE: To analyze the stress state of human femur with finite element analysis method and to investigate a method that can rapidly construct femoral finite element model and precisely analyze the biomechanics. METHODS: Normal male femur was used as specimen for CT scan to obtain cross-sectional images of femur in each slice. Three-dimensional reconstruction was performed with DICOM data and MIMICS software, then the femoral three-dimensional finite element model was established with the finite element analysis ABQUS 6.8 software, and the stress distribution of the model was analyzed under loading condition. RESULTS AND CONCLUSION: Based on DICOM data, three-dimensional finite element model of femur was constructed more quickly and precisely. The models were divided into 38 636 nodes and 201 422 units. The model included the parts of cortical and cancellous bone. The biomechanical test results were accorded with the previous results, so the model could objectively reflect the real femur shape and biomechanical behavior with high precision. The Mimics software provided a simpler and effective method for the construction of femur model and improved the efficiency of modeling, and the three-dimensional finite element model based on DICOM data was accurate in shape and can be used for the normal research on biomechanical behavior of femur. The stress distribution analyzed with ABQUS 6.8 software is consistent with the clinical observation. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of degenerative scoliosis biomechanics Zheng Jie, Yang Yong-hong, Lou Su-liang, Zhang Dong-sheng, Liao Sheng-hui 2013, 17 (30):  5490-5496.  doi: 10.3969/j.issn.2095-4344.2013.30.012 Abstract ( 496 )   PDF (853KB) ( 570 )   Save BACKGROUND: Spine is relatively complex in structure, shape, material properties, and load bearing. The traditional biomechanical method cannot solve these problems. OBJECTIVE: To investigate the stress distribution of intervertebral disc, zygapophysial joints and vertebral body of degenerative scoliosis, and to provide accordance to the biomechanical mechanism of degenerative scoliosis occurrence and development. METHODS: Based on the successive CT images of spinal column from T12 to superior segment of S1 of degenerative scoliosis patients, the special material properties were attributed to the model to form the integrated and effective three-dimensional finite element model of degenerative scoliosis. The model was loaded on the anteflexion, extension, left lateral bending, right lateral bending, left rotation and right rotation conditons. Then the spinal activity and the stress distribution of intervertebral disc, vertebral body and articular cartilage of zygapophysial joints were calculated and analyzed. RESULTS AND CONCLUSION: The spinal activities of degenerative scoliosis finite element model were less than those of common lumbar spine. The stress distribution of intervertebral disc was inclined to the verge of it and the greatest stress was appeared on the extension motion. The apex of scoliosis was the place of stress concentration and the obvious stress concentration of articular cartilage of zygapophysial joints was appeared on the rotation motion, then followed by the extension motion, especially that of articular cartilage of zygapophysial joints on the apex of scoliosis. Stress concentration is easily appeared on the apex of scoliosis, and the extension and rotation motion can aggravate the development of degenerative scoliosis. Figures and Tables | References | Related Articles | Metrics

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Cervical vertebrae morphology in skeletal class Ⅱ and class Ⅰ malocclusion patients Reziwan•Keyimu, He Hong, Wu Hui 2013, 17 (30):  5497-5502.  doi: 10.3969/j.issn.2095-4344.2013.30.013 Abstract ( 483 )   PDF (801KB) ( 775 )   Save BACKGROUND: The incidence rate of cervical abnormalities of the patients with skeletal class Ⅱ and normal occlusion has been studied abroad, but the researches on the incidence of cervical abnormalities in different malocclusion patients is rare at home. OBJECTIVE: To observe the imaging of patients with cervical abnormalities and to statistics the incidence of cervical abnormalities in different malocclusion patients through analyzing the lateral cephalogram of different malocclusion patients. METHODS: Skeletal class Ⅱ group was consisted of 93 patients, 41 male (aged 18-40 years) and 52 female (aged 22-35 years), with the A point-nasion-B point angle > 5°. Class Ⅰ group was consisted of 45 patients, 31 female (aged 20-36 years) and 14 male (aged 17-38 years), with the 1°< A point-nasion-B point angle < 4°. The initial lateral cephalograms of the patients were taken to analyze and statistic the incidence of sub-categories of cervical abnormalities. The incidence of sub-categories of cervical abnormalities and the lateral cephalogram were measured with Logistic regression analysis. RESULTS AND CONCLUSION: Cervical abnormalities could be divided into two categories: posterior arch developmental defects and integration, and the posterior arch developmental defects could be divided into two subclasses of spondyloschisis and hypoplasia, while the integration could be divided into two subclasses of occipitocervical fusion and interbody fusion. In the skeletal class Ⅱ group, the cervical fusion was accounted for 49% and the posterior arch developmental defect was accounted for 4%. In the skeletal class Ⅰ group, the cervical fusion was accounted for 15% and the posterior arch developmental defect was accounted for 46%, and there was significant difference in cervical fusion between two groups. The incidence rate of cervical fusion was closely related with the A point-nasion-B point angle and the A point-nasion-pogonion angle, while there was no relationship between posterior arch developmental defect and the measurements. The results indicate that cervical fusion may related with the cranial facial sagittal development, while the skull facial development will not influence the posterior arch developmental defect. Figures and Tables | References | Related Articles | Metrics

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Serum monocyte chemoattactant protein-1 level and spinal tuberculosis susceptibility Guo Chao-feng, Zhang Hong-qi, Gao Qi-le, Tang Ming-xing, Liu Shao-hua, Deng Ang, Wang Yu-xiang, Lu Shi-jin, Li Jin-song, Yin Xin-hua 2013, 17 (30):  5503-5510.  doi: 10.3969/j.issn.2095-4344.2013.30.014 Abstract ( 384 )   PDF (864KB) ( 501 )   Save BACKGROUND: The monocyte chemoattactant protein-1 gene polymorphism is associated with spinal tuberculosis susceptibility. OBJECTIVE: To investigate the association between serum monocyte chemoattactant protein-1 expression level and spinal tuberculosis susceptibility in Han population of Hunan province. METHODS: The patients with spinal tuberculosis and the healthy volunteers were recruited in Xiangya Hospital of  Central South University from December 2004 to December 2010. The empty peripheral venous blood 2 mL were collected from the subjects in early morning, then the monocyte chemoattactant protein-1-362 genotypes were detected by polymerase chain reaction and DNA sequencing technology. And the serum monocyte chemoattactant protein-1 level was detected by enzyme linked immunosorbent assay technology. The ROC curve was used for diagnostic tests to calculate diagnostic threshold value of serum monocyte chemoattactant protein-1 level to spinal tuberculosis susceptibility, and to analyze the diagnostic titer. RESULTS AND CONCLUSION: 208 patients with spinal tuberculosis and 210 healthy volunteers were included. The serum monocyte chemoattactant protein-1 level of the spinal tuberculosis patients was significantly higher than that of the healthy volunteers [(134.58±51.63) ng/L vs. (39.18±17.45) ng/L, P < 0.01]. The serum monocyte chemoattactant protein-1 level could not be affected by gender, but over-expressed in patients with monocyte chemoattactant protein-1-362-CC genotypes. The serum monocyte chemoattactant protein-1 level higher than  101.65 ng/L indicated that the patients might suffered from spinal tuberculosis (sensitivity: 85.5%, specificity: 94.3%, Youden index: 0.799, area under curve of ROC: 0.946, 95% confidence interval: 0.916-0.975, P < 0.01). The serum monocyte chemoattactant protein-1 level may be associated with spinal tuberculosis susceptibility in Han population of Hunan province, highly expressed serum monocyte chemoattactant protein-1 can be used as one of the indicators for the diagnosis of spinal tuberculosis. Figures and Tables | References | Related Articles | Metrics

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Bone morphogenetic protein 2 expression in rabbit radial defect site with different lengths Zhan Yu-lin, An Zhi-quan, Sun Lu-yuan, Zhang Chang-qing, Zeng Bing-fang, Xu Feng, Hou Guo-zhu, Li Wen-ju, Zhu Xiao-meng, Song Xing-hua 2013, 17 (30):  5511-5517.  doi: 10.3969/j.issn.2095-4344.2013.30.015 Abstract ( 402 )   PDF (779KB) ( 378 )   Save BACKGROUND: It has been studied that the distribution of bone morphogenetic protein 2 is regular under bone defect situation. OBJECTIVE: To observe the expression of bone morphogenetic protein 2 in rabbit radial defect site with different lengths. METHODS: Forty-eight New Zealand rabbits were divided into two groups randomly, 0.5 cm bone defect and 3.0 cm bone defect were made by wire saw at the middle part of radius bone after anaesthesia. RESULTS AND CONCLUSION: Western blot results showed that in the 0.5 cm bone defect group, the expression of bone morphogenetic protein 2 of the tissues in the bone defect site was increased gradually at 1, 3, 4 weeks after operation, and the expression in each defect group was increased when compared with that immediately after injury (P < 0.05). In the 3.0 cm bone defect group, the expression of bone morphogenetic protein 2 of tissues in bone defect site was increased gradually and reached to its peak at 3 weeks after the operation (P < 0.05), and the peak value in the 3.0 cm bone defect group was significantly higher than that in 0.5 cm bone defect group (P < 0.05). The peak value was maintained in high level. The comparison of bone callus formation showed that the bone callus formation of 3.0 cm bone defect group was less than that of the 0.5 cm bone defect group at 3 and 4 weeks after operation (P < 0.05). The results indicate that expression of the bone morphogenetic protein 2 in 3.0 cm bone defect site is increased significantly, but the expression level cannot make the bone defect heal itself. Figures and Tables | References | Related Articles | Metrics

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Bernese periacetabular osteotomy for the treatment of acetabular dysplasia Song Li-ming 2013, 17 (30):  5518-5524.  doi: 10.3969/j.issn.2095-4344.2013.30.016 Abstract ( 581 )   PDF (640KB) ( 411 )   Save BACKGROUND: Changing the acetabular orientation is the best method for the treatment of acetabular dysplasia, and Bernese periacetabular osteotomy is one of the most commonly used and successful treatment methods. OBJECTIVE: To review and analyze the operation indication, surgical technique and influencing factors of Bernese periacetabular osteotomy for better clinical application. METHODS: The PubMed database, Elsevier database and Springer database were retrieved for related articles published before December 2012 with the key words of “Bernese osteotomy, Ganz osteotomy, periacetabular ostetomy”. The articles that related to the clinical application of Bernese periacetabular osteotomy in patients with acetabular dysplasia were enrolled in this study. Repetitive studies and Meta analysis were excluded. And the analysis emphasis was put on the operation indication, surgery technique and influencing factors of Bernese periacetabular osteotomy. RESULTS AND CONCLUSION: A total of 483 articles were screened out after primary computer-based online research. And according to the exclusion criteria, 43 articles were selected for review. Bernese periacetubular osteotomy was performed through polygonous osteotomy around the acetabula by modified Smith-Peterson approach. The surgical technology was improved gradually, but the major osteotomy procedures never changed, only the soft tissue release method was modified. The direct factors that influence the surgical effect of Bernese periacetabular osteotomy are the degree of radiographic hip degeneration and dysplasia. In the future, with the in-depth understanding of hip deformity, the operation indication and technique of Bernese periacetabular osteotomy will also developed. Figures and Tables | References | Related Articles | Metrics

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Femoral head necrosis after severe acute respiratory syndrome: Etiology and treatment Qiu Nan-hai, Zhang Wen-long 2013, 17 (30):  5525-5530.  doi: 10.3969/j.issn.2095-4344.2013.30.017 Abstract ( 652 )   PDF (675KB) ( 508 )   Save BACKGROUND: Majority of patients appeared different degrees of hip joint bursitis and gradually developed into femoral head necrosis in the early rehabilitation process of severe acute respiratory syndrome. OBJECTIVE: To analyze various causes of the severe acute respiratory syndrome sequela, and to review the treatment method of femoral head necrosis. METHODS: The PubMed database, China Journal Full-text database (CNKI), VIP database and Wanfang database were retrieved by the first author with computer for the related articles from January 1997 to August 2012. The key words of “infectious atypical pneumonia, sequela, femoral head necrosis, bone ischemia, etiology, infectious atypical pneumonia virus, conservative treatment, operation treatment, total hip replacement” in English and Chinese were put in the title and abstract to search articles. A total of 872 articles were screened out after primary retrieval, and eventually 56 articles were included for review. RESULTS AND CONCLUSION: Severe acute respiratory syndrome sequela, femoral head necrosis, was related with the dose and duration of hormone, patient’s sensitivity to hormone, using method, the secretion of leptin and bone calcitonin, and also infectious atypical pneumonia virus. The femoral head necrosis caused by the above factors can be treated with conservative treatment to slow down the process of femoral head necrosis and delay prosthesis replacement. Eventually, most of the patients will receive surgical method. For the treatment of advanced severe acute respiratory syndrome sequelae femoral head necrosis, prosthesis replacement can get the best effect. Figures and Tables | References | Related Articles | Metrics

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Non-operation treatment of primary knee osteoarthritis   Jin Feng-yu 2013, 17 (30):  5531-5538.  doi: 10.3969/j.issn.2095-4344.2013.30.018 Abstract ( 567 )   PDF (797KB) ( 1234 )   Save BACKGROUND: Knee osteoarthritis is a common and frequently-occurring disease in the elderly, the incidence in the postmenopausal women is significantly higher than that in other groups. The clinical manifestation is various, mainly pain and dysfunction of the knee joint. There are many methods for the treatment of the knee osteoarthritis, and the non-operation treatment is the main and basic treatment method. OBJECTIVE: To summary the advantages and limitations of various non-operation treatment methods of knee osteoarthritis. METHODS: The VIP database, Wanfang database, CNKI database, Medline database and PubMed database were retrieved for the clinical reports and reviews on epidemiology, related factors, pathogenesis and non-operation treatment of knee osteoarthritis from January 2000 to May 2013 with the key words of “osteoarthritis, knee osteoarthritis, epidemiology, etiology, pathogenesis, treatment” in Chinese and “osteoarthritis, knee osteoarthritis, pathogenesis, therapy” in English. The reproductive researches and atypical reports were excluded. RESULTS AND CONCLUSlON: The etiology of knee osteoarthritis is unknown, and the pathogenesis may be related to various, of factors such as age, sex hormone, load conduction disturbance and genetic correlation. The clinical manifestations of knee osteoarthritis are varied, and many clinical treatment methods can be selected, but different treatment methods have different indications and the effects are not identical, and each has its own merits. Drugs are the most commonly used means for the treatment of knee osteoarthritis, such as traditional Chinese medicine, acupuncture and massage, which can significantly relieve the pain and improve the function of knee joint. Strength training and mechanical vibration are new methods of treatment, although not widely used in clinic, the effect has been gradually confirmed, but still need clinical exploration and experience accumulation. In addition, a large number of clinical data also showed that the oral drug in combination with life changing, exercise or muscle training therapy, its clinical effect is often better than single therapy. Figures and Tables | References | Related Articles | Metrics

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Recurrence factors of spinal implant fixation for the treatment of lumbar disc herniation Chen Xiao-ming, Ma Hua-song, Wang Meng, Tan Rong, Yang Bin 2013, 17 (30):  5539-5544.  doi: 10.3969/j.issn.2095-4344.2013.30.019 Abstract ( 463 )   PDF (846KB) ( 623 )   Save BACKGROUND: The correct method selected according to the specific type and characteristics of lumbar disc herniation can achieve satisfactory effect, but in clinic, there still some patients have recurrence symptoms after treatment. OBJECTIVE: To investigate the recurrence factors of spinal implant internal fixation for the treatment of lumbar disc herniation, as well as the intervention measures. METHODS: Fifty-two patients with recurrence symptoms of lumbar disc herniation after internal fixation from January 2002 to December 2007 in the Department of Orthopedics, the 306th Hospital of PLA were retrospectively analyzed, including 28 male cases and 24 female cases, the average age was 43.2 years, ranged from 25-52 years. The time form first internal fixation to the recurrence was 3-192 months, average 38 months. The patients had the symptoms of lumbar and bilateral/unilateral leg pain and numbness. All the patients underwent the anteroposterior radiographs of lumbar spine and the hyperextension and flexion lateral X-ray films to evaluate the stability of the lumbar spine. Lumbar magnetic resonance imaging was used to observe the intervertebral disc situation of the segment treated with lumbar internal fixation as well as the spinal stenosis and disc degeneration. RESUTLS AND CONCLUSION: Among the 52 patients, 22 cases had recurrence lumbar disc herniation on the same segment after first internal fixation; four cases had recurrence symptoms caused by the spondylodiscitis after implant internal fixation; five cases had scar adhesions caused nerve compression on the site treated with internal fixation; 10 cases had the symptoms of lateral recess and nerve root canal stenosis on the site treated with internal fixation; 11 cases had recurrence symptoms caused by lumbar instability after internal fixation. It has reality clinical significance to analyze the reasons of recurrence of lumbar disc herniation after internal fixation. Figures and Tables | References | Related Articles | Metrics

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Knee meniscus injury evaluated with magnetic resonance imaging  Feng Lei, Wang Jing-xue, Wang Guo-hua, Song Xiu-feng, Zhang Ting-ting, Zhang Tong 2013, 17 (30):  5545-5550.  doi: 10.3969/j.issn.2095-4344.2013.30.020 Abstract ( 1190 )   PDF (695KB) ( 1116 )   Save BACKGROUND: Conventional imaging method has significant limitations in the diagnosis of knee meniscus injury, which is difficult to detect the full extent of the knee meniscus. OBJECTIVE: To evaluate the knee meniscus injury with magnetic resonance imaging. METHODS: The knee meniscus injury patients diagnosed with clinical treatment were retrospectively analyzed, and the characteristics of the magnetic resonance imaging were analyzed and graded. Then, the meniscus injury was analyzed and compared with the arthroscopic or surgical results. RESUTLS AND CONCLUSION: In the magnetic resonance imaging of knee meniscus injury, the Ⅰ level knee meniscus injury was presented as the punctate or round high signal that did not contacted with the surface of the meniscus, Ⅱ level knee meniscus injury was presented as the horizontal or oblique line or strip-like high signal in the meniscus, and Ⅲ level knee meniscus injury was presented as lines and complex high signal in the meniscus that extended to the articular surface of the meniscus, and accompanied with morphological changes of the meniscus. Magnetic resonance imaging, as a noninvasive checking method, can clearly show the meniscal degeneration and tearing, and correctly diagnosed the location, shape and severity of meniscus injury, which has significant guiding value in determine the clinical treatment options. Figures and Tables | References | Related Articles | Metrics

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Early application of front-ankle-foot orthosis affects the walking ability and speed of the patients with hemiplegia after stroke Shen Xuan-lin, Qian Yi-fei, Zhang Jie 2013, 17 (30):  5551-5556.  doi: 10.3969/j.issn.2095-4344.2013.30.021 Abstract ( 480 )   PDF (852KB) ( 503 )   Save BACKGROUND: Most of the traumatic brain injury and stroke survivors have foot drop and varus deformity, that need to be treated with ankle-foot orthosis. OBJECTIVE: To investigate the advantages and effect of early application of front-ankle-foot orthosis on the walking function of the patients with hemiplegia after stroke. METHODS: The clinical data of 54 patients with hemiplegia after stroke treated in the Changshu No. 2 People’s Hospital from June 2008 to October 2009 were retrospectively analyzed. The patients treated with front-ankle-foot orthosis were the front group (n=28), and the patients treated with rear-ankle-foot orthosis were the rear group (n=26). All the patients received 10 m maximum walking speed test, and the recovery of walking function of the patients in two groups were observed daily. RESUTLS AND CONCLUSION: There were no patients exited and dead in the observation period. The activities of daily living Barthel index in the front-ankle-foot orthoses group (60.0±12.9) was significantly higher than that  in the rear-ankle-foot orthoses group (59.1±10.9), and there was no significant difference in the activities of daily living Barthel index between two groups (P > 0.05). For the 10 m maximum walking speed test, the walking speed of (39.6±11.6) m/min in the front-ankle-foot orthosis group was significantly faster than that of (33.0±12.4) m/min in the rear-ankle-foot orthosis group (P < 0.05). Front-ankle-foot orthosis is more appropriate for patients with hemiplegia after stroke to improve the walking speed. Figures and Tables | References | Related Articles | Metrics

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Fractures around femoral prosthesis after artificial hip replacement  Liu Ying-fei, Wang Tao, Zhang Ping-de 2013, 17 (30):  5557-5562.  doi: 10.3969/j.issn.2095-4344.2013.30.022 Abstract ( 336 )   PDF (624KB) ( 588 )   Save BACKGROUND: With the wide application and in-depth research of artificial hip joint, more secondary fractures around femoral prosthesis are reported. OBJECTIVE: To investigate the reasons, preventive measures, classification and treatment method of fractures around femoral prosthesis after artificial hip replacement. METHODS: The clinical data of the type classification, treatment method and clinical efficacy of fractures around femoral prosthesis after artificial hip replacement were retrospectively analyzed. The multi-level study was performed to investigate the trend of the relevant literatures. According to the Vancouver classification criteria, the various types of fractures and the results and complications of various treatment methods were analyzed, the treatment methods of different fractures were identified, and the effective and objective evaluation criteria were established to provide references for the clinical treatment. RESUTLS AND CONCLUSION: The fractures around femoral prosthesis after artificial hip replacement were closely related with the age of the patients, basic diseases, osteoporosis and selection of prosthesis type. The Vancouver classification criteria and treatment programs have guiding significance to the clinical efficacy. The fractures should be treated with different methods according to the different types in order to promote the fracture healing. The fractures around femoral prosthesis after artificial hip replacement were commonly treated with shape memory alloy embracing fixator, minimally invasive fixation system, locking compression plate, allograft cortical bone plates, carbon fiber, impaction bone grafting and renovation. In the practice application, various methods are often used in combination. For the patients with B2 and B3 type fractures, we should pay attention to the bone grafting around the fractures and the inner and outer medullary cavity. Figures and Tables | References | Related Articles | Metrics

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Quadrant System in lumbar disc herniation treatment of lumbar instability  Wei Jin-song, Zeng Rong, Chen Si-yuan, Wei Bo, Lin Hao 2013, 17 (30):  5563-5568.  doi: 10.3969/j.issn.2095-4344.2013.30.023 Abstract ( 624 )   PDF (874KB) ( 560 )   Save BACKGROUND: There are still about 10%-30% of patients presenting no obvious improvement of symptoms after lumbar disc herniation surgery, which are collectively known as the lumbar spine post-surgery failure syndrome, and lumbar instability is one of the important reasons. OBJECTIVE: To evaluate the feasibility and efficacy of surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation on lumbar intervertebral disc protrusion concurring lumbar instability via MAST Quadrant retractor. METHODS: From December 2011 to October 2012, 62 cases of lumbar intervertebral disc protrusion concurring lumbar instability were treated with posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor. There were 38 female and   24 male ranging in age from 37 to 69 years (average 53.7 years). After operation, all patients were followed-up to evaluate the effect of the treatment. RESULTS AND CONCLUSION: The operative time was 90-210 minutes, average 145 minutes, and the amount of blood loss was 50-300 mL, average 120 mL. The hospitalization time was 5-9 days, average 6 days. All incisions healed by first intention. All patients were followed up 7.2 months on average (from 3 to 10 months). The preoperative JOA score was (10.25±2.34) points. The postoperative JOA score decreased to (18.31±3.12) points at the follow-up after 1 month and (25.35±2.61) points at the last follow-up, showing significant difference when compared with preoperative score (P < 0.01). The preoperative VAS score was (8.24±1.15) points. The postoperative VAS score decreased to (2.97±1.12) points after 1 month and (1.13±0.39) points at the last follow-up, showing significant difference when compared with preoperative score (P < 0.01). According to reforming Macnab standard, the results were excellent in 53 cases and good in 9 cases at the last follow-up. The surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor is a safe, effective and minimally invasive surgical technique in treating lumbar intervertebral disc protrusion concurring lumbar instability. Figures and Tables | References | Related Articles | Metrics

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Percutaneous plate and anatomical locking plate fixation for the treatment of proximal humeral fractures  Qiu Qin-ye, Hu Han-sheng, Fan Zhen-bo, Li Sui, Zhang Hua-huan, Yu Sheng-hua, Yang Zhan-xiang, Li Yuan-hui, Yin De-long 2013, 17 (30):  5569-5574.  doi: 10.3969/j.issn.2095-4344.2013.30.024 Abstract ( 327 )   PDF (871KB) ( 537 )   Save BACKGROUND: For the patients with proximal humeral fractures or serious complications, internal fixation is the effective method that cannot influence the activity of the shoulder with few trauma. OBJECTIVE: To investigate the biomechanical characteristics of percutaneous plate combined with anatomical locking plate fixation for the treatment of proximal humeral fractures. METHODS: Seventy-five patients with proximal humeral fractures were selected from Department of Orthopedics, the Third Affiliated Hospital of Guangzhou Medical University between March 2007 and December 2011. The healing after the locking plate fixation and the shoulder joint score after internal fixation were observed. The biomechanical advantages of locking plate fixation in the treatment of proximal humeral fractures were analyzed. RESUTLS AND CONCLUSION: All the 75 patients were followed up for 6-24 months, average 13.3 months. The X-ray film after treatment showed all the screws were in correct position with satisfactory fracture reduction, and the fractures were healed without neurovascular injury and humeral head necrosis; one case had infection and healed after treatment, 72 cases had no shoulder pain, while three cases had occasional shoulder pain. The Neer score was excellent in 57 cases, good in 11 cases, moderate in seven cases and poor in none, and the excellent and good rate was 90.7%. Compared with other fixation implants, the locking plate fixation in the treatment of proximal humeral fractures has the advantages of high fixation strength and satisfactory effect, becoming the first choice for the clinical treatment of proximal humeral fractures. Figures and Tables | References | Related Articles | Metrics

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Stability of lumbar vertebra in patients with thoracolumbar vertebral metastases after treated with artificial vertebral placement or internal fixation Wang Dong-lai, Feng Jian-gang, Li Zeng-huai, Feng He-lin, Zhang Jin-ming, Xun Jian-jun 2013, 17 (30):  5575-5580.  doi: 10.3969/j.issn.2095-4344.2013.30.025 Abstract ( 513 )   PDF (886KB) ( 434 )   Save BACKGROUND: Vertebral metastatic tumor often occurs in the thoracolumbar segment, and it is difficult for internal fixation due to the complex anatomical position. OBJECTIVE: To evaluate the stability of lumbar vertebra in the patients with single thoracolumbar vertebral metastases after treated with artificial vertebral placement and internal fixation. METHODS: Sixteen patients (9 male and 7 female) with single thoracolumbar vertebral metastases treated in the Department of Orthopedics, the Fourth Hospital of Hebei Medical University from January 2006 to January 2009 were selected, and the age ranged 40-74 years, averaged 52 years. Before treatment, all the patients were evaluated according to Frankel classification: A grade in two cases, B grade in three cases, C grade in three cases, D grade in five cases, and E grade in three cases. And the vertebral state of patients was detected with X-ray plain film examination, systemic radionuclide bone scanning, CT and MRI. The T11 vertebral metastases were treated with chest approach artificial vertebral placement and internal fixation, and T12-L2 vertebral metastases were treated with artificial vertebral placement and internal fixation via extrapleural and extraperitoneal space approach. RESULTS AND CONCLUSION: All the 16 patients were followed up for 4-32 months, and the average survival time after treatment was 12 months. After treatment, Frankel classification was C grade in three cases, D grade in five cases and E grade in eight cases. The visual analog scale score was decreased from (6.22±1.31) before treatment to (3.25±0.94) after treatment, and there was significant difference between two groups (P < 0.05). The artificial vertebral placement and internal fixation can restore the stability of lumbar vertebra in the patients with spinal metastases, and thus improving the symptoms and quality of life. Figures and Tables | References | Related Articles | Metrics