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26 November 2010, Volume 14 Issue 48 Previous Issue    Next Issue

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An image compression and coding system for visual cortex prosthesis Zheng Xiao-lin, Zhao Can, Hou Wen-sheng, Yin Zheng-qin 2010, 14 (48):  8933-8936.  doi: 10.3969/j.issn.1673-8225.2010.48.002 Abstract ( 357 )   PDF (446KB) ( 267 )   Save BACKGROUND: At present, the visual cortex prostheses have become a way to restore the vision. Image compression plays an important role in the pre-image processing of visual cortex prostheses. OBJECTIVE: To discuss methods for the image information compression from spatial and brightness. METHODS: Haar wavelets were selected to compress spatial resolution and the mutiscale wavelet transforms were used to extract spatial frequency signal from the original image appropriately to achieve further compression of image information. In addition, non-uniform compression model was established in the spatial resolution. It makes image processing closer to the visual processing. Then, the brightness information was compressed and encoded by the system to achieve the final compression. RESULTS AND CONCLUSION: Digital signal processor-based pre-image compression and coding system were constructed, and image information expression in 10*10 bitmap array was achieved. Related Articles | Metrics

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Biotype total hip arthroplasty for hip osteoarthritis: Medium-term efficacy evaluation Chen Ming, Guo Cheng-jun, Huang He-sheng, Shu Yong, Han Zhi-min 2010, 14 (48):  8937-8940.  doi: 10.3969/j.issn.1673-8225.2010.48.003 Abstract ( 354 )   PDF (272KB) ( 421 )   Save BACKGROUND: The clinical treatment effect of joint replacement has been improved. However, there are no follow up and evaluation standards of treatment effect. OBJECTIVE: To assess the medium-term efficacy and impact factor of hip osteoarthritis cases following biotype artificial total hip arthroplasty. METHODS: From July 2001 to March 2003, biological-based prosthetic treatment was used in 35 cases of hip osteoarthritis. All operation incisions were modified Gibson incision, cementless artificial total hip prosthesis was produced by Stryker U.S. companies. The cases were followed-up for 5.3-8 years. Harris score was used as the standard for clinical assessment, postoperative follow-up imaging was used as the standard assessment with anterior and posterior, lateral X-ray film of double hip joint to observe the acetabular cup, femoral prosthesis location and the surrounding bone change, the speed and trend of wear and tear of acetabular cup line. Prosthesis survival rate was analyzed using Kaplan-Meier analysis, acetabular cup and femoral aseptic loosening of prosthesis and renovation were detected respectively. RESULTS AND CONCLUSION: Harris score was improved from average 41 points preoperatively to average 91.3 points at the recent follow-up. No case of aseptic loosening was diagnosed by imaging or required renovation, neither the limitations of pelvic osteolysis. The average linear polyethylene liner wear rate was (0.13 ± 0.06) mm per year. Kaplan-Meier survival analysis showed that the acetabular cup and femoral prosthesis survival rate was 100%. The medium-term follow-up (at least 5.3 years) showed that the biological-type prosthesis for hip osteoarthritis in patients with total hip replacement can provide an ideal fixed effects and satisfactory clinical efficacy. Aseptic loosening does not occur, and the incidence of osteolysis is low. However, the probability of occurrence of aseptic loosening increases with aging, and the long-term results require further follow-up. Related Articles | Metrics

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Significance of knee joint parameters in prosthesis design Zhang Bo, Pan Jiang, Lin Yuan, Wang Jin-jun, Zhang Xiao-dong, Wang Zhi-wei, Ren Shi-xiang, Chen Tong, Qu Tie-bing 2010, 14 (48):  8941-8944.  doi: 10.3969/j.issn.1673-8225.2010.48.004 Abstract ( 518 )   PDF (273KB) ( 466 )   Save BACKGROUND: he matching degree of shape and dimension of the total knee arthroplasty prosthesis to the knee joint significantly affects the operative and postoperative effects. There are few researches the Chinese proximal tibia parameters, so it is necessary to explore the characteristic data and domestic prosthesis. OBJECTIVE: To obtain the normal linear parameters on the different resection levels of normal proximal tibia in Chinese. METHODS: A total of 82 normal people/135 knees, including 85 knees of males and 50 females, with an average age of 47.2 years (range from 19 to 82 year), were selected. Original CT image data were utilized to set up the three-dimensional model of Chinese normal knees and measure the related linear parameters of proximal tibia section on the work station. RESULTS AND CONCLUSION: The average anterior-posterior (AP) and medial-lateral (ML) lengths of the proximal tibia section were (48.41±3.41) and (75.03±4.88) mm, respectively; the average ratio of AP and ML (RAP／ML) was (0.655±0.032). AP and ML showed statistical significances among different genders and different osteotomy height (P < 0.01). Therefore, the characteristics and the gender difference should be considered when we design the tibial plateau prosthesis. Related Articles | Metrics

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Three-dimensional knee joint model reconstruction Wang Da-zhong, Yu Zheng-hong, Zhou Min-qiang, Li Jian-yi 2010, 14 (48):  8945-8949.  doi: 10.3969/j.issn.1673-8225.2010.48.005 Abstract ( 383 )   PDF (613KB) ( 730 )   Save BACKGROUND: Three-dimensional reconstruction is a foundation of knee joint stimulation. There are few reports regarding structural subdivision and reconstruction of ligament surrounding joint, cartilage, and meniscus. OBJECTIVE: To reconstruct a 3D knee model with ligments, cartilage and meniscus based on previous knee joint anatomy using CT and MRI data. METHODS: CT and MRI data of 1 adult knee joint were harvested and import in Mimics10.1 to reconstruct the structures such as bone, atricular cartilage, meniscus and ligaments of knee joint. The registration was performed with reverse-engineering software Geomagic 8. RESULTS AND COCNLUSION: 3D knee joint model with bone, meniscus, ligaments and articular cartilage was reconstructed, which lays a foundation for finite element analysis of corresponding knee joint. Related Articles | Metrics

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Resistance characteristics of Escherichia coli associated with implant infection Qian Xue-feng, Shi Jin-fang, Qiu Shan-min, Gu Guo-hao 2010, 14 (48):  8950-8953.  doi: 10.3969/j.issn.1673-8225.2010.48.006 Abstract ( 286 )   PDF (307KB) ( 285 )   Save BACKGROUND: Implantation of biomaterials can induce infection, resulting in implant loosening, shedding, even bacteremia. Previous studies do not focus on bacterial drug resistance in implant-related infection. OBJECTIVE: To investigate the resistance characteristics of implant infection-associated Escherichia coli to provide strategies for prevention and treatment of this infection. METHODS: With E.coli ATCC 25922, Staphylococcus aureus ATCC 25923 and Pseudomonas aeruginosa ATCC 27853 as quality control strain, 17 commonly used antibiotics were selected to perform susceptibility test. The resistance rates were calculated to analyze resistance characteristics; disc screen test and disc diffusion phenotypic confirmatory test were used to detect strains producing Amp C and ESBLs, a clear enzyme production rate; resistance plasmid was extracted. Drug resistance genes were detected by PCR expansion. Genotype distribution was analyzed. RESULTS AND CONCLUSION: Of 17 antibiotics, imipenem resistance rate was the lowest, followed by amikacin, cefoperazone/sulbactam, cefepime and piperacillin/tazobactam, and most were multi-drug resistant strains. A total of 42 strains (61.8%) were screened and produced ESBLs and 27 isolates (39.7%) Amp C production strains, while producing ESBLs and Amp C strains were 23 (33.8%). ESBLs producing strains carrying CTX-M type gene were the most common accounting for 66.7%, 19 strains (45.2%) carrying two or more genes. Of producing Amp C production, the majority of strains were DHA-type, and 5 strains (18.5%) carried two genes. Implant infection of Escherichia coli strains showed high levels of resistance, resistance spectrum to expand, and multiple drug resistance. The drug resistant gene is complex and diverse. Sensitive drugs in combination with amikacin are recommended to treat this kind of infection. Related Articles | Metrics

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Three-dimensional modeling of leg prosthetic socket by computer Zhang Shao-lan, Li Gu-qiang, Shao Chang-qing 2010, 14 (48):  8954-8957.  doi: 10.3969/j.issn.1673-8225.2010.48.007 Abstract ( 280 )   PDF (286KB) ( 424 )   Save BACKGROUND: Prosthetic socket as the only passage to transfer load between patient affected limb and prosthesis significantly influence matching degree of the prosthesis. Three-dimensional modeling of prosthetic socket is important for socket utility to obtain accurate data. OBJECTIVE: To establish the three-dimensional model of prosthetic socket by computer to provide data for prosthetic socket finite element analysis and provide reliable parameter for processing prosthetic socket. METHODS: One male patient, 32 years old, undergoing below knee amputation, was selected, with normal hip muscle strength, 18° flexion contracture, and normal other joint activity. According to CT and MRI, data were processed using the Mimics10.0 software to construct three-dimensional model of the prosthetic socket and accurately simulate the residual limb and prosthetic socket structure. RESULTS AND CONCLUSION: The three-dimensional models of the prosthetic socket and residual limb accurately displayed geometry characteristic and exterior outline. The establishment of prosthetic socket is helpful to improve manufacture success ratio, fundamentally changes the traditional manual design, measurement, sampling and repair. Related Articles | Metrics

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Stress distribution on pedicle screw and cage in posterior fusion surgery of lumbar spondylolysis: A three-dimensional finite element analysis Zhang Zhen-hui, Tao Zhi-qiang, Wu Shao-cheng, Ruan Cai-zheng 2010, 14 (48):  8958-8961.  doi: 10.3969/j.issn.1673-8225.2010.48.008 Abstract ( 258 )   PDF (322KB) ( 402 )   Save BACKGROUND: Nowadays, most of three-dimensional finite analysis concern normal lumbar vertebra models in spinal surgery. Few researches have been conducted regarding models of postoperative pathological state. OBJECTIVE: To develop a three-dimensional finite element model of posterior fusion surgery of L 4-5 spondylolysis to evaluate the stability and the stress distributions of pedicle screw and cage in different models. METHODS: The L 4-5 motion segment data were obtained from CT scans of the lumbar spine of an adult man with spondylolysis. The three-dimensional finite element model of L 4 -5 spondylolysis was established by abaqus6. 51. The models were subjected to gridding and attribute assignment. The finite element models of pedicle screw and cage were also established, and various posterior fusion models of different approaches were created according to the clinical operation types. The boundary was set, and the models were subjected to different forces including axial compressive, anterior bending, posterior extension, left bending, and right rotation. The von Mises stress, displacement of the fusion segments on the pedicle screw and cages were recorded. All the measuring data were analyzed by SPSS 13.0. RESULTS AND CONCLUSION: All the stress mostly concentrated in the joint position of the arch bar and screw fixed. The stress was minimal under axial compression and maximal under axial rotation. The stress of the Cage mainly located in the anterior part and posterior parts. The displacement of posterior fusion was less than the lateral fusion (P < 0.05). A three-dimensional finite element model of different posterior fusion methods for L4 spondylolysis was established, and the stress distribution and displacement was clinically significant under loading. The stability of lumbar interbody fusion was better than pedicle screw fixation plus lateral fusion. Related Articles | Metrics

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CosmosWorks-based finite element analysis for lumbar elastic fixation rod Shi Geng-qiang　　 2010, 14 (48):  8962-8965.  doi: 10.3969/j.issn.1673-8225.2010.48.009 Abstract ( 327 )   PDF (303KB) ( 337 )   Save BACKGROUND: Mechanical and biological factors are main causes for prosthesis loosening, so the stress distribution and implant loosening mechanisms have aroused the attention of scholars. OBJECTIVE: To analyze mechanical properties of lumbar spine "U"-type flexible mechanical fixation device using finite element analysis. METHODS: Three-dimensional modeling software of solidworks2008 was used to establish a flexible rod fixation of the entity model, and CosmosWorks tools were used for finite element analysis, respectively, to exert compression, flexion, and tensile and other physical load. The stress distribution of model under different loads elastic fixation device was observed, and each node unit force and displacement situation of fixation rods in the deformation process were observed. RESULTS AND CONCLUSION: The "U"-type elastic stress distributes within the fixation device in the "U"-type connecting rods of the "U"-type area, and the stress-strain curves show a good elasticity. Related Articles | Metrics

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Anatomical observation of transforaminal lumbar interbody fusion using single anatomical threaded cage insertion Wang Zhao-jie, An Rong-ze, Wang Ke-qiang, Qi Xin-wen, Yu Hua-wei 2010, 14 (48):  8966-8969.  doi: 10.3969/j.issn.1673-8225.2010.48.010 Abstract ( 268 )   PDF (254KB) ( 390 )   Save BACKGROUND: The surgical instruments of transforaminal lumbar interbody fusion (TLIF) have been shown to be designed according to the body of the Western. Therefore, it is necessary to explore the related anatomy technique. OBJECTIVE: To measure the lumbar intervertebral foramen and the anatomical data associated with TLIF. METHODS: Intervertebral foramen width, length, and height of 14 normal adult cadavers lumbar spine were observed; the distance from structure of the lumbar spine to the midst sagittal plane from L3 to L5 was measured as well. RESULTS AND CONCLUSION: Lumbar intervertebral foramen width gradually become smaller from L1 to L5; the height was gradually increased from L1 to L4, and L5 was slightly smaller than L4; the height was significantly greater than the width from L1 to L5 (P < 0.01); the length of intervertebral foramen was gradually increased from L1 to L5 as well (P < 0.05). The distance from the lateral margin of the pars interarticularis to the midst sagittal plane from L3 to L5 was gradually increased, and the distance from inferior articular process to the midst sagittal plane from L3 to L5 was increased as well. There was no significant difference in gender or two sides (P > 0.05). Results showed that 9-14 mm single posterolateral threaded fusion cage can be inserted by intervertebral foramen approach in Chinese. Single cage implant do not pull dura or nerve roots, thereby preventing spinal cord and nerve root injury. Related Articles | Metrics

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New adjustable nested stud versus common screw in treatment of abruption of lower tibiofibular ligament union with ankle joint fracture Liu Yi, Yan Jian-jun, Shen Hai-qi 2010, 14 (48):  8970-8973.  doi: 10.3969/j.issn.1673-8225.2010.48.011 Abstract ( 242 )   PDF (322KB) ( 366 )   Save BACKGROUND: Doornail, steel wire, polyester twin wire plus button have been used to treat lower tibiofibular ligament union. However, the fixation is not stable, with high incidence of re-separation. OBJECTIVE: To compare the effects of new adjustable nested stud and common screw in curing the abruption of lower tibiofibular ligament union with ankle joint fracture.  METHODS: A total of 113 patients with the abruption of lower tibiofibular ligament union and ankle joint fracture were selected from Department of Orthopedics, Nanjing First Hospital and Nantong First People’s Hospital between March 1988 and September 2008. All patients were treated with open reduction internal fixation, including 66 cases with the new adjustable nested stud and 47 with common screw. Excellent good rate of two methods was evaluated according to clinical standards. RESULTS AND CONCLUSION: A total of 94 patients were followed-up for 8 months to 11 years. X-ray showed that bone fracture healed in all patients. Except for open wound, all wounds healed at the primary stage, with no bursitis or infection. Of patients treated with new adjustable nested stud, 49 (90.7%) were excellent, 4 (7.4%) good, 1 (1.9%) poor, with the excellent and good rate of 98% and high quality rate of 91%. Of patients treated with common screw, 30 (75%) were excellent, 6 (15%) good, and 4 (10%) poor, with the excellent and good rate of 90% and high quality rate of 75%. The new adjustable nested stud is simpler than the common screw to operate, fix firmly and reliably, with better recover normal dissection structure. It is an ideal treatment for the abruption of lower tibiofibular ligament union with ankle joint fracture. Related Articles | Metrics

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Comparison of biomechanical and clinical effects among dynamic hip screw, proximal femur nail antirotation and Gamma3 Qian Zhong-lai, Xu Yao-zeng, Wang Xian-bin, Geng De-chun, Tang Tian-si 2010, 14 (48):  8974-8979.  doi: 10.3969/j.issn.1673-8225.2010.48.012 Abstract ( 229 )   PDF (398KB) ( 537 )   Save BACKGROUND: How to choose an appropriate internal fixation method for the treatment of intertrochanteric fracture of femur is a common problem in clinic. OBJECTIVE: To compare the biomechanical functions and clinical effects of dynamic hip screw (DHS), proximal femur nail antirotation (PFNA) and the third generation Gamma nail (Gamma3). METHODS: A total of 18 fresh specimens of proximal femur were prepared into models of intertrochanteric fracture, which were fixed with DHS, PFNA and Gamma3. The different internal fixation methods were tested and proved by means of experiment stress analysis. Clinical effects of 392 cases of intertrochanteric fracture of femur undergoing fixation with the above three methods were retrospectively analyzed. RESULTS AND CONCLUSION: The stress analysis proved that the biomechanical functions of Gamma3 and PFNA were better than DHS (P < 0.05). There was no obvious difference between Gamma3 and PFNA. The DHS group had the most average intraoperative bleeding and greatest incidence of complications related with internal instrument (P < 0.05). The Harris score of the PFNA and Gamma3 groups in earlier period was better than the DHS group (P < 0.05). There was no obvious difference in the long-term scores between the three groups (P > 0.05). DHS is not recommended for the treatment of the type-A2 intertrochanteric fractures. PFNA and Gamma3, which present excellent biomechanical nature and clinical effects, especially are suitable for the osteoporotic patients of type-A2 or type-A3 intertrochanteric fractures. Related Articles | Metrics

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Biomechanical properties of bone interface following different-shaped titanium mesh implantation Cai Li, He Shi-xiong,Yao Guo-rong, Han Yi, Wu Da-peng, Tian Hong-yu 2010, 14 (48):  8980-8983.  doi: 10.3969/j.issn.1673-8225.2010.48.013 Abstract ( 565 )   PDF (378KB) ( 432 )   Save BACKGROUND: Titanium mesh as a new kind of bone graft implants has been commonly used in spinal surgery because the advantages of good instant stability, maintenance of cervical curvature, surgical angle of the intervertebral segment, prevention of donor area complications, and high fusion rate. However, there has no consensus or a standard for trimming in titanium mesh surgery. OBJECTIVE: To investigate effect of individualized design titanium mesh on the recovery of cervical curvature and to test the biomechanical properties of bone interface after Trapezoidal titanium mesh implant. METHODS: A total of 16 cervical specimens with no difference in bone mineral density underwent C5 corpectomy, and 8 specimens were randomly selected as straight-shaped titanium mesh group, the others as trapezoidal titanium mesh group. The mesh was trimmed and implanted. Cervical curvature, intervertebral angle, disc height, the maximum load (N) of narrowing the operation intervertebral height 1 mm, and stiffness were measured. RESULTS AND CONCLUSION: Cervical lordosis angle in straight-shaped titanium mesh group and trapezoidal titanium mesh group was significantly greater than the blank control group (P < 0.05, P < 0.01), especially the trapezoidal titanium mesh group was greater. Intervertebral height of trapezoidal titanium mesh group and common titanium mesh group was increased 3.71 mm and 3.25 mm compared with the blank control group (P < 0.01), but no difference was observed between trapezoidal titanium mesh group and common titanium mesh group (P > 0.05). The maximum load and stiffness to narrow the gap of surgery 1 mm of trapezoidal titanium mesh group were significantly greater than common titanium mesh group (all P < 0.05). Results showed that individualized titanium mesh can simulate the normal disc shape, and under certain interbody distraction, it can effectively restore the physiological curvature of cervical spine and angle of the surgical intervertebral segment. It adapts for the high-low morphological characteristics of intervertebral space, and exhibits biomechanical properties. Related Articles | Metrics

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Biomechanical evaluation of different fixation methods using screws and less invasive stabilization system-distal femur plate at proximal fracture  Zhang Yan, Yang Tie-yi, Ji Hai-long, Liu Yue, Wang Zhi, Jiang Rui, Fan Xin-bin, Ye Wei-guang, Huang Guo-hua, Liu Shu-yi, Ding Zu-quan 2010, 14 (48):  8984-8987.  doi: 10.3969/j.issn.1673-8225.2010.48.014 Abstract ( 271 )   PDF (296KB) ( 278 )   Save BACKGROUND: In recent years, Less Invasive Stabilization System-distal femur (LISS-DF) plate has been widely used clinically, and proximal screw loosening and withdrawal are observed during follow-up. However, it remains unclear whether there is correlation between this phenomenon and unilateral cortical fixation of proximal screw. OBJECTIVE: To explore the biomechanical effect of LISS-DF by screw fixation with different unilateral or bilateral cortical in proximal distal femoral fracture. METHODS: Of 185 fresh sheep femora, the distal femoral fracture model of AO33-A3 was made. Five-hole LISS-DF plate was used in combination with screws through the fracture of the proximal cortex of unilateral or bilateral cortical fixed. Pulling and torsion tests were performed to identify ideal fixation way.   RESULTS AND CONCLUSION: Fracture distal and proximal screws were used for 4-hole conventional fixation. Pull out experiment showed that there was no significant difference in fracture strength values at both ends of the resistance to pull out in the first 1 and 3 hole fracture of the proximal screws double cortex, 2, 4 and 1, 4 bilateral cortical fixation (P > 0.05). Torsion experiment showed that when the holes of 1 and 3, 2 and 4 and 1 and 4 were fixed, the anti-torque values were similar, and no differences were observed between 1-3 and 2-4 holes (P > 0.05), but differences were observed among other groups (P < 0.05). Results show that when using the same specification LISS-DF plate in the treatment of distal femoral fractures, the 1, 3 holes or 2, 4 holes bilateral cortical fixation displayed good fixation strength of the balance between plate and screw, and better resistance against torsion and pulling out compared with other fixation methods. Related Articles | Metrics

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Effects of lateral angular deformity of tibial fracture on tibiofemoral joint biomechanics Zheng Wen-kui, Peng A-qin, Liu Yong, Jiao Jian-bao, Wang Cong, Ma Xiao-yong 2010, 14 (48):  8988-8992.  doi: 10.3969/j.issn.1673-8225.2010.48.015 Abstract ( 281 )   PDF (422KB) ( 306 )   Save BACKGROUND: The angular deformity of tibial fracture on biomechanical characteristics of knee joint remains controversial. OBJECTIVE: To evaluate the effect of tibial fracture on biomechanical characters of knee joint and prescribe the most acceptable extent of lateral angular deformity using biomechanics and pressure sensitive film. METHODS: The six specimens of lower limbs were obtained from fresh human cadavers. The cadaveric specimens were not infected with diseases. Model of lateral angular deformity was established, and tibiofemoral joint contact area, mean stress, and maximum stress were measured under tibial lateral angulation at 5°, 10°, 15° using pressure sensitive film. RESULTS AND CONCLUSION: The 5° lateral angular deformity had changed the contact character of the tibiofemoral joint. Thus, when dealing with tibial fracture, a lateral angular deformity > 5° should be reduced, and the anatomic position of tibia should be recovered. Related Articles | Metrics

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Reliability assessment for idiopathic scoliosis different Cobb angles by X-ray Sheng Wen-hui Xun Chuan-hui, Wu Bing, Xu Tao, Zheng Xin-feng, Shang Qi-song, Sheng Wei-bin 2010, 14 (48):  8993-8997.  doi: 10.3969/j.issn.1673-8225.2010.48.016 Abstract ( 287 )   PDF (422KB) ( 280 )   Save BACKGROUND: The measurement of Cobb angles is one of the most important factors to affect the reliability of the King, Lenke, and PUMC classification system for idiopathic scoliosis. Studies show reliability of coronal Cobb angle measurements. However, the range of Cobb angles in studies is too wide to contrast the results of these studies. Moreover, relatively few studies have attempted to validate the reliability of different coronal Cobb angles. OBJECTIVE: To determine the reliability and reproducibility of the different Cobb angles for idiopathic scoliosis. METHODS: A total of 94 curves of 53 patients, including 53 main thoracic curves and 41 thoracolumbar/lumbar curves, were evaluated by four orthopedic surgeons independently. Two weeks later, the sequence of the X-ray films was re-ordered and re-measured. Reliability and reproducibility was quantified using intraclass correlation coefficient. RESULTS AND CONCLUSION: Coronal Cobb angle measurement of total curves demonstrated excellent intraobserver reproducibility (0.961-0.977) and interobserver reliability (0.972, 95% confidence interval 0.919-0.964), and had a measurement error average 7.3° (range 20°-27°). The measurement average error was 6.4° (range 20°-14°) in 41 curves of Cobb angles from 46° to 70° and this curves demonstrated best reliability than other curves, intraobserver 0.914-0.930, interobserver 0.960 (95% confidence interval 0.935-0.977). The measurement error average was 6.5° (range 20°-13°) and 10.1° (range 30°-27°) in 31 curves of Cobb angles from 20° to 45°and more than 70° respectively. These two groups demonstrated excellent intraobserver reproducibility (0.854-0.912 and 0.864-0.950) and interobserver reliability (0.933 and 0.926, 95% confidence interval 0.884-0.965 and 0.865-0.965), respectively. Results of reliability were similar between different Cobb angles and measurement error for larger Cobb angles had very little effect to reliability. Related Articles | Metrics

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Dynamic MRI detection of cervical spondylotic myelopathy in the healthy and individuals with neck discomfort Li Zhi-fei, Zhong Yuan-ming, Zhang Jia-li, Xu Jian-wen, Yang Guang, Wei Jia-ding, Wu Liang, Ma Xian-sheng, Tang Fu-bo 2010, 14 (48):  8998-9002.  doi: 10.3969/j.issn.1673-8225.2010.48.017 Abstract ( 323 )   PDF (279KB) ( 402 )   Save BACKGROUND: MRI examination of cervical spondylotic myelopathy (CSM) is static plain scanning in a supine position with no movement or loading. Therefore, the spinal organic changes under loading and movement are omitted. OBJECTIVE: To investigate the clinical significance of clinical manifestations in combination with cervical dynamic MRI in early diagnosis of CSM. METHODS: A random sample of 10 normal population (normal group), 20 sub-health population with neck and shoulder discomfort (subhealth group), 20 patients with symptoms and signs of CSM, but not supported by conventional MRI (normal MRI CSM group), 20 CSM patients consistent with current diagnostic criteria (CSM group) were subjected to evaluation of JOA score, cervical spine lateral view, the neutral position of cervical spine MRI and dynamic MRI. They were followed up for at least 18 months, and index changes and transformations in four groups were observed.  RESULTS AND CONCLUSION: CSM group were enrolled within six months treatment; Of 20 cases in normal MRI CSM group， 16 cases were treated in 16 months, and 4 in 1 year in the neutral position during MRI, which displayed no significant change; 12 patients with typical changes in 1 year in the neutral position after the cervical MRI underwent CSM surgical treatment, and the former treatment was better than the latter (P < 0.05); 4 cases in the subhealth group displayed CSM symptoms and signs, and the finding of their dynamic cervical MRI had signs of spinal canal narrowing of spinal cord compression, but the neutral position MRI revealed only one case of this change, who showed spinal cord compression on dynamic MRI at 12 months. In the follow-up of normal group, MRI in neutral position and dynamic MRI showed one case had spinal canal narrowing of spinal cord compression signs, but no symptoms were considered false-positive; the false positive rate was identical. Results showed that compared with MRI in neutral position, dynamic MRI can earlier and more realistic objective to display signs of spinal cord compression. In clinical symptoms and signs checks, MRI in neutral position in combination with dynamic MRI can early discover CSM. Related Articles | Metrics

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MRI evaluation of craniovertebral junction malformation with transoral atlantoaxial reduction plate internal fixation Chen Geng, Han Li-xin, Cao Hui-xia, Wang Jun, Zhao Yu-cui, Mo Shu-qun 2010, 14 (48):  9003-9006.  doi: 10.3969/j.issn.1673-8225.2010.48.018 Abstract ( 250 )   PDF (444KB) ( 340 )   Save BACKGROUND: X-ray, CT examinations only show bone structure of craniocervical junction, but not the situation of spinal cord during craniovertebral junction malformation with transoral atlantoaxial reduction plate (TARP) internal fixation surgery. OBJECTIVE: To analyze the magnetic resonance images before and after craniovertebral junction malformation with TARP internal fixation, so as to evaluate the value of MRI in choosing surgical approach and judging effects of postoperative. METHODS: A total of 25 patients with craniovertebral junction malformation were selected from June 2009 to April 2010, comprising 9 males and 16 females. All patients underwent X ray, CT, and MRI examination. All patients were treated with TARP internal fixation surgery, and MRI examinations were performed in three months after surgery. RESULTS AND CONCLUSION: All patients completed surgery successfully, and did not appear serious complications such as spinal cord vascular injury. MR imaging in 25 patients showed postoperative fixation in site, skeletal of cranio-cervical junction reposition, compression of spinal cord improvement. In 11 cases which were followed up, the original partial upper cervical pain and limited mobility improved or disappeared in 9 cases. MRI can show deformity of craniocervical junction clearly in multi-dimensions, especially for spinal cord and cranio lesions; it may provide an objective basis for choice of surgery, judgment of compression condition of spinal cord and postoperative recovery. Related Articles | Metrics

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Selection of the baseline in functional MRI study of acupuncture Chen Shang-jie, Peng Shu-ming, Xu Ming-hui, Zhang Jia-wei, Shi Xue-min 2010, 14 (48):  9007-9010.  doi: 10.3969/j.issn.1673-8225.2010.48.019 Abstract ( 258 )   PDF (322KB) ( 354 )   Save BACKGROUND: Functional MRI (fMRI) is important to study acupoint specificity in recent year. Most of fMRI studies of acupuncture utilize the block design, and scanned after the needle is inserted. It is supposed that resting after needle into acupoint is pure rest and can be a baseline control. However, it is conflict with traditional Chinese acupuncture theory which thinks that acupuncture effect occurs after the needle into acupoint. OBJECTIVE: To investigate how to choose baseline of acupuncture fMRI. METHODS: Block design in Hui’s method was used. Acupuncture effect after needling into acupoint was analyzed to observe whether there was activation of brain function after needling into acupoint. RESULTS AND CONCLUSION: It did not produce a certain function after tactile stimulus. But it produced a certain function after needling into acupoint. Rest phase after needling is not pure rest phase and is not a good baseline. Related Articles | Metrics

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Synovia analysis in normal versus osteoarthritis rabbits Xu Bin, Liu Wen-xiang, Xu Hong-gang 2010, 14 (48):  9011-9016.  doi: 10.3969/j.issn.1673-8225.2010.48.020 Abstract ( 480 )   PDF (372KB) ( 550 )   Save BACKGROUND: Studies show that there are relationships between the changes of osteoarthritis (OA) synovia with the damage of the articular cartilage. OBJECTIVE: To determine the content of some important ions, cell and hyaluronic acid of synovial fluid in normal and OA rabbits to observe the relationship between the early changes of OA synovia with the pathological changes of the articular cartilage and analyze the variation and significance of inflammatory cytokines interleukin (IL)-1 and tumor necrosis factor (TNF)-α in early osteoarthritis. METHODS: New Zealand white rabbits were used to establish OA models at the right knee, and the left knee joint served as control. Sampling of both knees was performed at 4, 6, and 8 weeks. The synovia was removed for routine biochemical quantification, using ELISA method for the hyaluronic acid, IL-1 and TNF-α quantitative detection. RESULTS AND CONCLUSION: There were no significant differences between OA group and normal group in ions concentration. Hyaluronic acid, IL-1 and TNF-α changes at the fourth week: hyaluronic acid level was significantly increased at 4 weeks, decreased with increasing cartilage lesion degree, and returned to normal level at 8 weeks; IL-1 level was significantly increased at 4 weeks, and changed at 4, 6, and 8 weeks in a increase tendency; TNF-α was significantly increased at 4 weeks, and remained increasing 6 and 8 weeks. Related Articles | Metrics

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Correlation between normal angle of acromioclavicular joint and glenohumeral joint motion Zhang Chun-hong, Yan Xu, Wang Shu-li, Zhang Qing, Zhang Jian-guo, Ye Wei-sheng 2010, 14 (48):  9017-9019.  doi: 10.3969/j.issn.1673-8225.2010.48.021 Abstract ( 376 )   PDF (195KB) ( 297 )   Save BACKGROUND: The angle of the hook of the clavicular hook plate could not change in application of dislocation of acromioclavicular joint and or fracture of the clavicle distal end. But the angle of the acromioclavicular joint will change somewhat during the glenohumeral joint abduction. OBJECTIVE: To investigate the normal acromioclavicular joint value and its relation to glenohumeral joint motion during abduction as well as their clinical significance. METHODS: A total of 97 cases with their TOP images among the CT data containing the shoulder joints were selected, including 57 males and 40 females. The angle of acromioclavicular joint values on the screen of the CT monitor was measured. The angle of acromioclavicular joint is the included angle between the major axis of acromeon and the major axis of clavicle distal part. The glenohumeral joint angle is the major axis of humoros in abduction and vertical line. RESULTS AND CONCLUSION: The average angle of the acromioclavicular joint was (162.04±10.53) ° when the glenohumeral joint angle at (16.06±11.87) ° (R=0.010, P < 0.000), suggesting the correlation between two angles. The average angle of the acromioclavicular joint was (174.34±10.14) ° when the glenohumeral joint angle at (137.64±14.48) ° (R=0.053, P < 0.01) suggesting the correlation between two angles. Results indicate that the acromioclavicular joint angle is changing during active humeral elevation. The acromioclavicular joint angle moves during glenohumeral joint angle change. Related Articles | Metrics

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Objective measurement system of eye diopter based on image processing　　 Zhao Jun-qi, Chen An-shi, Guo Zhi-yong, Yan Jie 2010, 14 (48):  9020-9023.  doi: 10.3969/j.issn.1673-8225.2010.48.022 Abstract ( 313 )   PDF (333KB) ( 418 )   Save BACKGROUND: Recent methods for diopter measurement utilize the infrared LED light emitting diode as the light source. The infrared light passes through the cornea, the aqueous, the lens, the vitreous and the retina, and causes the uneven reflection image. The edge determination error is inevitable, and affects the measurement results. OBJECTIVE: To design a new measurement system of eye diopter based on image processing to improve precision of diopter measurement. METHODS: The infrared image of six dots was emitted in retina, and it was displayed on CCD through optical system. First, the binary image was divided up with adaptive multi-threshold method. Subsequently, the center coordinate was calculated by centroid method. Finally, the parameter of diopter was acquired by least-squares fitting. The standard analogue eye was used for testing, and the testing results were compared with that of the refractor made in Japan TPCON. RESULTS AND CONCLUSION: The precision of diopter measurement can meet the requirement of ±0.25 m-1 which is prescribed by National Metrology Bureau, and the error which caused by uneven image on CCD can be avoided. The structure of system is simple, and the light energy can meet the requirement. The experiment shows that the precision of diopter parameter can be increased, and the prototype has been made. In the hospital, the technology can be used in quick clinical examination and vision screening. However, the structure is too simple, and may lead to the error in large diopter measurement. The coaxial requirement of the light source and the optical system is high, which should be improved in future. Related Articles | Metrics

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Multichannel signal wireless telemetry technology for visual cortex prosthesis Wang Li-ping, Peng Cheng-lin, Hou Wen-sheng, Wang Xing 2010, 14 (48):  9024-9028.  doi: 10.3969/j.issn.1673-8225.2010.48.023 Abstract ( 291 )   PDF (763KB) ( 389 )   Save BACKGROUND: Wireless signal telemetry system participates in the information exchange inside and outside visual cortex prosthesis. In order to enable prosthesis to effectively stimulate by multi-targets in the intended region, a variety of diverse extracorporal stimulative signals are needed. OBJECTIVE: To propose a design proposal of a wireless simultaneous-signal transmission system. METHDOS: The proposal can transmit simultaneous signal in one channel using the technology of Frequency Division Multiplexing. The whole system design is divided into extracorporal transmission circuit and intracorporal receiving circuit and the latter adopts passive design to reduce the harm of energy supply to the implants. As providing the specific circuit design, we analyze the factors affecting transmission efficiency and validate its feasibility by multisim simulation experiment. RESULTS AND CONCLUSION: The multichannel signal wireless telemetry system can be applied to the part of signal transmission of various implantable prostheses, which employs passive design to reduce the harm of energy supply to the implants. Preliminary simulated experiments showed the feasibility of this system, which exhibits a wide range of promising applications. Related Articles | Metrics

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Tumble detection based on three-dimensional acceleration transducer Zhang Ai-hua, Wang Lu 2010, 14 (48):  9029-9032.  doi: 10.3969/j.issn.1673-8225.2010.48.024 Abstract ( 383 )   PDF (242KB) ( 551 )   Save BACKGROUND: Body of the elderly changes along with aging. Pathological changes of acute and chronic diseases may influence sense input, central nervous system function and skeletal muscle strength coordination, leading to extremely high probability on tumble. In daily life, falls of the elderly may cause serious consequence. OBJECTIVE: To design a tumble detection device based on three-dimensional acceleration technology. METHODS: A tumble detection device was designed based on the three dimensional acceleration and ZigBee wireless communication technology. The collected acceleration signals were sent to PC by ZigBee wireless communication for data analysis and processing. RESULTS AND CONCLUSION: Results of experiments show that this equipment can achieve an accurate judgment on tumble occurrence, and is able to classify the type of tumble, so the elderly may obtain timely medical aid after tumbles. Moreover, it provides information for doctor to judge the health of older persons. Related Articles | Metrics

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Design of data acquisition system for biochip based on advanced RISC machines and field programmable gate array Zheng Bin, Wan Sui-ren, He Nong-yue 2010, 14 (48):  9033-9036.  doi: 10.3969/j.issn.1673-8225.2010.48.025 Abstract ( 303 )   PDF (351KB) ( 376 )   Save BACKGROUND: Imaging instrument in combination with computer limits application range of biochip. With continuous development of biotechnology, biochip detection requires miniaturization, integrating and intelligentification. OBJECTIVE: To implement the high speed, high resolution and real-time in biochip detection system. METHODS: To meet the demands of high speed, high resolution and real time for biochip, a new design of data acquisition based on advanced RISC machines (ARM) and field programmable gate array (FPGA) was introduced. The system hardware architecture and interface design were discussed, with the emphasis on design and implement of software system. It is a new system for design and implementation of biochip detection system. RESULTS AND CONCLUSION: The system design based on ARM and FPGA can meet the demand of high resolution, high speed and real-time effectively which proved by the simulation. Besides, the design has improved system reliability, and it solves the problems of complex and redundancy of hardware and software design in data acquisition effectively. Related Articles | Metrics

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Reliability and validity for Chinese Version of Pediatric Quality of Life Inventory PedsQLTM3.0 Cardiac Module Huang Zhuo-yan, Hao Yuan-tao, Zhu Qi, Lin Dan-er, Yang Zhong-yi, Hu Jia-mei 2010, 14 (48):  9037-9040.  doi: 10.3969/j.issn.1673-8225.2010.48.026 Abstract ( 483 )   PDF (288KB) ( 560 )   Save BACKGROUND: Health related quality of life (HRQOL) of children with heart disease receives increasing attention, but there are few related studies in China. One of the main reasons is a lack of suitable questionnaire. OBJECTIVE: To test the reliability and validity of Chinese Version “Pediatric Quality of Life Inventory PedsQL3.0 Cardiac Module”. METHODS: The standard procedure of cross-culture adaptation was used to develop the Chinese version PedsQL3.0 Cardiac Module. A total of 310 pediatric outpatients/inpatients with heart disease and their parents from three Triple A hospitals in Guangzhou completed the Chinese version PedsQL3.0 Cardiac Module. The psychometric properties of the scale such as internal consistency, content validity and construct validity were evaluated. RESULTS AND CONCLUSION: A total of 462 of 480 questionnaires were completed. The rate of item missing was less than 1%. All domains' Cronbach alpha ranged from 0.66-0.9, except the 5-7 years old group (α=0.35 in “Appearance”). The results of correlation analysis showed that there was higher correlation between item and its belonged domains than that with other domains. The results of Confirmatory Factor Analysis indicated that the factor structure was similar to the theoretical construct of the original instrument. An acceptable psychometric property of the Chinese Version PedsQL3.0 Cardiac Module was indicated. Chinese version PedQL3.0 Cardiac Module can be used in health-related quality of life research for Chinese cardiac children. Related Articles | Metrics

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Research and application of digital human Lü Ting 2010, 14 (48):  9041-9045.  doi: 10.3969/j.issn.1673-8225.2010.48.027 Abstract ( 633 )   PDF (312KB) ( 975 )   Save BACKGROUND: Digital human project is a new field regarding the integration of life science and information science. International series of plans have been performed, such as the visible human project, virtual human project, and digital human project. OBJECTIVE: To review the progress of digital human research and its application. METHODS: A computer-based online search of CBM and CNKI published between January 2000 and January 2010 was performed with key words “visible human, virtual human, digital human” in English and Chinese. Also Google search engine was used to retrieve the relevant Web information resources. RESULTS AND CONCLUSION: Digital human research has entered physiological stage from physical human stage. At present, with the digital medicine developing rapidly, medical information researchers should focus on how to use information technology in digital medicine, accurate medicine, minimally invasive medicine, telemedicine, and how to implement these rapid changes in medicine. This article introduces a series of digital human research program and some digital human models. Also, it introduced the progress of digital human research, the scientific significance of studying digital human in the medical field. Related Articles | Metrics

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Bibliometric analysis of rapid prototyping techniques in the field of orthopaedics Bai Zhao-hui, Zhang Ying, Yin Qing-shui, Xia Hong, Li Ping-yue 2010, 14 (48):  9046-9050.  doi: 10.3969/j.issn.1673-8225.2010.48.028 Abstract ( 284 )   PDF (323KB) ( 469 )   Save BACKGROUND: In recent years, rapid prototyping (RP) techniques have been used widely in the field of hard tissue surgery. However, no related reports of bibilometric analysis have been published in China. OBJECTIVE: To explore the current and tendency of the application of RP techniques in the field of orthopaedics in our country using bibiometric analysis for relative documents. METHODS: CBMdisc (1978-01/2010-06) with subject headings “orthopaedics” and keywords “rapid prototyping” or other keywords describing RP techniques, and CHKD (1994-01/2010-06) with keywords “rapid prototyping” or other keywords describing RP techniques were used for computer-based online search. Hand retrieval was performed by searching documents from current journals such as Chinese Journal of Orthopaedics, Chinese Journal of Orthopaedic Trauma, Orthopaedic Journal of China and Journal of Clinical Rehabilitative Tissue Engineering Research. A total of 241 articles were collected, and 201 were finally included after reading the full-text and excluding repetitive articles and independent articles. RESULTS AND CONCLUSTIONS: The first document regarding RP techniques application in orthopaedics field was published in 1998 in our country. Following increasing recognition and profound researches on RP techniques, more and more researchers paid attention to this topic. Journal of Clinical Rehabilitative Tissue Engineering Research, Chinese Journal of Orthopaedic Trauma and Orthopaedic Journal of China and Orthopedic Journal of China were important periodicals and the related documents were mainly published on orthopaedic academic journals, high school journals and some professional journals which focused on biomedical engineering, tissue engineering, mechanical engineering and material science closely related to digital orthopaedics. Li Xiang, Lu Sheng, Ma Xing, Yan Yongnian and Chen Yubing were prolific authors, but professional researchers group had not been formed. First authors of the theses were all from 3A hospitals and high schools. Xijing Hospital of the Fourth Military Medicine University, Xi’an Jiaotong University and Tsinghua University offered the most documents which indicated the entire academic levels in our country; Xi’an and Beijing were the most active fields, and there existed imbalance in the field distribution. Fund-sponsored articles occupied 63.2% in all documents and most of the funds were from the National Science Foundation, National High-tech R&D Program of China as well as China Post-doctoral Science Foundation, showing the relative documents’ advantage of high starting point, strong scientific research strength and good quality. In addition, the application of RP techniques in the field of orthopaedics had been transferred gradually from basic researches to clinical researches which mainly focused on fabrication of artificial bone, prosthesis design and manufacture, orthopaedic instrument developing as well as computer aided design models, while most clinical researches were concentrating on the therapy for complex fractures of extremities, orthopaedic surgery of extremities malformation, bone neoplasms and spine diseases. Related Articles | Metrics

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Design of respiratory trainer in perioperative period Liu Xin, Zhang Hong, Chen Lan 2010, 14 (48):  9051-9056.  doi: 10.3969/j.issn.1673-8225.2010.48.029 Abstract ( 293 )   PDF (597KB) ( 537 )   Save BACKGROUND: Because of the effect of narcotic analgesics, sedatives, brain injury and abdominal surgery in the perioperative period, shallow breathing is the most common symptom for the patients, which may lead to the decrease of forced vital capacity (FVC) and lung congestion. Thus, the patents will be more difficult to recover. Using the respiratory trainers during pre-surgery and post-surgery can improve the respiratory systems and decrease the incident of lung congestion. OBJECTIVE: To summarize and analyze the respiratory trainers in perioperative period. METHODS: A computer-based online search of CNKI, VIP and USPTO Patent Full-Text and Image Database was performed for articles published between 1977 and 2009 regarding respiratory trainers in perioperative period with key words “respiratory training, inspiratory capacity, respirator” in Chinese and “inhalation device, respiratory exerciser” in English. Repetitive studies were excluded. Patent structural design and theoretical evidence were summarized. RESULTS AND CONCLUSION: A total of 15 studies and 15 patent designs were collected. This paper analyzed patent designs of respiratory trainers and summarized patent structural design and theoretical evidence. The design principles were divided into three types: airflow rate, total gas volume, and respiratory resistance produced by special structures. The advantages and disadvantages of three types of design were compared. In addition, the clinical application of respiratory trainers was reviewed. Related Articles | Metrics

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Evaluation of total hip arthroplasty for development dysplasia of the hip with osteoarthritis Zheng Ji-nan, Hong Qing-nan, Fang Jun 2010, 14 (48):  9057-9060.  doi: 10.3969/j.issn.1673-8225.2010.48.030 Abstract ( 232 )   PDF (281KB) ( 412 )   Save BACKGROUND: Total hip arthroplasty (THA) for adult developmental dysplasia of the hip (DDH) can effectively relieve hip pain, improve hip function and quality of patient life. OBJECTIVE: To comprehensively evaluate the effects of THA in treating osteoarthritis secondary to DDH. METHODS: Articles of clinical studies regarding THA for osteoarthritis secondary to DDH published between January 2001 and June 2010 were searched from CNKI database. Repetitive studies and review articles were excluded. Included articles were evaluated and summarized.   RESULTS AND CONCLUSION: By reading titles and abstracts, 50 articles were collected, and 16 were included in the final analysis. The Harris hip scores, recent excellent and good rate, and satisfaction degree were analyzed. Results showed that THA is an effective method to treat osteoarthritis secondary to DDH. However, THA is difficult to operate. Deepening the acetabular reaming, firmly placing the acetabular component in the true acetabulum, and reforming the anatomical rotational center are important for successful THA, which improves effects of THA. Related Articles | Metrics

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Treatment features and prosthesis selection of artificial joint replacement for elderly intertrochanteric fracture Fan Shao-di, Yu Jie, Chen Rong-bo, Liu Jian, Shen Bin, Wang Guo-juan 2010, 14 (48):  9061-9064.  doi: 10.3969/j.issn.1673-8225.2010.48.031 Abstract ( 399 )   PDF (299KB) ( 483 )   Save OBJECTIVE: To explore prosthesis selection and clinical treatment features of artificial joint replacement for elderly unstable intertrochanteric fracture. METHODS: A computer-based online search of Wanfang database (http://www.wanfangdata.com.cn/) was performed for articles related to artificial joint replacement for elderly unstable intertrochanteric fracture published between January 2000 and August 2010, with key words “intertrochanteric, fracture, artificial joint, elderly” in Chinese. Repetitive study, review articles and Meta analysis was excluded. A total of 25 articles were included. RESULTS: Prosthesis selection is very important for artificial joint replacement for elderly unstable intertrochanteric fracture. The prosthesis should be selected according to Evans standard classification and proximal femoral fracture condition. The artificial hip prosthesis is classified into three types: shaft length, i.e. lengthened shaft or common shaft; total hip prosthesis and bipolar femoral head prosthesis; cemented shaft and biological shaft prosthesis. In addition, the prosthesis should be selected according to sclerotin condition. Cemented prosthesis can obtain immediately stability following replacement, so it is recommended for most elderly patients with unstable intertrochanteric fracture. CONCLUSION: Artificial joint prosthesis selected according to fracture type and patient condition is safe and effective in treating elderly intertrochanteric fracture, which can rapidly restore function and reduce complications. Related Articles | Metrics

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Transvertebral pedicle screws internal fixation for thoracolumbar fracture                               Yu Chang-shui, Yang Wei-liang 2010, 14 (48):  9065-9068.  doi: 10.3969/j.issn.1673-8225.2010.48.032 Abstract ( 262 )   PDF (280KB) ( 370 )   Save OBJECTIVE: To evaluate effect and adverse effect of pedicle screw internal fixation for thoracolumbar fracture. METHODS: A computer-based online search was performed with key words “thoracolumbar, fracture, injured vertebra, pedicle screws, internal fixation” in Chinese and English for articles published between January 1993 and October 2009. Articles related to injured vertebra pedicle screws internal fixation for thoracolumbar fracture were included. Repetitive and Meta analysis was excluded. A total of 22 studies were included, which discussed clinical outcomes and adverse effects of injured vertebra pedicle screws internal fixation for thoracolumbar fracture. RESULTS: Pedicle screws internal fixation through injured vertebra can obtain favorable reduction, reconstruct vertebral height, enhance spinal anti-compression and stability, reduce loosening or breakage, and decrease complications. Biomechanical test shows that pedicle screws internal fixation through injured vertebra can enhance spinal stability. Clinical application shows that pedicle screws internal fixation through injured vertebra is operable, and appropriate, reliable fixator and tools, rigorous operation can reduce adverse effects. CONCLUSION: Pedicle screws internal fixation through injured vertebra is a reliable and effective therapy for thoracolumbar fracture, with few adverse effects. Related Articles | Metrics

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Resource sharing strategy of regional medical information and images digitalization Zhou Jin-hai, Yin Zhi-hong 2010, 14 (48):  9069-9073.  doi: 10.3969/j.issn.1673-8225.2010.48.033 Abstract ( 310 )   PDF (459KB) ( 496 )   Save OBJECTIVE: To explore sustainable development of digital images and regional health information resources sharing. METHODS: Through direct visit and telephone survey of 44 hospital information, as well as community and public media public demands, resource sharing strategy was analyzed objectively using electronic databases. A computer-based online search of CNKI (2000/2010), PubMed databases was performed with key words “medical treatment information, health information, images digitization” in Chinese and English. Repetitive studies and outdated articles were excluded. RESULTS: Almost all hospital information obtained feedback, and only some hospitals need local government support, but the people are absolutely support. A total of 266 articles were collected from the Network professional database, and 238 outdated or repetitive were excluded. Finally, 28 articles were included. According to the domestic and foreign medical and health information development situation, sustainable development of digitization, people-orientation, science, and coordination of regional health information is explored, especially for digital images sharing patterns, as well as the advantages and feasibility. CONCLUSION: Regional medical and health information should be integrated for resource sharing to improve levels of health and health information service, reduce the expense, and embody the new medical principle of people-oriented. Related Articles | Metrics

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Thrombotic prevention of acute normovolumic hemodilution in patients undergoing total hip replacement Cao Gui-mao, Zhang Xin-yu, Yu Jin-gui 2010, 14 (48):  9074-9077.  doi: 10.3969/j.issn.1673-8225.2010.48.034 Abstract ( 276 )   PDF (276KB) ( 284 )   Save BACKGROUND: Allogeneic transfusion and transfusion-induced complications in total joint replacement have aroused increasing attention. Recently, the influence of acute normovolumic hemodilution (ANH) on hemodynamics and coagulation function has been understood in animal experiments, which can reduce incidence of thrombosis. OBJECTIVE: To evaluate the effect of ANH on circulatory function and homoiostasis of perioperative period in patients undergoing total hip replacement. METHODS: A total of 60 patients undergoing elective total hip replacement randomly divided into control and ANH groups, with 30 cases in each group, respectively injected with balanced solution and Voluven. The mean blood pressure (MBP), heart rate (HR) and central venous pressure (CVP) were continuously monitored throughout the operation. The values of blood clotting, arterial blood gas and blood routine were detected in two groups. RESULTS AND CONCLUSION: Compared with control group, MAP was more stable in ANH group. The hemoglobin and hematocrit were significantly greater in 6 and 24 hours postoperatively in ANH group compared with control group (P < 0.01). The volume of allogeneic transfusion was lower in ANH group than the control group (P < 0.01). ANH is more effective and safer in patients undergoing total hip replacement with stable hemodynamics and few effects on homoeostasis. Moreover, ANH can reduce thrombosis. Related Articles | Metrics

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Perioperative risks of simultaneous versus staged bilateral total hip arthroplasty in 112 patients Jiang Yu, Yang Yu-sheng, Zhu Guo-xing 2010, 14 (48):  9078-9081.  doi: 10.3969/j.issn.1673-8225.2010.48.035 Abstract ( 332 )   PDF (218KB) ( 421 )   Save BACKGROUND: Comparison of perioperative complications between simultaneous and staged bilateral total hip arthroplasty remains controversial. OBJECTIVE: To compare the rates of perioperative complications in patients undergoing simultaneous or staged bilateral total hip arthroplasty and evaluate the safety of simultaneous total hip arthroplasty METHODS: A total of 112 cases undergoing primary bilateral total hip arthroplasty were retrospectively analyzed, including 81 of simultaneous and 31 staged bilateral total hip arthroplasty. A total of 31 patients of age and sex matched were selected from simultaneous group to compare with staged group. Rate of perioperative complications of two groups was compared. RESULTS AND CONCLUSION: No significant differences between the two matched groups were detected with regard to preoperative complications (P > 0.05). The percentage of patients who had cardiovascular and cerebrovascular complications was significantly higher in the simultaneous group than in the staged group (P < 0.05). Preoperative health status must be assessed carefully. Patients must be fully informed the risks of simultaneous bilateral total hip arthroplasty before surgery. Active prevention of perioperative complications should be applied after surgery． Related Articles | Metrics

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Influence of individualized rehabilitation prescription on the hip functional recovery following fracture Dai Min, Ai Jiang-bo, Fan Hong-xian, Zhang Bin, Shuai Lang 2010, 14 (48):  9082-9085.  doi: 10.3969/j.issn.1673-8225.2010.48.036 Abstract ( 263 )   PDF (269KB) ( 509 )   Save BACKGROUND: 22%-75% of patients with hip fracture cannot obtain function before injury at 6 months following treatment. Operations for fracture have been reported, but rehabilitation guidance and functional training for patients are few. OBJECTIVE: To investigate the effect of individualized rehabilitation and exercise prescription developed according to "Orthopedic Sports Rehabilitation Safety Assessment Scale" on hip function in patients following open reduction and internal fixation. METHODS: A total of 90 elderly patients with proximal femoral fractures were treated with open reduction and internal fixation. Rehabilitation manner was divided into two groups: rehabilitation group (n=46), postoperative exercise prescription developed according to Orthopedic Sports Rehabilitation Safety Assessment; control group (n=44), conventional rehabilitation. The two groups were followed up 3 and 6 months following internal fixation, and the scores of Performance evaluation test for the body (PPT) and functional status questionnaire (FSQ) were compared between the groups. RESULTS AND CONCLUSION: General condition of two groups was not significantly different (P > 0.05), so two groups were comparable. Rehabilitation group exhibited greater PPT and FSQ total scores after 6 month compared with the control group (P < 0.05). The increase rate of preoperative PPT score and FSQ score to 6 months after the internal fixation in rehabilitation group was significantly greater compared with the control group. Open reduction and internal fixation can obtain reliable fixation for elderly hip fracture. Systematic rehabilitation is an important measure to ensure the efficacy, help accelerate postoperative functional rehabilitation of patients, and improve the quality of life. Related Articles | Metrics

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Effect of intra- and peri-operative analgesia on the recovery of joint function following total knee arthroplasty Lu Zhi-dong, Li Peng 2010, 14 (48):  9086-9089.  doi: 10.3969/j.issn.1673-8225.2010.48.037 Abstract ( 241 )   PDF (311KB) ( 343 )   Save BACKGROUND: Pain control following artificial total knee arthroplasty (TKA) is a key concern for orthopedic surgeons. Although analgesis techniques have been improved in recent years, they have specific disadvantages. OBJECTIVE: To asses the effect of a multimodal pain management protocol in primary TKA. METHODS: A total of 30 patients, including 5 males and 25 females, undergoing primary unilateral TKA were selected and randomly assigned to 2 groups. Trial group was treated with cyclooxygenase-2 inhibitor, periarticular ropivacaine infiltration analgesia and femoral nerve block to pain control. Control group received cyclooxygenase-2 inhibitor and patient-controlled analgesia (PCA). The pain severity and range of motion (ROM) in patients was observed postoperatively. RESULTS AND CONCLUSION: A multimodal protocol that emphasizes local periarticular injections after TKA provides better pain control and improved postoperative ROM of troubled knee in early time compared with control group. Multimodal pain management that emphasizes local periarticular infiltration analgesia in peri-operative period of TKA could provide better pain control and improved function of the knee. Related Articles | Metrics

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Microendoscopy discectomy versus open lumbar disectomy for lumbar disc herniation: A Meta-analysis She Wei, Chen Gen-yuan, Hou Wei-hua, Hu Long, Zhang Hui, Lü Xiao-hua 2010, 14 (48):  9090-9094.  doi: 10.3969/j.issn.1673-8225.2010.48.038 Abstract ( 399 )   PDF (339KB) ( 389 )   Save BACKGROUND: Microendoscopy system combines traditional open surgery and microendoscopy and is minimally invasive. Moreover, compared with traditional open operation, microendoscopy discectomy can enlarge operating field, enhance illumination system, and reduce surrounding tissue injury. OBJECTIVE: To compare the surgical outcome and investigate the clinical value between microendoscopy discectomy and open lumbar disectomy in the treatment of lumbar disc herniation. METHODS: A computer-based online search of Medline (1990-01/2010-03), PubMed, Embase (1990-01/2010-03), Cochrane Library, and Chinese Biomedical Literature Database was performed, and conference references were manually searched. Using the Cochrane Collaboration guidelines, all randomized controlled trials comparing open lumbar disectomy and microendoscopy discectomy were systematically reviewed. The Cochrane Collaboration’s RevMan 5.0.1 software was used for data analyses. RESULTS AND CONCLUSION: A total of 12 studies involving 1 748 patients were included. The results of meta-analyses showed that there were no significant differences in the treatment outcome and the operation time between open lumbar disectomy and microendoscopy discectomy; microendoscopy discectomy was superior to open lumbar disectomy in intraoperative blood loss, time in hospital and the time out of bed after operation. Microendoscopy discectomy is an ideal minimally invasive surgery to treat lumbar disc herniation. Related Articles | Metrics

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Meta analysis of types B and C Pilon fracture treatment by staged open reduction and internal fixation versus external fixation combined with limited internal fixation Wang Cheng, Li Ying, Wang Man-yi 2010, 14 (48):  9095-9099.  doi: 10.3969/j.issn.1673-8225.2010.48.039 Abstract ( 255 )   PDF (396KB) ( 463 )   Save BACKGROUND: Treatment of Pilon fracture has always been a controversial topic, but there is no authoritative clinical instruction at present. Currently, more attention has been paid to the soft tissue and its protection. The main treatment strategy has been focused on staged open reduction and internal fixation or external fixation combined with limited internal fixation. There is no favorable evidence to prove the effectiveness of these two strategies, though a large amount of retrospective studies have been reported. It is still unknown which strategy is better.   OBJECTIVE: To find out the differences in advantages and disadvantages of different operation methods by Meta analysis, followed by collection of the literatures addressing the effectiveness of different treatments for Pilon fracture of types B and C. METHODS: The relevant literatures about the effectiveness analysis of staged open reduction plus internal fixation and external fixation combined with limited internal fixation were collected through database retrieval and manual search, with tibia fractures, surgery, therapy and pilon as index words and 1977-2008 as publishing date limit. Soft tissue infection rate, myelitis incidence rate, bone nonunion and malunion incidence rate, joint fusion incidence rate were taken as evaluation indicators, analyzed with RevMan4.2 software, and followed by observation of the analyzing features and results indicated by forest plots. RESULTS AND CONCLUSION: The risk of soft tissue infection following staged open reduction and internal fixation was lower than external fixation combined with limited internal fixation, and staged open reduction and internal fixation provided a more reliable, accurate and stable reduction to Pilon fracture. Theoretically, it owns obvious advantage in fracture healing at the right anatomy site. The result of Meta analysis is in accord with the hypothesis, but there is no statistic evidence. No difference is found in the risk of deep infection, nonunion, and joint fusion between the two methods. Related Articles | Metrics

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Influence of bone quality on initial stability of implantable distraction A three-dimensional finite element analysis Qiu Min, Wang Ji-ling, Hui Guang-yan, Jia Wen-min, Ding Hong 2010, 14 (48):  9100-9103.  doi: 10.3969/j.issn.1673-8225.2010.48.040 Abstract ( 318 )   PDF (271KB) ( 349 )   Save BACKGROUND: The initial stability of implantable distractor depends on the stress distribution of bone-distractor interface. The understanding of the biomechanical change in initial stage can improve the clinical success ratio of implantable distractor used in alveolar crest. OBJECTIVE: To evaluate the influence of bone quality on stress distribution and deformation in initial distraction stage. METHODS: Four three-dimensional models with 10 079-11 456 cells and 17 299-20 101 nodes were prepared by finite element methods (11 mm in length and 3.7-4.1 mm diameter). Implantable distractor was embedded in a segment of mandible. The elastic modulus of cancellous bone and the thickness of cortical bone, stress and deformation of bones and distractor were calculated. RESULTS AND CONCLUSION: The highest stress in the bone was concentrated in transportable section and the maximum deformation of transportable section was observed at the edge of the cortical bone, both of which were increased with bone quality decreased. The subsidence of distractor was observed with bone quality decreased. Bone quality influenced the initial stability and the result of the implantal distraction. The decrease of bone elastic modulus would increase the failure risk of distraction osteogenisis. Related Articles | Metrics

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Finite element analysis of acetabular medial wall displacement osteotomy in adult acetabular dysplasia Li Dong-song, Li Shu-qiang, Cai Bo, Zhao Zhen-gang, Guan Ji-kui, Yang Chen, Feng Wei, Qi Xin, Liu Jian-guo 2010, 14 (48):  9104-9108.  doi: 10.3969/j.issn.1673-8225.2010.48.041 Abstract ( 234 )   PDF (308KB) ( 372 )   Save BACKGROUND: Adult acetabular dysplasia in advanced stage combined with hip joint osteoarthritis should undergo total hip replacement. The severity of acetabular lesion is various in different patients, which leads to significantly increased difficulty in reestablishing acetabulum. Acetabular medial wall displacement osteotomy can solve the component of acetabular prosthesis, but the displacement range of the acetabular medial wall following osteotomy is controversial. OBJECTIVE: To look for a suitable displacement range of acetabular medial wall following osteotomy by computer-aided design finite element analysis. METHODS: SolidWorks 2008 software was used to establish three-dimensional models of acetabular dysplasia pelvis. Acetabular medial wall displacement osteotomy was simulated to make acetabular medial wall bone displace from 2 mm bone contact to 7 mm bone contact in the pelvic cavity. One experimental group was set at 1 mm intervals, totally 10 experimental groups. The acetabulum in each group was split into four quadrants. The prosthesis acetabulum-bone interface in each group was analyzed by computer simulation contrast mechanics experiment. The Mises stress and shear stress values were measured between acetabular prosthesis and bone interface. RESULTS AND CONCLUSION: In groups 1, 5, 6, 9 and 10, the Mises stress was unevenly distributed in posterior inferior, anterior superior and anterior inferior quadrants. In groups 2, 3, 4, 7 and 8, the Mises stress was evenly distributed in posterior inferior, anterior superior and anterior inferior quadrants. Of them, the stress was most even in the group 4. In groups 2, 3, 4, 7 and 8, the shear stress was evenly distributed in the above-mentioned three quadrants. The shear stress was lowest in the groups 7 and 8. These indicate that joint force in the acetabulum mainly focused in the posterior superior quadrant. With the displacement of acetabular cup, the contact area of acetabular cup and bone would gradually increase, which finally increased the Mises stress in the contact surface. However, shear stress decreased with displacement of acetabular medial wall. Therefore, the suitable displacement range of acetabular medial wall osteotomy is 1 mm away from the pelvic cavity and 1 mm complete embolism in the pelvic cavity. The optimal position was 1 mm complete embolism in the pelvic cavity. Related Articles | Metrics

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Preparation of a gear distraction plate device for spinal reduction and fixation Cui Xue-wen, Tian Jin, Ding Liang, Lü Shu-hong 2010, 14 (48):  9109-9112.  doi: 10.3969/j.issn.1673-8225.2010.48.042 Abstract ( 253 )   PDF (286KB) ( 328 )   Save BACKGROUND: The most commonly used rod-screw posterior spinal fixation system has some biomechanical drawbacks. The screw-plate system is more preferred for patients.  OBJECTIVE: To prepare a new posterior spinal fixation system based on imaging results of distance between two pedicles, radian of spine flexion, extension and the height of intervertebral space of Chinese population. METHODS: The thoracolumbar data of 129 normal people were measured. According to the imaging measurements and relative documents, a device of gear-distraction plate (GDP) for spine reduction and fixation was designed. Eighteen fresh calf lumbar specimens were randomly divided into 3 groups, the test group was fixed by GDP and the other groups were fixed by CD and Steffee plate, respectively. The results of the displacement, strain, strength, stiffness and ultimate strength were measured under the states of vertical compression, flexion, extension and lateral bending respectively, and the results were statistically analyzed. RESULTS AND CONCLUSION: GDP could meet the need of strength and stiffness of human bodies. It showed superior to the CD and Steffee plate groups in strength and stiffness (P < 0.05), with 13% or 14% torsion intensity greater than that of the CD or Steffee plate groups. The ultimate mechanical performance test showed that, the load bearing of the GDP group was greater than that of the CD and Steffee plate groups (P < 0.05). The findings demonstrated that GDP for Chinese human presented with good biomechanical stability, which can promote vertebrae fracture union and prevent kyphosis relapses or vertebral height loses.  Related Articles | Metrics

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Anatomical observation of the retromandibular vein by mandibular angle ostectomy Liu Wei-hua, Wu Shao-ping, Li Xin 2010, 14 (48):  9113-9116.  doi: 10.3969/j.issn.1673-8225.2010.48.043 Abstract ( 353 )   PDF (185KB) ( 661 )   Save BACKGROUND: Arterial injury surrounding the mandibular angle is very common during mandibular angle ostectomy. The retromandibular vein is susceptible to injury owing to thin vascular wall and deep location. Anatomical studies regarding the retromandibular vein are rarely reported. OBJECTIVE: To observe the construction, branches, backstreaming of the retromandibular vein and its relation to the facial nerve and mandibular angle. METHODS: Twenty formalin-fixed adult cadavers (40 samples) were randomly selected. Bilateral retromandibular veins and their branches were cleaned. The construction, branches, backstreaming of the retromandibular vein and its relation to the facial nerve and mandibular angle were anatomically observed. RESULTS AND CONCLUSION: The retromandibular vein originated constantly and provided an average length of    (4.51±2.01) cm, with an average outer diameter of (0.52±0.28) cm at the origination part. A total of 34 samples showed that the retromandibular vein was formed by the union of the superficial temporal and maxillary veins, and six samples showed that the retromandibular vein originated from the superficial temporal vein. The retromandibular vein divided into two types according to the backstreaming and course: one type consisted of the anterior and posterior branches: the anterior branch mostly drained into the internal jugular vein and minorly drained into the external jugular vein; the posterior branch was joined by the posterior auricular vein and became the external jugular vein. Another type of retromandibular vein without the anterior and posterior branches directly connected with the posterior auricular vein and entered the external jugular vein. The retromandibular vein had the following branches (appearance frequency): facial transverse vein (88%), mandibular articular vein (98%), parotid veins (95%), anterior auricular veins (58%), styloid process vein (43%). 88% of the retromandibular vein was located in the superior and inferior trunks of the facial nerve and in the medial branches. The retromandibular vein connected with facial nerve trunk or major branches in a decussated fashion. 75% of the arc-shaped structures formed by the retromandibular vein and its branches coursed close to the inferior and posterior border of the mandibular angle, and 25% of the arc-shaped structures were not close to the lowest point of the mandibular angle. The thin periosteum between the venous wall and cortical bone was just the position of ostectomy line of mandibular angle. The retromandibular vein was easily injured no matter in vein dissection or ostectomy. Related Articles | Metrics

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Anterior cervical subtotal decompression combined with bone grafting and titanium plate internal fixation for treatment of cervical spondylotic myelopathy in 118 patients Shu Dong-ping, He Min, Liu Shi-liang 2010, 14 (48):  9117-9120.  doi: 10.3969/j.issn.1673-8225.2010.48.044 Abstract ( 278 )   PDF (195KB) ( 342 )   Save BACKGROUND: Anterior decompression and internal fixation for treatment of cervical spondylotic myelopathy has been widely accepted. However, there are few clinical case reports regarding this. OBJECTIVE: To investigate the curative efficacy of anterior cervical decompression combined with bone grafting and titanium plate internal fixation in treatment of cervical spondylotic myelopathy.  METHODS: A total of 118 patients with cervical spondylotic myelopathy who underwent anterior cervical subtotal vertebrectomy, iliac bone grafting (or bone grafting with titanium cage) and anterior locking titanium plate internal fixation at the Department of Orthopedics, Huang Gang Central Hospital of Hubei Province between January 2001 and August 2007 were retrospectively analyzed. According to the X-ray photographs taken before, immediately after surgery and during postoperative follow-up periods, Cobb’s angle, anterior vertebral height and posterior vertebral height of fused segments. Bone graft fusion was evaluated. Neurological function was assessed according to Japanese Orthopaedic Association (JOA) scores. RESULTS: During the follow-up period (6-32 months, mean 19 months), three patients presented with slight titanium mesh sinking, and no fragmentation or loosening during internal fixation was observed in all patients, with a final bone fusion rate of 100%. JOA scores obtained immediately after surgery and during last follow-up were significantly greater compared with those obtained prior to surgery (P < 0.05). The excellent and good rate of neurological function recovery during the last follow-up was 86.2%. After surgery, sagittal Cobb’s angle, anterior and posterior vertebral heights of fused segments were significantly improved (P < 0.05). These findings indicate that anterior cervical subtotal decompression combined with bone grafting and titanium plate internal fixation for treatment of cervical spondylotic myelopathy can thoroughly decompress, effectively correct cervical vertebrae malformation, and achieve stable bone fusion and reconstruction, with satisfactory clinical efficacy. Related Articles | Metrics