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24 September 2013, Volume 17 Issue 39 Previous Issue    Next Issue

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Isolation and culture of rabbit nucleus pulposus cells in vitro by type Ⅱ collagenase digestion methods plus explant culture method Li Shu-wen, Wu Hai-jun, Yin He-ping, Bai Ming, Du Zhi-cai 2013, 17 (39):  6861-6866.  doi: 10.3969/j.issn.2095-4344.2013.39.001 Abstract ( 485 )   PDF (462KB) ( 602 )   Save BACKGROUND: Intervertebral disc can bear load but lack vessels. Nucleus pulposus cells have the problem of phenotype loss during in vitro culture that can lead to degenerative changes. The mechanism of intervertebral disc degeneration remains unclear.    OBJECTIVE: To explore the approaches of isolation, adherence culture, amplification and identification of the rabbit nucleus pulposus cells in vitro, to observe the growth characteristics of nucleus pulposus cells in different generations. METHODS: Type Ⅱ collagenase digestion method plus explants culture method was used to isolate and purify nucleus pulposus cells and then amplify in vitro. The morphology and growth of primary and passaged cells was observed under the inverted microscope, the number of cells was counted and the growth curve was draw. The morphology of the cells was observed under light microscope after hematoxylin-eosin staining, and the expressions of collagen type Ⅱ and aggrecan were examined by immunocytochemistry. RESULTS AND CONCLUSION: Nucleus pulposus cells of rabbit were isolated, cultured and amplified in vitro successfully. Growth activity was observed, and found that the 1-3 generation nucleus pulposus cells proliferated more rapidly and vigorously. The proliferation of nucleus pulposus cells was decreased while the cell passaged more generations. These isolated and cultured nucleus pulposus cells could positively express the collagen type Ⅱ and aggrecan. In vitro combination of type Ⅱ collagenase digestion method and explants culture method could obtain high purity nucleus pulposus cells, and the cultured nucleus pulposus cells were grew in round or polygonal. The 1-3 generation of cells had strong activity. Figures and Tables | References | Related Articles | Metrics

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Meloxicam versus indomethacin in the prevention of heterotopic ossification after total hip arthroplasty 2013, 17 (39):  6867-6874.  doi: 10.3969/j.issn.2095-4344.2013.39.002 Abstract ( 565 )   PDF (683KB) ( 539 )   Save BACKGROUND: In order to avoid heterotopic ossification after total hip arthroplasty, nonsteroidal anti-inflammatory drugs are commonly used for prevention. OBJECTIVE: To compare the effect of meloxicam and indomethacin in the prevention of heterotopic ossification after total hip arthroplasty. METHODS: Fifty-one patients who treated in the Department of Orthopedics, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from 2010 to 2011 were collected. Among the 51 patients, nine patients were treated with bilateral total hip arthroplasty, and all the patients had total hip arthroplasty with the posterior-lateral approach. The patients were divided into the control group and the experimental group according to the drugs used after replacement, and the patients in the two groups were administered with indomethacin sustained-release tablet 25 mg + omeprazole capsule 20 mg or meloxicam tablet 15 mg after replacement. RESULTS AND CONCLUSION: There were no significant differences in the incidence of heterotopic ossification, pain, modified D’Aubigne and Postel scores after replacement between two groups (P > 0.05). But, the gastrointestinal adverse reactions of the experimental group were less than those of the control group. The application of meloxicam only can effectively avoid the heterotopic ossification and release pain. Consequently, we recommend meloxicam as postoperative drug for the prevention of heterotopic ossification and pain remission following total hip arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Theory analysis and research on the dispelled stress shielding on artificial hip joint Liu Chang-xing, Lu Tong-cheng 2013, 17 (39):  6875-6880.  doi: 10.3969/j.issn.2095-4344.2013.39.003 Abstract ( 445 )   PDF (379KB) ( 521 )   Save BACKGROUND: For reducing the stress shielding, a lot of the schemes have adopted, and there is no great improvement although via the trial and the application for several ten years. It comes from a root which is the combination by thigh bone (abbreviation of the bone) and metallic handle (abbreviation of the handle) which causes the serious problems of absorption of bone quality, and this kind of stress shielding effect is produced by abnormal stress and abnormal strain, and affected by various factors, so there is no effective and applicable method to solve this problem.    OBJECTIVE: To select the primary porous layer scheme as the subject of the study and entirely change the appearance and inherent quality as the metallic handle that cannot transmit the stress is the key to eliminate the stress shielding; making the senior porous layer with the effective measure is the basis to eliminate stress shedding and can solve the disaster and partial inferior position aroused by the primary porous layer. METHODS: The cobalt-chromium-molybdenum alloy small metallic spherules with equal diameter were used to manufacture the senior porous layer structure. The structural member employed in the thigh bone could separate the handle from the bone. This structural member welded on the plane of bone neck could fix the handle with  calcar osteotomy surface. And these structural members had an ability to eliminate all the stress shieldings on the artificial hip joint surface. RESULTS AND CONCLUSION: The senior porous layer was made with cobalt-chromium-molybdenum alloy small metallic spherules with the same diameter (1.00-1.29 mm), and the surface of the porous layer was plated with high property of medium layer alloy and arranged orderly and inseparable, and then connected with active diffusion welding technology. The diameter of all the holes was 155-200 μm and distributed evenly which was benefit for the bone unit to grew. The alloying of metal materials, ceramic of alloy surface and controlling of size and number of wear particles can solve the bone dissolution of the surrounding porous layer of bone, metal dissolution as well as its pure cobalt and chromium particle toxicity, cancerization and leukemia. A stipulation of theoretical basis was to eliminate the handle rigidity firstly that could made the separation of handle from the bone became the premise for eliminating the stress shielding. The calcar osteotomy surface grew into the pores of the structural member welded on plane of bone neck could fix the handle, and that was the basis for eliminating the stress shielding. The common roles can eliminate the stress shielding in thigh bone, and the stress shielding on acetabulum is easily to eliminate. Figures and Tables | References | Related Articles | Metrics

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Application of Deluxe-ps knee prostheses in simultaneous bilateral total knee arthroplasty Sheng Wen-hui, He Fang-sheng, Wang Chun-hui, Wang Zi-gang, Shang Qi-song, Han Peng-yuan 2013, 17 (39):  6881-6886.  doi: 10.3969/j.issn.2095-4344.2013.39.004 Abstract ( 600 )   PDF (357KB) ( 712 )   Save BACKGROUND: Deluxe-PS knee prosthesis is designed based on the anatomical characteristics of the Chinese peoples’ knee joint, especially the morphological features of femoral condyle. The distance between median and lateral knee prosthesis femoral condyle is less than that of the imported prosthesis for 3.5 mm. OBJECTIVE: To explore the short-term efficacy of Deluxe-ps knee prosthesis in simultaneous bilateral total knee arthroplasty. METHODS: Fifteen knee osteoarthritis patients (30 knees) were included as the experimental group, and treated with simultaneous bilateral knee arthroplasty by Deluxe-ps knee prosthesis. Twenty patients (40 knees) in the control group were treated with simultaneous bilateral knee arthroplasty by PFCSigma knee prosthesis. The knee society score, hospital for special surgery knee score and knee joint range of motion were compared between two groups; the operation time and the intraoperative blood loss were compared between two groups. RESULTS AND CONCLUSION: The patients in both groups were followed-up for 12 to 24 months, with an average of 16 months. Postoperative knee pain was relieved, and the joint function was recovered satisfactorily. The knee society score, hospital for special surgery knee score and knee joint range of motion in two groups were improved significantly after treatment (P < 0.05). There were no significant differences in postoperative knee society score, hospital for special surgery knee score and knee joint range of motion between two groups (P > 0.05), and there was no significant difference in intraoperative blood loss between two groups (P > 0.05), while there was significant difference in operation time between two groups (P < 0.05). The results showed that the short-term effect of Deluxe-ps knee prosthesis in simultaneous bilateral total knee arthroplasty was satisfied. Figures and Tables | References | Related Articles | Metrics

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Periprosthetic femoral fracture after total knee arthroplasty Zhu Xing-yang, Su Hai-tao, Huang Yong-ming 2013, 17 (39):  6887-6895.  doi: 10.3969/j.issn.2095-4344.2013.39.005 Abstract ( 680 )   PDF (227KB) ( 1182 )   Save BACKGROUND: Periprosthetic femoral fracture after total knee arthroplasty is related with the osteoporosis, bone defects, prosthesis, frail patients and high complication rate, so it is difficult to prevent and treat. OBJECTIVE: To explore the risk factor, classification, treatment, rehabilitation and prophylaxis of periprosthetic femoral fracture after total knee arthroplasty based on the reviewed and summarized articles published in recent years. METHODS: A computer-based online search was conducted in PubMed database from January 1, 1990 to December 31, 2011 and in SpringerLink database from 1980 to 2011 for the related articles with the key words of “periprosthetic fracture, knee” in English. A total of 626 articles were retrieved. RESULTS AND CONCLUSION: According to inclusion and exclusion criteria, the articles were screened and 40 articles were included finally. The results showed that with the extensive development of total knee arthroplasty, the incidence of periprosthetic femoral fracture was increased gradually; due to the poor prognosis, we should pay attention to the prevention. The risk factors of periprosthetic femoral fracture included patients’ internal factor that was hard to control, and some external factors such as the surgical techniques. Rorabeck classification was commonly applied for periprosthetic femoral fracture after total knee arthroplasty, but it was not perfect in clinical application. Kim classification will be better for clinical guidance. The treatment of periprosthetic femoral fracture included nonoperative treatment, open reduction and internal fixation, retrograde intramedullary nailing and revision arthroplasty. An appropriate treatment is chosen depending on fracture classification, local bone quality, patients’ medical and nutritional status. At present, however, there is not a perfect guideline for the selection of appropriate treatment method. But the early functional exercise is beneficial to prevent the related complications caused by longtime immobilization and the loss of joint function. Therefore, the indications must be under strict control in the treatment of periprosthetic femoral fracture after total knee arthroplasty. Except the firm fixation, early exercise for the patients should be encouraged at the same time. Figures and Tables | References | Related Articles | Metrics

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Changes of biochemical indexes and joint function in the patients with rheumatoid arthritis after total knee arthroplasty Wu Li-xin, Zhang Hai-bin, Li Xiao-hui, Ren Kai-jing, Yang Guo-yue 2013, 17 (39):  6896-6901.  doi: 10.3969/j.issn.2095-4344.2013.39.006 Abstract ( 682 )   PDF (372KB) ( 1006 )   Save BACKGROUND: There are many reports on the clinical effect of total knee arthroplasty in the treatment of advanced rheumatoid arthritis, but the reports on the effect of total knee arthroplasty on the disease activity in patients with rheumatoid arthritis are rare. Therefore, the more clinical evidences are needed for supporting. OBJECTIVE: To explore the effect of total knee arthroplasty on disease activity in patients with rheumatoid arthritis. METHODS: 109 patients with rheumatoid arthritis were included; 48 cases in the replacement group, and received total knee arthroplasty combined with internal medicine medications; the 61 cases in the drug treatment group were treated with simple internal medicine medications. The rheumatoid factor, blood sedimentation rate and C-reactive protein levels of the patients in two groups were measured before treatment, 1 and 2 years after treatment, and the Ishikawa joint function scoring criteria was used to assess the functions. RESULTS AND CONCLUSION: There were no significant differences in the rheumatoid factor, blood sedimentation rate and C-reactive protein levels between two groups before treatment (P > 0.05). At 1 and 2 years after treatment, the indicators in the drug treatment group were higher than those in the replacement group (P < 0.05); the indicators in the two groups at 2 years after treatment were significantly lower than those before treatment (P < 0.05). The rheumatoid arthritis symptom scores of the affected joints of the patients in two groups were significantly improved, especially the pain, swell and subjective attitudes, and the replacement group was better than the drug treatment group (P < 0.05). The total knee arthroplasty can affect the disease activity of rheumatoid arthritis in short-term, and the effect of total knee arthroplasty is better than simple drug treatment. Figures and Tables | References | Related Articles | Metrics

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Effectiveness of operating room environment in preventing artificial joint replacement infection Wu Qiu-ji, Li Qiang, Zhang Shao, Guo Zhong-wei, Li Shi-long, Yu Tao 2013, 17 (39):  6902-6907.  doi: 10.3969/j.issn.2095-4344.2013.39.007 Abstract ( 608 )   PDF (421KB) ( 741 )   Save BACKGROUND: Laminar flow operating room used in artificial joint replacement can improve the aseptic conditions and can effectively prevent the infections after joint replacement.  OBJECTIVE: To compare the number of colonies during artificial joint replacement in laminar flow operation room and traditional operation room. METHODS: 300 patients with artificial joint replacement in hundred-level laminar flow operation room and 300 patients with artificial joint replacement in traditional operation room were selected, and all the patients had no infection. Then 100 patients with artificial joint replacement were randomly selected from the hundred-level laminar flow operation room and traditional operation room respectively. The number of colonies in operation room of two groups was compared before and after replacement.   RESULTS AND CONCLUSION: There was no significant difference in the number of colonies between two groups before replacement, and the settling bacteria number of the artificial hip replacement patients in the hundred-level laminar flow operation room was significantly smaller than that in the traditional operation room (P < 0.05). The results indicate that compared with the traditional operation room, the hundred-level laminar flow operation room for artificial joint replacement has higher safety and can effectively prevent infections after replacement. Figures and Tables | References | Related Articles | Metrics

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Biomechanical properties of monosegmental pedicle screw fixation via the fractured thoracolumbar vertebrae Liu Shang-lou, Xu Jun, Ni Zhuo-min, Zhang Yun-qing, Zhou Feng, Jiang Xue-feng 2013, 17 (39):  6908-6913.  doi: 10.3969/j.issn.2095-4344.2013.39.008 Abstract ( 339 )   PDF (461KB) ( 565 )   Save BACKGROUND: In clinic, monosegmental pedicle screw fixation via the fractured vertebrae is commonly used for the treatment of thoracolumbar fracture. Studies have confirmed that the spinal stability is strengthened through bilateral pedicle screw fixation via fractured vertebrae, but some studies suggest that monosegmental pedicle screw fixation via fractured vertebrae can increase the spinal stability, and the conclusion lacks of the supports of biomechanics. OBJECTIVE: To evaluate the biomechanical properties of monosegmental pedicle screws fixation via fractured vertebrae for thoracolumbar fracture. METHODS: Eight cadavers’ thoracolumbar specimens (T11-L3) were provided by the Department of Anatomy, Yangzhou University School of Medicine. Saw was used to transect 2/3 of the vertebrae in order to make complete experimental thoracolumbar specimens. Eight specimens were divided into two group; beyond-fractured vertebrae fixation group and monosegmental fixation via fracture vertebrae group. The specimens in the two groups were treated with adjacent vertebral four screw fixation beyond fractured vertebrae and adjacent vertebral four screw fixation + monosegmental pedicle screw fixation via fractured vertebrae respectively. RESULTS AND CONCLUSION: After thoracolumbar fracture, the differences between beyond fractured vertebrae fixation and monosegmental pedicle screw fixation via fractured vertebrae were as follows: load-strain relationship 12%, load-displacement relationship 11%, strength 18%, axial rigidity 11%, torsional mechanical properties 11% and pullout test 1.8%, and there were no significant differences between two groups (P < 0.05). The biomechanics performance of monosegmental pedicle screw fixation via fractured vertebrae was more superior to that of pedicle screw fixation beyond the fracture vertebra for thoracolumbar fracture. Figures and Tables | References | Related Articles | Metrics

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Clinical application of three-dimensional measurement before lumbar pedicle screw fixation Chen Kun, Liu Ai-gang, Cai Hui-min, Wang Hong-tai, Chen Rong-zi 2013, 17 (39):  6914-6919.  doi: 10.3969/j.issn.2095-4344.2013.39.009 Abstract ( 563 )   PDF (446KB) ( 675 )   Save BACKGROUND: Pedicle is the strongest bone structure for the connection between vertebrae and lamina, and the screw fixation through pedicle can provide reliable mechanical basis for the reconstruction of spinal stabilization. OBJECTIVE: To analyzed the three-dimensional analogue measurement parameters of lumbar pedicle, in order to improve the accuracy and stability of the clinical application of pedicle screw fixation. METHODS: The original CT data of the spine (L1-L5) related diseases patients who treated with pedicle screw were analyzed, and the three-dimensional multiplanar reconstruction imaging model was established with Mimics software. By the using of the Mimics software, the lumbar three-dimensional construction was conducted, and the screw length, diameter, transverse section angle and sagittal section angle were predicted, and then statistically compared with the actual data of the patient postoperative. RESULTS AND CONCLUSION: Case analysis showed that the position and the length of the screw were good without screw offset and fracture after internal fixation. There were no significant differences in the screw length, diameter, transverse section angle and sagittal section angle between the preoperative predicted parameters and the actual parameter after fixation (P > 0.05), while the sagittal section angle of partial segments were smaller than the actual measure value (P < 0.05). The lumbar three-dimensional reconstruction and simulation of pedicle screws placement through Mimics software can precisely guide the actual screw placement and improve the safety of pedicle screws placement. Figures and Tables | References | Related Articles | Metrics

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Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of old vertebral osteoporotic compression fracture Liu Tao, Zhou Zhang-wu, Zhou Zheng-xin, Xu Sheng-wen 2013, 17 (39):  6920-6925.  doi: 10.3969/j.issn.2095-4344.2013.39.010 Abstract ( 348 )   PDF (330KB) ( 593 )   Save BACKGROUND: Pereutaneous vertebroplasty and percutaneous kyphoplasty as the minimally invasive treatment techniques have been widely used in the treatment of vertebral osteoporotic compression fracture, but there are controversies, and each method has its advantages and disadvantages. OBJECTIVE: To compare the clinical efficacy between percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of vertebral osteoporotic compression fracture. METHODS: 100 patients with vertebral osteoporotic compression fracture were collected, among them, 40 patients received percutaneous vertebroplasty, and 60 patients received percutaneous kyphoplasty. The visual analog scale score was used to assess the pain degree of the patients before treatment; the visual analog scale score was also used at 1 week after treatment. The X-ray film was taken to measure the ratio between anterior and rear edges of vertebrae. RESULTS AND CONCLUSION: The visual analog scale scores in the two groups were significantly decreased after treatment, and there was significant difference when compared with that before treatment(P < 0.05); there was significant difference in the restore of vertebral height in two groups when compared with that before treatment, but there was no significant difference in the orthopedic effect between two groups (P < 0.05). The incidence of complications of bone cement leakage after treatment was 35% in the pereutaneous vertebroplasty group and 12.5% in the percutaneous kyphoplasty group, and there was significant difference in the incidence of complications between two groups (P < 0.05). Pereutaneous vertebroplasty and percutaneous kyphoplasty can significantly relieve the pain of the patients with vertebral osteoporotic compression fracture, but there is no significant difference in the orthopedic effect between pereutaneous vertebroplasty and percutaneous kyphoplasty. Figures and Tables | References | Related Articles | Metrics

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Fast establishment of bone healing finite element model of femoral fracture treated by intramedullary nail fixation for 1 year Zhou Jiang-jun, Zhu Zhi-yu, Zhao Min, Yan Ya-bo, Lei Wei, Lü Ren-fa, Yu Wei-tao, Zhang Li,Chen Rong-jian 2013, 17 (39):  6926-6931.  doi: 10.3969/j.issn.2095-4344.2013.39.011 Abstract ( 435 )   PDF (358KB) ( 593 )   Save BACKGROUND: X-ray and CT data are common approaches for judging whether femur can be disrupted or not after removing fixation under normal standing. OBJECTIVE: To analyze the bone healing model through finite element method after treated with intramedullary nail fixation for 1 year, and to investigate whether this method can judge disrupt or not on the fracture site after removing fixation.  METHODS: Depend on fast individual establishment method, bone healing model of femur fracture were constructed based on data from multi-slice spiral CT with Mimics, Geomagic Studio and Abaqus softwares. And then four kinds of methods were used: no reduce; the surface mesh excluding healing area reduced for 50%; the surface mesh excluding healing area reduced for 20%; the surface mesh excluding healing area reduced for 10%. Finite element analysis was performed on the four models above. The models were loaded with 3 or 9 times weight loads and constraints to observe the maximum von Mises stress and the location. RESULTS AND CONCLUSION: According to material properties, the node of the maximum and minimum Mises stress of different kinds of materials were same under different stress loadings. The maximum von Mises stress in different materials appeared in the fracture site, and the nodes of maximum von Mises stress of different methods were similar, both in the middle and distal 1/4 junction part. The value of model with surface meshing reduced for 10% was minimum, and time of meshing, assigning material and finite element analysis were shortest. Appropriate individual modeling method can rapidly judge whether disrupt or not in the fracture site after removing fixation through finite element analysis on the fracture model. Figures and Tables | References | Related Articles | Metrics

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Intramedullary nail retention and augmentation plating for the treatment of nonisthmal femoral shaft nonunions Ru Jiang-ying, Cang Hai-bin, Hu Yu-hua, Hu Chuan-liang 2013, 17 (39):  6932-6939.  doi: 10.3969/j.issn.2095-4344.2013.39.012 Abstract ( 492 )   PDF (555KB) ( 760 )   Save BACKGROUND: Exchange nailing has been reported to be a very good method for metaphyseal nonunion after femoral shaft fracture treated with intramedullary nail. However, the effect of intramedullary nail exchanging is not ideal for the treatment of nonisthmal femoral shaft nonunions. OBJECTIVE: To compare the clinical and imaging outcomes between intramedullary nail exchanging and intramedullary nail retention plus augmentation plating for the treatment of nonisthmal femoral shaft nonunions.  METHODS: The clinical data of 39 patients with nonisthmal nonunions of femoral shaft fractures after failure of intramedullary nail were retrospectively analyzed, and 21 patients were treated with intramedullary nail exchanging and 18 patients were treated with intramedullary nail retention plus augmentation plating. Clinical therapeutic effect was evaluated by Tohner-Wrnch standard. RESULTS AND CONCLUSION: All cases were followed-up for more than 15 months. In the intramedullary nail exchanging group, postoperative internal fixator loosening occurred in three cases who obtained bony union by intramedullary nail retention plus augmentation plating combined with autogenous iliac bone graft. The fixation time, blood loss, volume for suspended red blood cells transfusion, hospitalization costs and re-operation rate in the intramedullary nail retention plus augmentation plating group were lower than that in the intramedullary nail exchanging group (P < 0.05). All the patients in two groups obtained bony union, and the clinical and radiographic healing time in the intramedullary nail exchanging group were longer than those in the intramedullary nail retention plus augmentation plating group (P < 0.05); according to Tohner-Wrnch standard at final follow-up, excellent in 10 cases, good in six cases and poor in five cases in the intramedullary nail exchanging group, and the excellent and good rate was 76%; in the intramedullary nail retention plus augmentation plating group, there were 11 cases of excellent and seven cases of good, and the excellent and good rate was 100%; there was significant difference between two groups (P < 0.05). Due to relatively simpler manipulation, shorter fixation time, less intraoperative blood loss, slighter trauma, less hospitalization cost, lower re-operation rate and more satisfactory therapeutic effect, intramedullary nail retention plus augmentation plating combined with autogenous iliac bone graft has been a better method for the treatment of nonisthmal nonunions of femoral shaft fractures after failure of intramedullary nailing when compared with intramedullary nail exchanging. Figures and Tables | References | Related Articles | Metrics

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Application of three-dimensional reconstruction and virtual surgery for treatment of complex tibial plateau fracture Chen Yu, Song Xuan, Zhang Hai-bing 2013, 17 (39):  6940-6945.  doi: 10.3969/j.issn.2095-4344.2013.39.013 Abstract ( 562 )   PDF (388KB) ( 637 )   Save BACKGROUND: Treatment of complex tibial plateau fracture is a difficulty in orthopaedic trauma. Comprehensive assessment and appropriate surgical plan before surgery are the key points of surgery. OBJECTIVE: To investigate the application value of three-dimensional reconstruction and virtual surgical techniques in assessing and surgical planning of complex tibial plateau fracture before surgery. METHODS: The CT scan data of 30 patients with tibial plateau fracture were imported into the Mimics 13.0 software to establish the three-dimensional digital models of complex tibial plateau fracture, and three-dimensional measurements and reclassification was performed according to three-column classification were made. Virtual surgeries such as bone window operation, reduction of the fracture and bone grafting were made in these models. RESULTS AND CONCLUSION: Reconstructed three-dimensional digital models of complex tibial plateau fracture could indicate the characteristics of fracture accurately, could be observed at any direction, and could help doctors to reclassify the fracture according to three-column classification. Virtual surgeries of bone window operation, reduction of the fracture and bone grafting made in computer by Mimics 13.0 were confirmed to be vividly simulate the clinical surgery, and helpful in estimating the amount of bone grafting. Three-dimensional reconstruction and virtual surgical techniques play an important role in assessing and surgical planning of complex tibial plateau fracture before surgery, which should be a conventional step in the management of complex tibial plateau fracture. Figures and Tables | References | Related Articles | Metrics

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Stability of simple suspension and twin-ring external fixation in the treatment of children clavicle fracture Paerhati•Rexiti, Yue Yong, Sheng Wei-bin, Adeli•Abudurexiti, Wang Qiang, Yilixiati•Alifu, Julaiti•Jilili 2013, 17 (39):  6946-6953.  doi: 10.3969/j.issn.2095-4344.2013.39.014 Abstract ( 504 )   PDF (487KB) ( 551 )   Save BACKGROUND: Open reduction is generally not advocated for the treatment of children clavicle fracture, because the thick and tough periosteum remains intact and attached by the ligament attachment. In clinic, twin-ring external fixation and simple suspension are commonly used, but there is no reliable basis on which method can get better effect. OBJECTIVE: To compare the stability of twin-ring external fixation and simple suspension for the treatment of children clavicle fracture. METHODS: The patients with children clavicle fracture and treated by twin-ring external fixation and simple suspension were selected from June 2008 to December 2012, including 17 patients treated with simple suspension and 22 patients treated with twin-ring external fixation. The X-ray film examination was performed regularly to observe the fracture healing and shoulder function. RESULTS AND CONCLUSION: The 17 patients treated with simple suspension had good healing; three cases had gap between fracture ends at 1 week after treatment, and re-suspension to increase the height and finally two fracture ends contacted in one case; for the other two cases, there was still gap between fracture ends, and changed for twin-ring external fixation, the fracture ends contacted. All the 22 patients in the twin-ring external fixation group obtained healing; five cases had performance of upper extremity neurovascular compression on the fracture side after fixation; after releasing, three cases had recovery, and two cases were treated with simple suspension, the fracture ends began to contact; six cases had armpit redness; four cases had early sleep difficulties; two cases had gap between fracture ends at 1 week after treatment, and after re-adjust, the fracture ends contacted in two cases. The results showed both two methods could not cause appearance deformity, and both could get healing. The simple suspension fixation is easy to operate with reliable effect, and it is comfortable which make it easy to accept by the children, it has the advantages of early for functional exercise, less tissue damage, does not affect the blood supply; the twin-ring external fixation is easy to compress the axillary arteries and nerves on both sides, thus resulting in upper extremity swelling, numbness and skin redness, and it can cause discomfort night sleeping and poor comfort which is not easy for children to accept. But, no matter what method we take, the review after 1 week, as well as the line between proximal and distal part and the contact between fracture ends is still important. Figures and Tables | References | Related Articles | Metrics

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Biomechanical factors in the design of new femoral neck screw in children Huang Xuan-huai, Liao Ying, Fan Wei-jie, Chen Zhi-wei 2013, 17 (39):  6954-6961.  doi: 10.3969/j.issn.2095-4344.2013.39.015 Abstract ( 395 )   PDF (611KB) ( 619 )   Save BACKGROUND: As the epiphyseal plate has an important role in the growth and development of femur, the design of internal fixation should avoid the damage to the epiphyseal plate. Therefore, the positioning of pediatric femoral epiphyseal plate is particularly important. OBJECTIVE: To investigate the biomechanical property of the new femur neck screw internal fixation in treatment of children femoral neck fracture.  METHODS: Twelve femurs were collected from six fresh children cadavers provided by Dissecting Room of University of South China. After exclusion of bone disease with X-ray film, three new children femoral neck screws and three Kirschner wires with the diameter of 2.0 mm were used for fixation. The biomechanical tests were conducted to detect the axial compression and torsion stiffness. RESULTS AND CONCLUSION: In the children femoral neck screw group, the axial compression stiffness and torsion stiffness under the torsional torque of maximum 3 N•m were (190.74±20.88) N/mm and (0.18±0.045) N•m/° respectively; (138.95±15.19) N/mm and (0.120±0.036) N•m/° respectively in the Kirschner wire group; there were significant differences in the axial compression stiffness and torsion stiffness between two groups (P < 0.05). The results showed that the compressive strength and torsional capacity of the children femoral neck screw were strong than those of Kirschner wire. The experiment suggested that the femoral neck screw for children is a new type of ideal internal fixation device which consist with the anatomical features of children proximal femur and can meet the requirement of children femoral neck fracture with good biomechanical property. Figures and Tables | References | Related Articles | Metrics

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Plate internal fixation versus external fixator for the treatment of unstable distal radius fractures: A Meta-analysis Chen Ke-yi, Yang Guang-zhong, Ma Chuang, Zhao Di-qing, Wang Guo-qi, Yu Kai, Yuan Chun-xiao, Li Jing, Yang Xin-ming 2013, 17 (39):  6962-6969.  doi: 10.3969/j.issn.2095-4344.2013.39.016 Abstract ( 574 )   PDF (327KB) ( 526 )   Save BACKGROUND: The surgical method for the treatment of unstable distal radius fracture mainly includes plate internal fixation and external fixator, but both of these two methods have the advantages and disadvantages. Which treatment is more conducive to the rehabilitation of patients, there is still controversy. OBJECTIVE: To evaluate the clinical effectiveness of internal fixation and external fixator for the treatment of unstable distal radius fractures. METHODS: The relative databases and literatures were searched with the computer and hand to collect the randomized controlled trials of internal fixation versus external fixator for the treatment of unstable distal radius fractures. After extraction literature data and quality evaluation, RevMan 5.2 software was used for system evaluation. The grip strength, disabilities of arm, shoulder & hand score, complications rates, infection rates, deformity rates and ulnar variance rates were compared between two groups. RESULTS AND CONCLUSION: A total of 9 literatures, involving totally 524 patients were included, 286 patients in the internal fixation group and 238 patients in the external fixator group. There was no significant difference in grip strength between internal fixation group and the external fixator group. The results of Meta-analysis showed that the internal fixation group was better than the external fixator group in the aspects of disabilities of arm, shoulder & hand score, complications rate, infection rate, deformity rate and ulnar variance rate at 3 months and 1 year after treatment. The results indicate that the plate internal fixation is better than external fixator in the treatment of unstable distal radius fractures, but the large sample, double-blind, and high quality randomized controlled trials are still needed to identify the results.  Figures and Tables | References | Related Articles | Metrics

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Plating versus intramedullary nail fixation for the treatment of humeral shaft fractures in adults: A systematic review update Li Lian-hua, Wang Hao, Zhang Yan, Cai Yan-hong, Zhang Hao, Liu Zhi, Sun Tian-sheng 2013, 17 (39):  6970-6977.  doi: 10.3969/j.issn.2095-4344.2013.39.017 Abstract ( 386 )   PDF (384KB) ( 631 )   Save BACKGROUND: There is controversial on which method is preferred for the treatment of humeral shaft fractures, plate or intramedullary nail fixation? Some studies have compared the effect of those two methods, but the results are different. While the results of the systematic research and the Meta-analysis on the comparative studies is also different due to the differences in the number and the extraction of the researches.   OBJECTIVE: To systematically evaluate the efficacy of plating versus intramedullary nail fixation in the treatment of adult humeral shaft fracture. METHODS: A computer-based retrieve was conducted in PubMed database, MEDLINE database, Cumulative Index to Nursing & Allied Health Literature, Evidence-Based Medicine database, CBM database, Wanfang database and CNKI database for the randomized or quasi-randomized controlled trials on the comparison of plating and intramedullary nail fixation in the treatment of adult humeral shaft fracture. The quality of these trials was critically assessed according to Jadad. The effective data were extracted for Meta-analysis by Stata 12.0 software. RESULTS AND CONCLUSION: Totally, 15 randomized or quasi-randomized controlled trials were collected including four quasi-randomized controlled trials and 11 randomized controlled trials. The results showed that intramedullary nail fixation may increase the risk of complications (odds ratio=0.37(0.19, 0.59), P=0.00). Bias Egger’s test of P=0.91 showed there was no significant publication bias. The risk of re-operation of intramedullary nail fixation was increased (odds ratio=0.28(0.14, 0.57), P=0.00) with the Egger’s test of P=0.69. The incidence of shoulder impingement of intramedullary nail fixation was significantly higher than that of pate fixation (odds ratio=0.13(0.05, 0.35), P=0.00), and there were no significant differences in postoperative infection, nonunion, implant failure, iatrogenic nerve palsy, operation time and bone union time between two methods. The results showed that compared with plate fixation, intramedullary nail fixation may increase the incidence of shoulder impingement, complications and re-operation, while there were significant differences in postoperative infection, nonunion, implant failure, iatrogenic nerve palsy, operation time and bone union time between two methods. Figures and Tables | References | Related Articles | Metrics

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Design principle and research development of artificial lumbar disc prosthesis Bai Wen-yuan, Gu Hong-sheng, Liao Zhen-hua, Liu Wei-qiang 2013, 17 (39):  6978-6984.  doi: 10.3969/j.issn.2095-4344.2013.39.018 Abstract ( 377 )   PDF (499KB) ( 1022 )   Save BACKGROUND: Artificial Lumbar disc replacement as a new choice for the treatment of degenerative disc disease has aroused widespread concern by clinicians because of the preservation of lumbar vertebra’s biomechanical characteristics during pain eliminating. While the design of the prosthesis structure and material needs further study and validation. OBJECTIVE: To review the structure and material types of several newly designed artificial lumbar discs, then to discuss the trends in the optimization design of prosthesis, in order to provide instruction for the design and assessment of new lumbar artificial disc prosthesis. METHODS: The PubMed database, CNKI database and SinoMed database were searched for related articles. New articles related to artificial lumbar disc structure, material, in vivo and in vitro biomechanics were included. Repetitive studies and stale perspectives were excluded. A total of 46 articles were summarized and discussed in the end. RESULTS AND CONCLUSION: Artificial lumbar disc has developed for nearly 30 years, the design of structure and biological material has been in continuous improvement. At first, we summarized the principle and current situation in the design of movement reservation, movement constraint, instant fixation, base material, weight-bearing material and coating material of artificial lumbar disc prosthesis, then combined with the exist newly in vivo and in vitro biomechanical results to evaluate different kinds of design with the recent research trend to prospect the development of biomimetic design, material improvement, the optimization design of prosthesis and assisted devices. Figures and Tables | References | Related Articles | Metrics

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Clinical application of minimally invasive total knee arthroplasty Gao Ying-jian, Wang Wei-li 2013, 17 (39):  6985-6990.  doi: 10.3969/j.issn.2095-4344.2013.39.019 Abstract ( 466 )   PDF (426KB) ( 685 )   Save BACKGROUND: With the continuous development of minimally invasive techniques and computer navigation assistive technology, they have powerful attraction and development prospects in theory and practice. But there are controversies and misunderstandings in the application and efficacy of total knee arthroplasty.  OBJECTIVE: To summarize and evaluate the definition indications, contraindications and complications of minimally invasive total knee arthroplasty, as well as the advantages and disadvantages after replacement and the application of computer navigation assistive technology. METHODS: A computer-based retrieve was performed in CNKI database and PubMed database for the articles on minimally invasive total knee arthroplasty from 2003 to 2013. The key words of “minimally invasive total knee arthroplasty, minimal incision total knee arthroplasty, computer navigated total knee arthroplasty, computer assisted total knee arthroplasty” in English and Chinese were put in the title and abstract. The articles on the minimally invasive total knee arthroplasty and computer assisted total knee arthroplasty were included, and the old and repetitive articles were eliminated. Finally, 44 articles were included for review according to the inclusion criteria.  RESULTS AND CONCLUSION: Knee joint diseases can seriously affect the life quality of the patients. Minimally invasive total knee arthroplasty is a newly developed technique in recent ten years, which can provide a new choice for the patients. Studies have shown that minimally invasive total knee arthroplasty has the advantages of reducing postoperative pain, decreasing the direct cost and fastening the recovery. The computer navigated total knee arthroplasty can make the force line more precise after replacement. But there exist many problems according to the reports at home and abroad, especially the life and prosthesis and time for revision, those are the fatal factors for the patients. But minimally invasive surgery is the developing trend of orthopedic surgery. Figures and Tables | References | Related Articles | Metrics

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Advances in research on anterior cervical fusion and replacement in vitro biomechanical experiment Lü Cong-wei, Pu Ting, Liao Zhen-hua,Liu Wei-qiang 2013, 17 (39):  6991-6996.  doi: 10.3969/j.issn.2095-4344.2013.39.020 Abstract ( 462 )   PDF (404KB) ( 750 )   Save BACKGROUND: Traditional “gold standard” of anterior cervical decompression with fusion and artificial cervical disc replacement rapidly developed in recent years are common clinical methods for the treatment of cervical spondylosis. A large number of researchers and clinicians hope to research the biomechanics of spine through cervical specimen in vitro experiments, which provide guidance for clinical surgery. OBJECTIVE: To review the cervical specimen in vitro experiments and to prospect the future research. METHODS: The PubMed database, CNKI database and Wanfang database were retrieved with the key words of “cervical spine, fusion, replacement, hybrid, biomechanics, in vitro, adjacent-level degeneration, review” in English and Chinese. The articles in the past 3 years on the in vitro biomechanical experiments of anterior cervical fusion and replacement from January 2007 to March 2013 were included. The old and repetitive articles were excluded. Finally, a total of 40 articles were included for review. RESULTS AND CONCLUSION: This article reviewed the in vitro cervical specimen fusion and replacement experiments, and introduced major progress in multi-level, motion control condition differences, cervical coupled motion test and newly designed implant device. The effects of fusion and replacement on adjacent-level range of motion, intra-articular pressure, pressure inside nucleus pulposus and intervertebral foramen morphology were compared to discuss the problems after fusion and replacement, and thus prospecting the development and application of in vitro cervical specimen experiments based on the clinical requirements. Figures and Tables | References | Related Articles | Metrics

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Mechanism of nerve root stretch injury Xu Peng, Liu Zhi-yong, Zhou Dong-sheng, Mu Wei-dong, Chen Chao-yang 2013, 17 (39):  6997-7002.  doi: 10.3969/j.issn.2095-4344.2013.39.021 Abstract ( 759 )   PDF (405KB) ( 1031 )   Save BACKGROUND: Under physiological conditions, nerve roots can move along with the movement of limbs and spine. However, the mechanisms of nerve root stretch injury under physiological conditions and the neurological dysfunction after injury are unclear. OBJECTIVE: To review the reason of nerve root stretch injury, and to analyze the mechanism of nerve function from biomechanics, pathology and neurophysiology. METHODS: A computer-based online search of PubMed database was undertaken by the first author to identify the articles related to the research of nerve root injury and nerve stretch injury between 1990 and 2012, with the key words of “nerve root, nerve, stretch injury”. A total of 391 articles were screened out. The articles on the anatomy and biomechanics research of nerve root were included, as well as the pathology and neurophysiology research after nerve root stretch injury. Finally, 44 articles were included for review.  RESULTS AND CONCLUSION: Nerve root can be stretched along with limbs and spine movement. However, diseases or trauma may cause pathological nerve root stretch, and thus leading neurological dysfunction. The nerve root is often influenced stretch because of its anatomical and tissue structure. Mechanical injury mechanism of stretch composes of peripheral (peripheral nerve conduction stress) and central mechanism (displacement of spinal cord content). Pathological studies found that the local fibrosis is caused by the extracted serum protein that difficult to remove after injury, and this is because of the shortage of lymphatic system in nerve roots. Fibrosis can cause nerve root ischemia, affect the nerve function, and change the biomechanical properties of nerve root. Nerve root injury can cause primary and secondary injury of internal axons, and this is the main reason for neurological dysfunction after injury. Figures and Tables | References | Related Articles | Metrics

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Cementless total hip arthroplasty versus hemiarthroplasty for the treatment of old femoral neck fracture Huang Dao-wen, Hu Wen-hao, Wei Bo, Xu Yan, Wang Li-ming 2013, 17 (39):  7003-7008.  doi: 10.3969/j.issn.2095-4344.2013.39.022 Abstract ( 677 )   PDF (474KB) ( 738 )   Save BACKGROUND: There is controversy on the treatment of old femoral neck fracture with hemiarthroplasty. OBJECTIVE: To observe the clinical effect of cementless hemiarthroplasty in the treatment of old femoral neck fracture, and to compare with total hip arthroplasty. METHODS: A retrospective analysis was performed on the clinical data of 23 old femoral neck fracture patients treated by artificial joint replacement from January 2009 to June 2010. Among the 23 patients, 11 cases were treated with cementless hemiarthroplasty, and 12 cases were treated with total hip arthroplasty. The time for off-bed activity, Harris score and the incidence of perioperative complications were compared between cementless total hip arthroplasty and hemiarthroplasty. RESULTS AND CONCLUSION: All the patients were followed-up for 12-18 months. The active straight leg raising angle, time for off-bed activity, incidence of early postoperative complications and Harris score at 1 week after treatment of the cementless hemiarthroplasty group were better than those of the total hip arthroplasty group; there were no significant differences in Harris score at 6 weeks, 3 and 6 months between two groups; the incidence of forward hip pain of the cementless hemiarthroplasty group was higher than that of the total hip arthroplasty group. So, we generally think that cementless hemiarthroplasty has better short-term effect in the treatment of old femoral neck fracture, but the long-term integrated efficacy needs to be further identified. Figures and Tables | References | Related Articles | Metrics

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Less invasive stabilization system plate fixation combined with bone cement for the treatment of distal femoral aneurysmal bone cyst Li Xue-jin, Wen Xiao-yan, Xu Jie, Wang Wei, Li Qun, Pei Bao-yan 2013, 17 (39):  7009-7014.  doi: 10.3969/j.issn.2095-4344.2013.39.023 Abstract ( 463 )   PDF (563KB) ( 659 )   Save BACKGROUND: The previous literatures have reported that the aneurysmal bone cyst has a high recurrence rate after curettage treatment. OBJECTIVE: To investigate the effect of less invasive stabilization system plate fixation combined with bone cement in the treatment of distal femoral aneurysmal bone cyst. METHODS: A retrospective analysis was conducted in 19 patients with distal femoral aneurysmal bone cyst who treated with less invasive stabilization system plate fixation combined with bone cement in the First Hospital of Qinhuangdao between January 2002 and January 2012. The purpose of the treatment of aneurysmal bone cyst was to completely remove the cyst and prevent recurrence, and to repair and reconstruct the structure and function of the damaged tissues through implant fixation. RESUTLS AND CONCLUSION: The 19 patients were followed-up for 1-3 years after treated with less invasive stabilization system plate fixation combined with bone cement, and 18 cases recovered well, one case had recurrence at 2 years after treatment. Complete removal of aneurysmal bone cyst is the key for the prevention of recurrence. The less invasive stabilization system plate is the combination of advantages of intramedullary nail and the biological locking plate technology, which has many advantages in the treatment of aneurysmal bone cyst. Filling the lesion area with bone cement had certain killing effect on tumor, and can increase the bone strength in the lesion area. The surgical treatment of distal femoral aneurysmal bone cyst is to clear the cystic lesions firstly, and then to prevent the recurrence through less invasive stabilization system plate fixation combined with bone cement.   Figures and Tables | References | Related Articles | Metrics

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Anchors for the treatment of ankle fracture combined with deltoid ligament injury Su Yan, Song Sa, Shen Long-xiang, Luo Cong-feng, Zhang Chang-qing, Zeng Bing-fang 2013, 17 (39):  7015-7020.  doi: 10.3969/j.issn.2095-4344.2013.39.024 Abstract ( 561 )   PDF (535KB) ( 818 )   Save BACKGROUND: Ankle fracture combined with deltoid ligament injury can disorders the anatomical structure of ankle joint. Improper treatment can cause more serious complication, such as walking disorders. OBJECTIVE: To evaluate the clinical effect of anchor repair plus open reduction internal fixation in the treatment of ankle fracture combined with deltoid ligament injury. METHODS: Thirty-five patients with ankle fracture combined with deltoid ligament injury were selected from the Department of Orthopedics, the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University between May 2009 and January 2011, including 24 males and 11 females, and all the patients were treated with anchor repair plus open reduction internal fixation. The age of the patients was 22-61 years, averaged 35.7 years, and all the patients were closed injury without other fractures. The treatment time was 2-10 days, average 4.6 days. According to Lauge-Hansen classification, 26 patients had supination-eversion ankle fracture and nine patients had pronation-eversion. According to Danis-Weber classification, 26 patients were C type and nine patients were B type. After all the three patients were treated with anchor repair, the treatment effect of anchor repair was evaluated through assessing the improvement of clinical symptoms and signs, as well as the imaging examination of repair and healing. RESULTS AND CONCLUSION: All the 35 patients were followed-up for 9-26 months, average 13.8 months. All the patients got Ⅰ stage healing without complications of infection and screw loosening. Follow-up X-ray film showed all the 35 patients with ankle fracture achieved bone union, the healing time was 10-21 weeks, average 13.6 weeks. Modified Baird-Jackson score system showed excellent in 11 cases, good in nine cases, average in four cases, poor in one case, and the excellent and good rate was 85.7%. At 6 months after internal fixation, the stress X-ray film examination showed the malleolus gap of the affect side was (3.49±0.36) mm, the malleolus gap of the healthy side was (3.37±0.41) mm, and there was no significant difference (P > 0.05). The results indicate anchor in the repair of deltoid ligament injury during the treatment of ankle fracture with open reduction internal fixation can achieve satisfactory therapeutic effect. Figures and Tables | References | Related Articles | Metrics