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28 May 2011, Volume 15 Issue 22 Previous Issue    Next Issue

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Three-dimensional finite analysis of hip contact area and contact pressure during normal walking Wang Guang-Ye, Zhang Chun-Cai, Xu Shuo-gui 2011, 15 (22):  3991-3994.  doi: 10.3969/j.issn.1673-8225.2011.22.001 Abstract ( 112 )   PDF (1071KB) ( 331 )   Save BACKGROUND: Estimation of the hip joint contact area and pressure distribution during activities of daily living is important in predicting joint degeneration mechanism, prosthetic implant wear, providing biomechanical rationales for preoperative planning and postoperative rehabilitation. OBJECTIVE: To explore the hip joint contact area and pressure distribution during different trait phases, which is important in predicting joint degeneration mechanism.  METHODS: CT scanning and computer image processing system were used to establish the model to simulate the situation of acetabulum for 32 phases during the trait. A finite element solves was used to calculate stress and contact area.  RESULTS AND CONCLUSION: Stress distribution within the acetabular cartilage was obtained and regions with elevated stress at 32 phases were located. The stress distributions of 32 phases were significantly different. The stress demonstrated the bimodal shape of a pronounced phush-off often seen in trial gait cycle (4.2 MPa). The regions of elevated stress and contact area of acetabulum both occurred during stance phases of a gait cycle. Persistent stress-transfer located on medial roof, while on anterior and posterior horn there is always no stress-transfer. The elevated stress located roof during stance phases and medial acetabular cartilage during swing-phases respectively. These results can be used to rationalize rehabilitation protocols, functional restrictions after complex acetabular reconstructions, the renions of elevated stress and contact area of acetabulum are important, which provide an insight into the factors contribution to the arthritis. Related Articles | Metrics

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Three-dimensional finite element analysis of the pelvis in sitting stance Gao Ying-chao, Guo Zheng, Fu Jun, Tian Wei-jun 2011, 15 (22):  3997-4001.  doi: 10.3969/j.issn.1673-8225.2011.22.003 Abstract ( 168 )   PDF (726KB) ( 443 )   Save BACKGROUND: As the the pelvis has complex structure, the studies of pelvis biomechanical properties are fewer in sitting stance. Finite element analysis is accepted gradually for biomechanics of the pelvis. OBJECTIVE: To study the stress distribution on the pelvis of the adult in static sitting stance with three-dimensional finite element model. METHODS: One healthy volunteer was scanned by multi-slices computerized tomography (MSCT). The three-dimensional images of the pelvis were reconstructed with the software Mimics 10.0. With the use of Geomagic and Proe5.0, the three-dimensional model of the pelvis was imported into the ANSYS10.0. Digital three-dimensional structures of the pelvic, such as ligament, were added to the three-dimensional model with powerful pre-processing modular of ANSYS. Finally, the integrated three-dimensional finite elemental model of the pelvis was established. The vertical load pressure (600 N) was exerted on the upper terminal plate of the first body of the sacrum to simulate sitting biomechanics. The stress, strain and displacement nephogram were obtained under axial load. RESULTS AND CONCLUSION: The distribution of stress in bilateral iliac bones was equal. The stress passed through the ala of sacrum and the sacroiliac joint to the tuberodties of ischium. The highest stress was found at the tuberodties of ischium. The von Mises stress and strains for specific location could reflect the characteristic biomechanics of the pelvic ring, implying the accuracy of the finite element model. The results agreed with those by other biomechanics test. The established three-dimensional finite element model of normal adult is valid and reasonable. It can be used for biomechanical analysis and also can meet the needs of clinical situation. Related Articles | Metrics

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Three-dimensional finite element model of the distal humerus and the related biomechanics analysis Wang Ya-bin, Zhou Xiao-jian, Ren Ya-jun, Zhang Yun-qing 2011, 15 (22):  4002-4005.  doi: 10.3969/j.issn.1673-8225.2011.22.004 Abstract ( 123 )   PDF (491KB) ( 447 )   Save BACKGROUND: Finite element analysis in biomechanics research of bone and joint has been widely used, but the finite element analysis of the distal humerus is less, and the model is rough, the method is cumbersome. OBJECTIVE: To establish a three-dimensional finite element model of the distal humerus, and to simulate under different loading the stress distribution and strain characteristics. METHODS: The raw data were obtained from a normal adult male. His elbow was scanned by spiral CT scans without any interval. Then the CT images were inputted into the Mimics, and produced a meshed three-dimensional surface image of the distal humerus. The three-dimensional model was inputted into the ANSYS 10.0, to create the finite element model following meshing and material property assignment. The model was constrained boundary conditions and applied axial load. Through constraining the boundary conditions and applied axial load, the stress distribution and strain results on the finite element model of the distal humerus were obtained. RESULTS AND CONCLUSION: The finite element model of the distal humerus was established with total unit number of 6 292, total node number of 10 232. When axial load was applied, the stress of the distal humerus emphasized at the medial and lateral column regions. The results indicate that the finite element model has high accuracy, and the clinical features are consistent with those of the distal humerus, so the model can properly simulate the biomechanical properties of the distal humerus. Related Articles | Metrics

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Measurement and analysis of linear parameters for the proximal tibial section of the northwest Han people of China Zhao Bin-xiu, Wang Kun-zheng, Wang Chun-sheng, Chen Xiao-liang 2011, 15 (22):  4006-4010.  doi: 10.3969/j.issn.1673-8225.2011.22.005 Abstract ( 104 )   PDF (552KB) ( 293 )   Save BACKGROUND: Knee prostheses for knee replacement in China are mostly imported from the United States and Europe, or produced based on these import prostheses. However, there are many differences in knee interface between Chinese people and European and Americal people, and even among different Chinese populations. It is important for good replacement outcomes to prepare apropriate knee prostheses suitable for different Chinese populations. OBJECTIVE: To define the geometric features of the tibial proximal section of Han population from the northwest China. METHODS: The digitized model of proximal tibia was established through putting the knee CT scan data into the workstation for digital image, in the model make corss sections backward 3° at the levels of 3 mm and 6 mm depth under the tibial plateau medial plate, several diameters of the two cross sections were measured, for example anteroposterior diameter and transverse diameter. RESULTS AND CONCLUSION: The value of the various diameter lines was obtained to get the correlation between the diameter lines with regression equation. The proximal section of the Han people group of northwest Chinese has its characteristics, compared with European and the other people groups in Asia. The knee prosthesis tibial side for Han people group of northwest Chinese should be chosen and designed according to its alone features. Related Articles | Metrics

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Artificial muscles of suspension system with anchor for lower extremity prosthesis enlargement  Wang Jiang-ning, Wang De-cheng, Ding Lu, Zhang Jin-guang, Gao Lei, Zhang Li-bin, Gao Yan, Fu Xiao-xiao 2011, 15 (22):  4011-4014.  doi: 10.3969/j.issn.1673-8225.2011.22.006 Abstract ( 122 )   PDF (629KB) ( 281 )   Save BACKGROUND: The lower limb prosthesis implantation has become a surgical method for lower limb enlarging, but due to movement and gravity, the possibility of tearing and shifting is high, so limb prosthesis implantation requires improvement. OBJECTIVE: To retrospectively analyze clinical data of cases of lower limb enlargement surgery and butt augmentation. METHODS: The 39-year-old male patient with left lower limb due to poliomyelitis muscular atrophy was admitted to the hospital for prosthesis implantation. Self-designed anchors with Mitek G Ⅱ suspension prosthesis was implanted for artificial limb muscle enlargement treatment. RESULTS AND CONCLUSION: Following surgery, asymmetric lower limbs were corrected, and the introduction of suspension anchors ameliorated prosthesis displacement. Related Articles | Metrics

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Effect of femoral nerve block and neural rehabilitation on functional outcome after total knee replacement: A randomized controlled study Wang Jiang-lin, Yang Min, Xu Fang-yuan 2011, 15 (22):  4015-4018.  doi: 10.3969/j.issn.1673-8225.2011.22.007 Abstract ( 104 )   PDF (607KB) ( 357 )   Save BACKGROUND: Continuous femoral nerve block is better than a simple analgesic treatment (morphine) during total knee replacement. Single-injection femoral nerve block does not require special equipment and expert management, and it is easy to operate and spends low cost. OBJECTIVE: To investigate the efficacy of single-injection femoral nerve block and neural rehabilitation to relieve pain and improve rehabilitation after total knee replacement. METHODS: A total of 40 patients were prospectively and randomly assigned to receive 40 mL of either 2.5 g/L bupivacaine (group B) or saline (group S) after total knee replacement. Blinded observers evaluated the patients for postoperative pain, morphine consumption, ambulating distances, and maximal knee flexion; pain was scored on the visual analog scale (VAS). RESULTS AND CONCLUSION: Compared with group S patients, group B patients had significantly lower VAS pain scores in the postoperative anesthesia care unit (P < 0.05-0.01); group B patients also showed significantly lower total morphine use (P < 0.05) and a lower incidence of morphine-related side effects. Significantly more group B than group S patients could ambulate on the day after surgery (P < 0.05) and mean ambulatory distance was significantly better for group B than group S patients at discharge (P < 0.01). Knee flexion was significantly better for group B than group S patients on the second day after surgery (P < 0.01), but there was no significant difference between the two groups at discharge. Mean length of hospitalization was significantly shorter for group B than group S patients (P < 0.05). The single-injection femoral nerve block combined with neural rehabilitation can obviously relieve pain, facilitate early ambulation, and reduce the length of hospitalization in patients undergoing total knee replacement. Related Articles | Metrics

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Investigation of using fast-track surgery in the rehabilitation process of patients undergoing total knee replacement Fu Li-min, Yang Xiao-hua, Lü Yong-ming, Yan Jing, Fu Qiao, Zhang Xin 2011, 15 (22):  4019-4022.  doi: 10.3969/j.issn.1673-8225.2011.22.008 Abstract ( 108 )   PDF (622KB) ( 485 )   Save BACKGROUND: Fast-track surgery (FTS), as a new rehabilitation concept, has been successfully used in general surgery, cardiac and thoracic surgery, etc., but it has not been applied in orthopedics till now. OBJECTIVE: To evaluate the effects of perioperative rehabilitation therapy under the guidance of FTS theory in patients under knee replacement. METHODS: Forty-five cases of osteoarthritis who received total knee replacement were selected as the experimental group, and they were treated under the guidance of FTS theory strictly in the perioperative period. Another 30 cases of patients undergoing total knee replacement who had traditional rehabilitation therapy before and after replacement were taken as the control group. RESULTS AND CONCLUSION: Compared with the control group, the experiment group had a grossly decreased incidence of complications, lowered hospital costs and time of hospitalization, and had remarkably elevated HSS scores in the postoperative follow-ups. The results show that FTS therapy used in perioperative rehabilitation treatment can accelerate the recovery rate of patients, shorten the treatment period and elevate the therapeutic effect. Related Articles | Metrics

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Coagulation factor replacement in total knee arthroplasty for hemophilic patients Zhang Zhuo, Guan Zhen-peng, Sun Tie-zheng, Li Yun-peng, Pei Zheng, Zhang Shao-long, Lü Hou-shan 2011, 15 (22):  4023-4027.  doi: 10.3969/j.issn.1673-8225.2011.22.009 Abstract ( 110 )   PDF (603KB) ( 479 )   Save BACKGROUND: According to the guidelines of World Hemophilia Association, joint replacement should ensure the activity of coagulation factors in patients. OBJECTIVE: To summarize the safety and validity of coagulation factor replacement in hemophilic arthritis patients undergoing total knee arthroplasty (TKA). METHODS: Between 1997 and 2006, we performed TKA on 4 hemophilic arthritis patients with 6 knee joints. Under the cooperation with the Hematology Department, we monitored levels of factors Ⅷ and Ⅸ perioperatively, and established routine process of factor replacement, according to the guideline of World Hemophilia Association, and factor replacement had been performed. RESULTS AND CONCLUSION: Hemophilic patients who had undergone therapy of perioperative coagulation factor replacement could suffer treatment of TKA. There was no significant difference in the amount of bleeding between patients with hemophilia and those with either of rheumatoid arthritis or osteoarthritis (P=0.885). Intraarticular bleeding occurred in 3 knees of 2 patients, and another with formation of inhibitor, which led to incision split in 1 knee. The wound healed well after treatment of epluchage. No other early or further complications had occurred. The average preoperative KSS score was 28.2 points, and the average functional score was 35 points, as compared to the postoperative average scores of 85.2 points by KSS and 87 for function. Recovery of the hemophilic arthritic knee was similar to the result of a regular TKA, while there were increases of three times in the hospitalized days and 2.5-3 times to the cost of a regular replacement surgery. Coagulation factor replacement and monitoring of coagulation factor levels are the key to the success of TKA in hemophilic arthritis patients. Related Articles | Metrics

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Curative effect of rivaroxaban versus low molecular weight heparin to prevent deep venous thrombosis following total hip arthroplasty Jing Guang-wu, Ye Shu-nan,Yang Shu-hua 2011, 15 (22):  4028-4031.  doi: 10.3969/j.issn.1673-8225.2011.22.010 Abstract ( 110 )   PDF (662KB) ( 585 )   Save BACKGROUND: Low molecular weight heparin can obviously reduce the incidence of deep venous thrombosis (DVT) following total hip arthroplasty (THA). However, subcutaneous injection limits the application of low molecular weight heparin. OBJECTIVE: To observe the clinical effects and security of low molecular weight heparin and rivaroxaban against DVT after THA. METHODS: Totally 58 THA patients were randomized into two groups: rivaroxaban group with 28 cases and heparin group with 30 cases. Occurrence of DVT and bleeding were observed under color Doppler of lower limbs. RESULTS AND CONCLUSION: There was no statistics differences in DVT prevention and intraoperative bleeding between the two groups (P < 0.05). Rivaroxaban has similar effects to low molecular weight heparin on DVT prevention after THA. Related Articles | Metrics

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Treatment of intertrochanteric hip fractures using percutaneous compression plate system and reverse less invasive stabilization system: A follow-up of 6 months Hua Jiong, Huang Wei-jie, Yan Jie, Cao Cong, Dong Yu-qi 2011, 15 (22):  4032-4035.  doi: 10.3969/j.issn.1673-8225.2011.22.011 Abstract ( 117 )   PDF (570KB) ( 280 )   Save BACKGROUND: There are many reports about the intramedullary fixation represented by proximal femoral nail and proximal femoral nail antirotation, but the comparison between these two fixation methods is rare. OBJECTIVE: To assess the clinical effect of percutaneous compression plate system (PCCP) and reverse less invasive stabilization systems (LISS) on intertrochanteric hip fractures. METHODS: Thirty-six patients with intertrochanteric hip fractures were treated with PCCP (n=21) and LISS (n=15), with age of 65 to 91 years old and followed up after surgery. Complications and hip function (Harris score) were observed and assessed. RESULTS AND CONCLUSION: All cases were followed up for 6 months. The Harris hip function: the excellent and good rate was 87% in the group PCCP and 87% in the group LISS. None of the 17 cases suffered from the complications such as fractures or looses of the screw and plates,deep vein thrombosis and coax vara. The incidence rate was very low. The PCCP and LISS for intertrochanteric hip fractures ISan ideal internal fixation in clinic because of less blood loss, minimal invasion and better recovery of the hip functions, especially for elder patients who are not suitable for intramedullary fixation. Related Articles | Metrics

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Minimally invasive percutaneous plate osteosynthesis with locking TCP versus dynamic condylar screw in the internal fixation of comminuted fracture of the distal femur Zhang Ying, Qiu Chui-ming, Jia Bing-shen, Zhou Jian-qiang, Li Jun1, Tan Hai-tao 2011, 15 (22):  4036-4039.  doi: 10.3969/j.issn.1673-8225.2011.22.012 Abstract ( 104 )   PDF (681KB) ( 386 )   Save BACKGROUND: There are many therapies for comminuted fracture of the distal femur, but no uniform standard for clinicians is considered to choose appropriate therapy.  OBJECTIVE: To compare the effects of minimally invasive percutaneous plate osteosynthesis (MIPPO) with locking TCP versus dynamic condylar screw (DCS) in the internal fixation of comminuted fracture of the distal femur. METHODS: Thirty-seven patients with comminuted fracture of the distal femur were randomized into two groups: MIPPO with locking TCP group (n=19) and DCS group (n=18). General conditions, damages, healing time, complications and function recovery were compared and analyzed between the two groups. RESULTS AND CONCLUSION: The patients undergoing MIPPO with locking TCP could walk earlier, recovered better and had a shorter healing time (P < 0.05). According to Karlstorm Knee Functional Evaluation Standard, the excellent and good rate in the MIPPO with locking TCP was significantly higher than that in the DCS group (P < 0.05). Locking TCP combined with MIPPO technology was better than DCS in treating comminuted fracture of the distal femur. Related Articles | Metrics

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A comparative study on pedicle screw internal fixation to the lower cervical vertebra by three screw place methods Yin Hua, Zhao Yin-bi 2011, 15 (22):  4040-4045.  doi: 10.3969/j.issn.1673-8225.2011.22.013 Abstract ( 101 )   PDF (681KB) ( 316 )   Save BACKGROUND: Nowadays there are so many screw place methods in lower cervical vertebra. But they have different accuracy. There was no comparative study on the pedicle screw internal fixation in lower cervical vertebra by three screw place methods such as vertebral plate partial resection screw place method, Abumi place screw method and pipeline dredge method. OBJECTIVE: To explore the feasibility of the pedicle screw internal fixation in lower cervical vertebra (C3-7), and to compare the differences in screw satisfaction rate, blood loss, screw placing time, complications among vertebral plate partial resection screw place method, Abumi screw place method, and pipeline dredge method.  METHODS: Totally 60 patients with lower cervical spine disease who needed the pedicle screw internal fixation through cervical posterior approach were chosen and divided into three groups each with 80 pedicle screws by vertebral plate partial resection place screw method (group A), Abumi screw place method (group B), and pipeline dredge method (group C). Intraoperative bleeding and time to place screw were calculated. The satisfaction rate and the constituent ratio in all sides of pedicle injury were observed before discharge. The incidence of lateral wall injury from C3 to C7 was compared. RESULTS AND CONCLUSION: The time to place screw was progressively decreased in groups A, B and C (P < 0.05). There was no significant difference in the intraoperative bleeding and the constituent ratio among three groups (P > 0.05). The incidence of lateral wall injury in C4-5 was higher than that in C3, C6-7. It is indicated that pipeline dredge method is superior to vertebral plate partial resection screw place method and Abumi screw place method in posterior pedicle screw fixation.  Related Articles | Metrics

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Individual optimized pedicle screw reset and fixation treatment for thoracolumbar fractures Chen Jia-lin 2011, 15 (22):  4046-4050.  doi: 10.3969/j.issn.1673-8225.2011.22.014 Abstract ( 103 )   PDF (560KB) ( 494 )   Save BACKGROUND: With the development of pedicle screw technology, it is not enough only to pedicle screw implantation. It should choose the best channel for pedicle screw implantation based on fracture reduction and fixation. OBJECTIVE: To improve the treatment safety and effectiveness of individual pedicle screw fixation for thoracolumbar fractures. METHODS: Preoperative X-ray and CT were performed in 50 cases of thoracolumbar fractures to measure the pedicle width, the screw path length, the distances between pedicles, the transverse and sagittal screw angle, the compress of the vertebrace, the spinal Cobb’s angle. The individual optimized range to safely implant pedicle screws was selected. Combined with anatomical localization, C-arm X-ray was used to guide operation orientation and inspect outcome. RESULTS AND CONCLUSION: The position of the screw was good, the angle was correct, and the length was suitable. The compress of the vertebrace and the spinal Cobb’s angle were improved significantly after operation (P < 0.01). Fifty cases were followed up for 2 to 26 months, with an average of 12 months, and the fractures healed. Individual radiology measurement combined with anatomical localization is a reasonable and effective method, which is helpful to evaluate the security and the efficiency of transpedicle internal fixation. Related Articles | Metrics

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Selective posterior thoracic fusions for adolescent idiopathic scoliosis: Hooks versus pedicle screws Fu Wei-ping, Zhang Hai-ying, Chu Ge, Xiang Ze-wen, Wang Fu-zhong, Lu Yong 2011, 15 (22):  4051-4055.  doi: 10.3969/j.issn.1673-8225.2011.22.015 Abstract ( 140 )   PDF (716KB) ( 299 )   Save BACKGROUND: Previous reports have documented to use hooks or pedicle screws with hooks in treating adolescent idiopathic scoliosis (AIS), or to discuss selective spinal segment for fusion. OBJECTIVE: To compare the clinical and radiographic results of selective posterior thoracic fusion using hooks versus pedicle screws in AIS patients. METHODS: Sixty-six consecutive patients with major thoracic-compensatory lumbar C modifier AIS curves underwent selective posterior thoracic fusion to T12 or L1 at a single institution. Hooks were used for instrumentation in 32 patients and pedicle screws were used in 34 patients. Patients were evaluated at a minimal 2-year follow-up. RESULTS AND CONCLUSION: There was no statistical difference between the preoperative thoracic and lumbar Cobb values for the hook group versus the pedicle screw group. The amount of correction obtained surgically of the thoracic Cobb and the amount of spontaneous lumbar Cobb correction were significantly greater in the pedicle screw group (P < 0.001). The incidence of postoperative coronal decompensation, with a greater than 20 mm shift to the left of the C7 plumb line, was higher in the hook group (13 patients) as compared with the pedicle screw group (4 patients) (P < 0.005). There were no complications or reoperations in either group. Selective thoracic fusion of main thoracic-compensatory lumbar C modifier AIS curves with pedicle screws allowed better thoracic correction and less postoperative coronal decompensation than that with hooks. Related Articles | Metrics

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Direct vision versus roentgenoscopy during screw fixation of the posterior malleolar fragment Zhang Guo-zhu, Jiang Xie-yuan 2011, 15 (22):  4056-4060.  doi: 10.3969/j.issn.1673-8225.2011.22.016 Abstract ( 110 )   PDF (573KB) ( 358 )   Save BACKGROUND: Previously, the roentgenoscopy, medial malleolus dislocation and lateral malleolus osteotomy often used in reduction and fixation of posterior malleolar fractures are dissatisfied to different extents. Direct vision method can provide an alternative way to observe the posterior malleolus. OBJECTIVE: To compare the direct vision and roentgenoscopy during screw fixation of the posterior malleolar fractures. METHODS: Twenty-six patients with posterior malleolar fractures were selected from Beijing Jishuitan Hospital between January 2006 and December 2006. The patients were divided into two groups according to sex, age, fracture type, time from injury to operation, and 13 cases were in each group. Roentgenoscopy group received the roentgenoscopy to observe the reduction and fixation of the posterior malleolar fragments, and direct vision group underwent direct vision. RESULTS AND CONCLUSION: The average time of follow-up was 23 (17-29) months in the direct vision group and 22.5 (17-28) months in the roentgenoscopy group. All the 26 cases had bone union wth the anatomic reduction of the posterior malleolar fragments. The time for reduction and fixation of posterior malleolar fractures was (8.08±1.55) minutes in the direct vision group and (20.15±4.22) minutes in the roentgenoscopy group (P < 0.01). There was a significant difference in the number of x-ray fluoroscopy between the direct vision group (3-8 times) and roentgenoscopy group (once) (P < 0.01). The AOFAS scores were 86-100, 96 on average, in both two groups, including 11 excellent cases and 2 good cases. It is indicated that the direct vision method is superior to the roentgenoscopy. Related Articles | Metrics

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Total hip replacement and bipolar hemiarthroplasty for femoral neck fracture in the elderly: A Meta analysis  Li Guo-wei, Dong Ming-yan, Zhang Hai-fei, Yan Xue 2011, 15 (22):  4061-4064.  doi: 10.3969/j.issn.1673-8225.2011.22.017 Abstract ( 112 )   PDF (511KB) ( 473 )   Save BACKGROUND: Bipolar hemiarthroplasty or total hip replacement can quickly recover hip function, which is the ideal and reliable treatment of femoral neck fracture in the elderly. OBJECTIVE: To systemically assess the effects of bipolar hemiarthroplasty and total hip replacement on femoral neck fracture in the elderly through a Meta analysis. METHODS: Medline (1990/2011-03), Embase (1984/2011-03), Cochrane Central Register of Controlled Trial (Issue 2, 2011), Current Controlled Trials, and CMB (1986/2011-03) were searched by computer for randomized controlled trials of bipolar hemiarthroplasty and total hip replacement for femoral neck fracture in the elderly. And the retrieved studies were strictly evaluated in accordance with the Cochrane Handbook 5 and underwent the Meta analysis using RevMan 5.1.1 software. RESULTS AND CONCLUSION: Totally 6 randomized controlled trials with 899 patients were included. The results of Meta analysis showed that the Harris score after total hip replacement was higher than that after bipolar hemiarthroplasty. However, there were no significant differences in the number of patients requiring reoperation, the number of postoperative dislocation, 1-year mortality, and complications. As compared with patients with semi-hip replacement, the operation time, intraoperative bleeding volume, postoperative bed time, postoperative hospital staying, hospital cost were obviously increased in patients with total hip replacement. Related Articles | Metrics

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Morphological proportion of chin soft tissue of beautiful females in China Zu Qing, Mi Cong-bo, Nie Jing, Yang Chuan, Song Mei-yun, Jumanjiang•Maimaiti, Qian Ya-jing 2011, 15 (22):  4065-4068.  doi: 10.3969/j.issn.1673-8225.2011.22.018 Abstract ( 108 )   PDF (695KB) ( 368 )   Save BACKGROUND: Scholars at home and abroad of beauty crowd facial structure measure and research establish its regional facial contour mean and facial structure relation, based on opposite type deformity for diagnosis and reconstruction, so as to get beautiful looks. OBJECTIVE: To explore the morphological proportion of chin soft tissue profile of beautiful females in China and its correlation. METHODS: Eighty beautiful women were selected from movies, TV and magazines. Their photos were processed by using Photoshop 8.0 image processing software by an experienced clinical physician in successive to measure the relative proportion of the chin every 2 weeks, each index was measured 3 times to calculate an average value as the final measurement results and relevant analysis was done on the measurement results. RESULTS AND CONCLUSION: The morphology of chin soft tissue might help clinicians make proper diagnosis and formulate correct correction plan. The morphological proportion of the chin was as follows: the height radio of upper lip to lower lip was about 1:2, the chin was almost from them mouth to 1/2 submental part, and the chin had a little protrusion to be in coordination with the lip. Related Articles | Metrics

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Bivariate evaluation of the short implant diameter and length in type Ⅱ jaw bone of maxillary sinus area Wang Han, Li De-chao, Zhu Yang, Zhang Lin-lin, Li He-jia 2011, 15 (22):  4069-4072.  doi: 10.3969/j.issn.1673-8225.2011.22.019 Abstract ( 103 )   PDF (694KB) ( 440 )   Save BACKGROUND: What changes occur in the biomechanical indexes of maxillary sinus area following short implant implantation? OBJECTIVE: To research the best range of length and diameter when applying the short implants at the vertical bone height in maxillary sinus of 9 mm, providing the theoretical basis for the clinical application of short implant. METHODS: The establishment of parameterization included the three-dimension finite element model of type Ⅱ bone of the upper jaw sinus area of short implant. The diameter of the short implants was 4-6 mm and the length was 6-8 mm. The maximum equivalent stresses of diameter and length for the jaw were analyzed. RESULTS AND CONCLUSION: Under vertical (buccal-lingual) loading condition, the amplification of maximum equivalent stresses in cortical bone and cancellous bone were 26% (40%) and 31% (45%) respectively with the diameter increasing; The amplification of maximum equivalent stresses in cortical bone and cancellous bone were 8% (5%) and 0 (7%) respectively with the length increasing. When diameter exceeded 4.8 mm and length exceeded 7.5 mm, the response curve curvatures of maximum equivalent stresses to diameter and length in jaw bone ranged from -1 to 0. And the variation of the maximum equivalent stresses in jaw bone was more sensitive to diameter than to length. The increasing for the diameter and length of short implants could reduce the stress of jaw bone. Especially the increasing of diameter are could improve distribution of mechanics better. From the biomechanics angle, when vertical bone height in maxillary sinus of 9 mm short implant, the diameter should be > 4.8 mm, the length should be > 7.5 mm, to ensure its stability. Related Articles | Metrics

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Mathematics model evaluation of soft tissue changes after Twin-block treatment Yan Bao-yong, Zuo Yan-ping, Liu Ya-fei, Cui Li-juan 2011, 15 (22):  4073-4079.  doi: 10.3969/j.issn.1673-8225.2011.22.020 Abstract ( 218 )   PDF (656KB) ( 299 )   Save BACKGROUND: Because the subjects of functional appliance are young people in the growing period, children’s growth and development need to be considered to study whether the functional appliance is valid. OBJECTIVE: To build a mathematical model to analyze the correlation between craniofacial soft and hard tissues after the correction of Class Ⅱ malocclusion with twin-block treatment. METHODS: Thirty-one Class Ⅱ Division 1 malocclusion subjects with hand-wrist radiographs in FG-G stage were selected. Among the 31 cases, 14 abandoned treatment. The remaining 17 subjects received Twin-block treatment. All the subjects were taken cephalometric radiographs before and after twin-block treatment as well as before and after natural growth of hard and soft tissue to observe the variation rule of soft and hard tissue cephalometric values so as to build the corresponding mathematical models. RESULTS AND CONCLUSION: Based on the mathematical models, the soft tissue indicators (Ls-EP, Pn-HP, NB-Pg'-Ls) and hard tissue indicators (ANB) showed the curve relationships. The formula were: NB-Pg′-Ls=-0.119 1(ANB)2 +3.002 9 (ANB)+ 6.148 5; Pn-HP=0.021 4(ANB)2 –1.026 7(ANB)+ 0.347 4; Ls-EP =0.132 4(ANB)2–0.536 4(ANB)+1.553 7. The results of this study provided evidence that ANB angle was to the decisive factor to improve soft tissue profile of Class II malocclusion patients after twin-block treatment. Related Articles | Metrics

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Computed tomographic virtual endoscopy versus double contrast examination in diagnosing small intestine protuberant lesions Yang Dong-sheng, Li Xin, Gong Feng-ling, Liu Zhen-cui, Chen Wei-bin 2011, 15 (22):  4080-4083.  doi: 10.3969/j.issn.1673-8225.2011.22.021 Abstract ( 130 )   PDF (774KB) ( 466 )   Save BACKGROUND: Due to the long and winding characteristics of small intestine, the examination technique is ineffective. The lesions of small intestine are mainly protuberant. At present, double contrast examination is chiefly applied in imaging examination. In the recent years, with the wide application of multi-slice spiral computed tomography (CT), CT virtual endoscopy (CTVE) gets more and more used in hollow organ. The value of the two techniques needs a comparison to make it clearer. OBJECTIVE: To evaluate the value of CTVE and double contrast examination in diagnosing small intestine pprotuberant lesions.  METHODS: Isolated porcine small intestines were taken as samples. MSCT scanned the quasi circular protuberant Lesions whose simulated heights of the intestinal wall were 1-5 mm, 5-10 mm and 10-15 mm. CTVE imaging was made through work station. Then we made small intestinal air-barium double contrast examination. The experienced physician compared the diagnostic self-confidence and accuracy between the two methods by single-blind evaluation.  RESULTS AND CONCLUSION: To the protuberant lesions less than 5 mm, the doctors were more confident in diagnosing by double contrast examination of small intestine than by CTVE. The diagnostic accuracy of the two methods has no statistic differences. CTVE and double contrast examination each have their advantages in diagnosing protuberant lesions of small intestine. The diagnostic accuracy can be improved by comprehensive application. Related Articles | Metrics

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MRI brain image segmentation based on point symmetry distance - fuzzy C means algorithm Deng Yu, Huang Hua 2011, 15 (22):  4084-4086.  doi: 10.3969/j.issn.1673-8225.2011.22.022 Abstract ( 108 )   PDF (552KB) ( 304 )   Save BACKGROUND: Image segmentation is a significant step of image processing and analysis. Within the traditional segmentation methods, fuzzy C means clustering (FCM) is applied widely. OBJECTIVE: To introduce point symmetry distance (PS)-FCM (PS-FCM) algorithm into the MRI brain image segmentation so as to promote the accuracy of MRI image segmentation. METHODS: In connection with the traditional FCM algorithm based on Minkowski distance, this pepper introduces PS-FCM algorithm into the MRI brain image segmentation. RESULTS AND CONCLUSION: Experimental results show that PS-FCM has obvious advantages compared with traditional FCM algorithm. Related Articles | Metrics

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Processing of wavelet fusion to MRI image Gai Li-ping, Ren Hong-qin, Wang Gui-lian, Wang Li, Zhang Long-mei, You Lian-lian 2011, 15 (22):  4087-4089.  doi: 10.3969/j.issn.1673-8225.2011.22.023 Abstract ( 196 )   PDF (504KB) ( 283 )   Save BACKGROUND: Wavelet fusion is the fusion of two or more images together to get more comprehensive and more accurate image information in same scene. OBJECTIVE: To restore the lack parts of image and improve the quality of medical image and make diagnoses more convenient. METHODS: The main principle of image fusion is to have wavelet decomposition by using two-dimensional wavelet analysis to MRI brain stem images and applies many fusion methods to approximations coefficients and details coefficients. Through comparing the renderings in different fusion methods it can identify the most suitable image fusion method for the MRI image; it is the minimum integration method. RESULTS AND CONCLUSION: The fusion methods can successfully restore the lack parts of original images. Many missing parts can be fully restored using suitable combination of all sorts of fusion methods. Integration with the minimum means the best fusion to the MRI image introduced in the paper. The two-dimensional wavelet analysis of medical images can simplify the program work and improve the visual effects and be helpful to clinical diagnosis. Related Articles | Metrics

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Application of wavelet prior in OSL reconstruction algorithm Xue Ying, Pan Jin-xiao, Kong Hui-hua 2011, 15 (22):  4090-4093.  doi: 10.3969/j.issn.1673-8225.2011.22.024 Abstract ( 162 )   PDF (719KB) ( 375 )   Save BACKGROUND: MAP (maximum a posteriori) statistical reconstruction methods can introduce appropriate prior knowledge in reconstruction process to remove the noises. OBJECTIVE: To process the corresponding high frequency information, according to statistic characteristics of wavelet coefficients and energy balance principle, and to apply multi-scale wavelet prior to OSL reconstruction algorithm to remove noises. METHODS: Most prior information can reduce noise in airspace. From “transform domain”, according to statistic characteristics of wavelet coefficients and energy balance principle of different scales, high frequency information is processed in wavelet domain. And processed wavelet coefficients are applied in wavelet reconstruction as a kind of multi-scale wavelet prior information to remove noises. RESULTS AND CONCLUSION: The errors and noises of reconstructed images and testing model of OSL algorithm based on wavelet priori information is less than ML-EM algorithm, and correlation greater. Reconstructed images have become smoother, and visual effect is clearer. This shows that wavelet prior, based on wavelet coefficient statistical characteristic and energy balance principle, can effectively reduce the noises in CT reconstruction process. Related Articles | Metrics

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Comparison of microscopy image denoising effects based on contourlet, curvelet and wavelet transform Tang Min, Chen Feng 2011, 15 (22):  4094-4097.  doi: 10.3969/j.issn.1673-8225.2011.22.025 Abstract ( 220 )   PDF (990KB) ( 459 )   Save BACKGROUND: Wavelets in two-dimension are good at isolating the discontinuities at edge points, but not the smoothness along the contours. In addition, separable wavelets only capture limited directional information, which weaken their application effects on image processing. Image multiscale geometric analysis theory is developed gradually to overcome the shortcomings of wavelets mentioned above. OBJECTIVE: To compare the microscopy image denoising effects qualitatively and quantitatively based on contourlet, curvelet and wavelet transforms. METHODS: Based on the brief descriptions of contourlet, curvelet and wavelet transform, performance analysis and comparison were done depending on image denoising with qualitative and quantitative indices computed, e.g., mean square error and peak signal-to-noise ratio. RESULTS AND CONCLUSION: Experimental results demonstrate that for the test Lena images and microscopy images, curvelet transform achieves the best result, while wavelet transform result is poor. Related Articles | Metrics

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A programmable and implantable neuromuscular electrical stimulator for denervated or neuromuscular electrical stimulation in animal models Song Guang, Wang Lei, Ren Chao-shi, Sha Hong 2011, 15 (22):  4098-4102.  doi: 10.3969/j.issn.1673-8225.2011.22.026 Abstract ( 147 )   PDF (746KB) ( 426 )   Save BACKGROUND: Implantable neuromuscular electrical stimulator is a useful tool for the study how functional electrical stimulation works on denervated muscle. However, its volume is a little big and the function is single. OBJECTIVE: To design an implantable micro-stimulator featuring adjustable parameters which can reach the requirement of animal pattern experiment through test and analysis. METHODS: Based on infrared communication technology, taking MSP430 as controller and setting stimulation parameters by controller in vitro, it generates charge balanced bipolar pulses, and stimulates nerve or muscle via electrodes. RESULTS AND CONCLUSION: The stimulator is programmable in vivo and all parameters, such as voltage amplitude, frequency, pulse width and rest time of the stimulation, can be set and changed flexibly. It enriches selectivity of stimulating protocol by setting parameters, so that the unpredictable stimulation to the tissue around the target neuromuscular is minimized, the design of current consumption is optimized and the safety of experimental animals is ensured. Related Articles | Metrics

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Feasibility of surface electromyography signal acquisition for action recognition Lu Lei, Yin Tao, Jin Jing-na, Li Ying, Liu Zhi-peng 2011, 15 (22):  4103-4106.  doi: 10.3969/j.issn.1673-8225.2011.22.027 Abstract ( 206 )   PDF (612KB) ( 804 )   Save BACKGROUND: Surface electromyography (sEMG) are widely adopted because of its scot-free. Because of the non-stationary of signals, sEMG signals can be classified in wavelet packet transform to obtain effective parameters. OBJECTIVE: To design a detection circuit according to the characteristics of the sEMG, which can pick-up the SEMG signals for action recognition. METHODS: The high CMMR preamplifier was designed to restrain the common code interference; low-pass filter and active double-T band-stop filter were carried on de-noising processing; sEMG signals could be classified in wavelet packet transform to obtain effective parameters. RESULTS AND CONCLUSION: In the experiment, the circuit could implement the anticipated target, pick-up the sEMG and restrain the interference with 50 Hz; further, four different actions on hands could be recognized by using sub band energy value extracted in the wavelet packet translation of the sEMG. Related Articles | Metrics

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Design of an exterior-chargeable implanted artificial cardiac pacemaker Wen Zhi-hao, Chen Hai-jun 2011, 15 (22):  4107-4110.  doi: 10.3969/j.issn.1673-8225.2011.22.028 Abstract ( 217 )   PDF (598KB) ( 748 )   Save BACKGROUND: An artificial cardiac pacemaker has to be implanted into human body for a long time, so its life-span is very important. The cell energy is an important factor, especially in energy-consuming implanted artificial cardiac pacemaker. Currently, an exterior-chargeable implanted artificial cardiac pacemaker has not been invented. OBJECTIVE: To study on the exterior-chargeable technology, reduce artificial cardiac pacemaker’s dependence on the cell energy, hoping to solve the technology problem of tremble-removing implanted artificial cardiac pacemaker. METHODS: The author proposed to use a certain medium, which is woundless and harmless to human body, transfers exterior energy to the receiver implanted into human body, providing the chargeable cell with energy, thus prolong pacemaker’s life-span. RESULTS AND CONCLUSION: The author trial-manufactured a chargeable artificial cardiac pacemaker, carried experiments on animals, using ultrasonic transferring energy. Thus, the author made further study on concerned technology. Related Articles | Metrics

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Expression of nuclear factor kappa B and matrix metalloproteinases 3 in intervertebral disc degeneration Yuan Ye, Zhao Jing, Li Yong-min, Wang Xu, Gu Shou-shan 2011, 15 (22):  4111-4114.  doi: 10.3969/j.issn.1673-8225.2011.22.029 Abstract ( 111 )   PDF (619KB) ( 409 )   Save BACKGROUND: During intervertebral disc degeneration, various cytokines, adhesion molecules, chemokines, inflammatory neurotransmitters, protein enzymes play an important role. OBJECTIVE: To study the expression and significance of nuclear factor kappa B (NF-κB) and matrix metalloproteinases 3 (MMP-3) in normal disc tissue and intervertebral disc degeneration. METHODS: Sixty-eight patients with intervertebral disc degeneration from surgical intervention for cervical disc herniation (lesion group) and 10 cases of normal disc tissue (control group) were included. The expressions of NF-κB and MMP-3 were tested by hematoxylin-eosin staining, immunohistochemistry method and ELISA. RESULTS AND CONCLUSION: The NF-κB and MMP-3 positive expression rate was higher in the control group (P < 0.05). There was a positive correlation (r=0.643 0, P< 0.01). It indicated that NF-κB and MMP-3 may have important effects on intervertebral disc degeneration. Related Articles | Metrics

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Gait comparison between normal young people and knee osteoarthritis patients Fu Hai-yan, Yang Hai-yun 2011, 15 (22):  4115-4118.  doi: 10.3969/j.issn.1673-8225.2011.22.030 Abstract ( 120 )   PDF (471KB) ( 427 )   Save BACKGROUND: Gait analysis technology is not yet widely applied in analyzing sole pressure distribution for knee osteoarthritis (KOA) patients, and the foot pressure database of KOA patients’ remains undeveloped. OBJECTIVE: To compare the different gait characteristics of patients with KOA and normal young people. METHODS: The footscan plate system was used to test the gait parameters of 40 patients with KOA and 10 normal people when walking. Gait phase, the contacting time between every plantar area and ground, foot axis angle and peak pressure were evaluated. RESULTS AND CONCLUSION: The contacting time between every plantar area and ground of KOA patients was higher than the normal young people, and the region of heel medial and heel lateral had significant differences; the time percentage of initial contact phase and forefoot push off phase of KOA were lower than normal group while foot flat phase was higher than normal group; the peak pressure of heel medial and heel lateral were lower than normal young people. The gait indexes of patients with KOA had the distinctive quality. Patients with KOA and normal young people had obvious difference, including the heel contacting time, the time percentage of initial contact phase, foot flat phase and forefoot push off phase. The heel lateral muscle’s activity, balance and control ability are weaker in patients with KOA than those of normal young people. Related Articles | Metrics

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Intramedullary nailing and minimally invasive plating osteosynthesis technique for humeral shaft fractures Jiang Chao-lai, An Zhi-quan 2011, 15 (22):  4119-4122.  doi: 10.3969/j.issn.1673-8225.2011.22.031 Abstract ( 123 )   PDF (543KB) ( 430 )   Save BACKGROUND: With the development of minimally invasive surgery, intramedullary nailing and minimally invasive plates for humeral shaft fractures get a good clinical result, but also have some complications. How to improve design of the internal fixation and operation, to reduce or avoid the complications becomes a research hotspot. OBJECTIVE: To review the research and progress in treatment of humeral shaft fractures in recent years. METHODS: PubMed/MEDLINE, Web of knowledge, OVID, Elsevier databases, Chinese National Knowledge Infrastructure (CNKI), Wanfang database were retrieved by computer with key words of “internal fixation; minimally invasvie plating osteosynthesis; humeral shaft fractures” in Chinese and English to search papers published between January 2005 and January 2010. According to inclusion criteria, 32 literatures were selected in this review. RESULTS AND CONCLUSION: Only accurately grasping characteristics of internal fixation and each fracture, using individual treatment, we could be get the best clinical results and reduce the complications mostly. The people have deepen recognition of rotator cuff injury in some extent, finded some way to prevent damages preliminarily and improved the design of intramedullary nailing and plates which is easy for the operation and reduce the time and avoid the risk of neurovascular injury in a certain degree. Related Articles | Metrics

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Biomechanical changes of tissue engineered cartilage in the moving state: A bibliometric analysis of scientific literature in the Web of Science Yu Hao 2011, 15 (22):  4123-4126.  doi: 10.3969/j.issn.1673-8225.2011.22.032 Abstract ( 98 )   PDF (450KB) ( 312 )   Save BACKGROUND: Biomechanical changes of tissue engineered cartilages are hot topics in recent years, however, bibliometric analysis addressing biomechanical changes of tissue engineered cartilage in the moving state remains poorly understood. OBJECTIVE: To summarize the current status and frontier of biomechanical changes of tissue engineered cartilage research via analyzing the biomechanical changes of tissue engineered cartilage in the moving state literatures with the method of bibliometric analysis. METHODS: Analyzes the biomechanical changes of tissue engineered cartilage in the moving state literatures from 1990 to 2011 which were embodied by Web of Science with the method of bibliometric analysis. It mainly discusses the distribution of publication years, country, institution, journal, cited times on biomechanical changes of tissue engineered cartilage in the moving state research area. RESULTS AND CONCLUSION: During 1991 to 2011, 82 literatures on the biomechanical changes of tissue engineered cartilage in the moving state were added to SCI. Literature is annual increase, and the United States had the most papers. Draw the biomechanical changes of tissue engineered cartilage in the moving state’s field of research dynamic and development trend, we put forward some proposes for China's in-depth research. Related Articles | Metrics

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Simulation training of surgical skills Li Jing 2011, 15 (22):  4127-4130.  doi: 10.3969/j.issn.1673-8225.2011.22.033 Abstract ( 166 )   PDF (567KB) ( 399 )   Save BACKGROUND: The simulation training of surgical skills originated about thirty years ago. It has been one of the main parts of medical education. OBJECTIVE: The features and virtues of surgical simulation training on the facility, feedback and measurement were presented and its future development was suggested. METHODS: A computer online search was performed to find papers published between 2000 and 2010 in PubMed database. The key words “surgery, simulation, training, accreditation and evaluation” were used to search. Documents concerning the methods and facilities of surgical skills training were included. In this way, 79 documents were obtained at first, and then 27 were selected according to the including standard. RESULTS AND CONCLUSION: The simulation training of surgical skills improves the skills of surgical residents, the adaptability of clinical environment and the security of surgery and reduces the government medical expenses. Therefore, the simulation training of surgical skills is replacing traditional clinical training to be the leading position in surgical education. Furthermore, it surely has a promising future. In terms of the future development, the improvements in the indices and methods of assessment, the level of the fidelity of simulators and the methods of simulation training were considered as the possible directions. Related Articles | Metrics

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Custom-made tumor prosthesis fracture and prosthesis design Xun Jian-jun, Li Yan-fang 2011, 15 (22):  4131-4133.  doi: 10.3969/j.issn.1673-8225.2011.22.034 Abstract ( 117 )   PDF (605KB) ( 451 )   Save BACKGROUND: The number of patients receiving second operation due to complications after tumor prosthesis replacement is increasing, and custom-made prosthesis fracture is one of the reasons.  OBJECTIVE: To analyze the reasons for custom-made prosthesis fracture, and to investigate their relationship with prosthesis design. METHODS: A computer retrieve was performed for related articles published from January 2000 to December 2010 using keywords of “custom-made prosthesis, endoprosthesis fatigue fracture” in Chinese and English. Articles about custom-made prosthesis fracture and design were included. Repetitive articles or Meta analysis were excluded. Totally 14 articles were included in result analysis. RESULTS AND CONCLUSION: The main reasons for prosthesis fracture included design defects, material and process failure, place errors, difficulty in soft tissue reconstruction, and lack of bone support, and so on. The life of fixation system could be predicted based on prosthesis stress site and peak. Related Articles | Metrics

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Effect of spinal-epidural anesthesia with different proportions on elderly hip replacement Yu Zi-hong 2011, 15 (22):  4134-4136.  doi: 10.3969/j.issn.1673-8225.2011.22.035 Abstract ( 98 )   PDF (652KB) ( 431 )   Save BACKGROUND: Now, anesthesia methods commonly used in the elderly include equal-density, high-density and low-density spinal-epidural anesthesia. The best anesthesia regimen can be chosen based on comparison of different proportion of spinal-epidural anesthesia. OBJECTIVE: To analyze and compare the drug regimen, onset time of anesthesia, anesthesia duration, Bormage motor blocking score among different proportion of spinal-epidural anesthesia. METHODS: A computer based search was performed to retrieve articles about spinal-epidural anesthesia for hip replacement published from 2000-01 to 2011-05 using the keywords of “hip replacement, combined spinal-epidural anesthesia” in Chinese and English. Repetitive articles or Meta analysis were excluded. Finally, 15 articles were included in the result analysis. RESULTS AND CONCLUSION: These proportions of the liquid can meet the requirements of total hip replacement. The Bromagc scores of the high-density and equal-density spinal-epidural anesthesia were higher than that of the low-density anesthesia. The onset time of 3 g/L ropivacaine regimen could be faster. Duration of high-density and equal-density anesthesia was longer than that of low-density anesthesia. Equal-density, high-density and low-density spinal-epidural anesthesias are all safe and reliable in elderly hip replacement. Related Articles | Metrics

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Biomechanical changes and clinical characteristics of cervical pedicle screws internal fixation Wang Hua-gang, Yang Fei 2011, 15 (22):  4137-4141.  doi: 10.3969/j.issn.1673-8225.2011.22.036 Abstract ( 106 )   PDF (760KB) ( 423 )   Save BACKGROUND: More and more scholars have focused on cervical pedicle screws because of their unique three-dimensional stability. OBJECTIVE: To review the anatomic characteristics of the cervical pedicle, and to investigate the safety and clinical application of cervical pedicle screws. METHODS: The literature concerning the cervical pedicle screw internal fixation in recent years were extensively searched from CNKI and PubMed databases (1994-01/2010-09) using the keywords of “cervical pedicle screws” in Chinese and English. Forty-three articles of 292 were included in the result analysis. RESULTS AND CONCLUSION: Cervical pedicle screw fixation can obtain a good biomechanics based on its three-dimensional fixation. However, due to the special anatomic structures of the cervical pedicle adjacent to the surrounding, potential risks of blood vessel, nerve root and cervical spinal cord injuries, it is difficult to the internal fixation of cervical pedicle screws with a certain risk. The clinical application of pedicle screws should be individualized. Related Articles | Metrics

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Different types of metal implants used in the internal fixation of scaphoid fractures Li Lei, Zhang Ji-ren, Qi Yong, Liu Zhen-yang, Zang Hong-wei 2011, 15 (22):  4142-4145.  doi: 10.3969/j.issn.1673-8225.2011.22.037 Abstract ( 97 )   PDF (601KB) ( 415 )   Save BACKGROUND: As compared with conservation therapy, stable internal fixation of scaphoid fracture can improve the healing rate, shorten the healing time and plaster fixed time. OBJECTIVE: To summarize the methods and progress of hollow screw and Kirschner wire in treating scaphoid fractures, and to compare the safety and long-term effect of different metal implants on scaphoid fractures. METHODS: The PubMed database and CNKI database were searched by the first author using keyword of “different implant materials, scaphoid fractures, internal fixation materials” in Chinese and “carpal bone, fracture ununited” in English. Papers related to biomaterials and tissue engineered vessels were selected. A total of 25 papers were included. RESULTS AND CONCLUSION: Bone flap with blood supply and periosteal transplantation are used in treatment of old scaphoid factures, and Kirschner screw, herbert screw, and hollow screw are applied as internal fixation materials, which have achieved a more satisfactory results. The hollow screw can reduce the nonunion rate, promote functional recovery of the wrist joint, and improve prognosis, and it can play a role of multi-axial, multi-plane stable fixation, which is a better material in clinical application. Related Articles | Metrics

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Spiral CT scanning and multi-mode three-dimensional reconstruction in diagnosis and treatment of lumbar intervertebral disc herniation Bin Huai-you, Long Teng-he, Chen Wu-xin 2011, 15 (22):  4146-4149.  doi: 10.3969/j.issn.1673-8225.2011.22.038 Abstract ( 166 )   PDF (602KB) ( 594 )   Save BACKGROUND: Spiral CT scanning and multi-mode three-dimensional reconstruction exert preoperative localization, intraoperative guidance, and postoperative review in the treatment of lumbar intervertebral disc herniation. OBJECTIVE: To evaluate the effect of spiral CT scanning and multi-mode three-dimensional reconstruction on lumbar intervertebral disc herniation so as to find a reasonable therapy. METHODS: A computer-based search of PubMed and Wanfang databases were conducted using keywords of “lumbar disc herniation, spiral CT, three dimensional reconstruction” in Chinese and English to retrieve relevant articles published 1998-01 to 2010-12. Repetitive articles or Meta analysis were excluded, and finally 36 articles were included. RESULTS AND CONCLUSION: Currently, spiral CT scanning and multi-mode three-dimensional reconstruction have been used in diagnosis and treatment of lumbar disc herniation, which achieves satisfactory results. Spiral CT combined with multi-mode three-dimensional reconstruction multi-mode three-dimensional reconstruction can accurately show direct signs and indirect signs, improve the diagnostic rate of disc herniation and differentiate from low back pain caused by other diseases as well as plays a role in localization, guidance and review. It is prompted that the rational use of spiral CT and multi-mode three-dimensional reconstruction is a developing direction in the diagnosis and treatment of lumbar disc herniation. Related Articles | Metrics

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Application of plate and artificial bone in the revision of femoral prosthesis in 11 cases Lin Jian-ping, Li Zao-min, Song Shi-feng, Zheng Nan-sheng, Chen Jian-fei 2011, 15 (22):  4150-4154.  doi: 10.3969/j.issn.1673-8225.2011.22.039 Abstract ( 93 )   PDF (604KB) ( 374 )   Save BACKGROUND: Most scholars tend to use long-handled cementless prosthesis for revision of Paprosky Ⅲ and Ⅳ defects. However, there is not a more mature view yet on the implant selection, grafting way, whether the plate is used or not. OBJECTIVE: To review the clinical results of plate and artificial bone in the revision of femoral prosthesis of total hip arthroplasty (RTHA). METHODS: Eleventh cases (8 cases of Paprosky Ⅲ, 3 of Paprosky Ⅳ) underwent RTHA with cementless techniques, including 4 cases of shape-memory alloy surround plate, 2 cases of compression plate or limited contact-dynamic compress plate (LC-DCP), 5 cases of LISS. All the cases underwent structural reconstruction with use of mesh, cable grip system, impacted allograft and cortical strut. Harris score was developed before and after the revision, and markers such as incision healing, body temperature, ESR, pain, activities of hip joint, daily life, walking and so on were observed in patients. RESULTS AND CONCLUSION: Postoperative clinical results were evaluated as good in 9 cases (82%), fair in 1 case (9%) and poor in 1 case (9%) which showed immunoresponse. In RTHA for the femoral component for the elderly patients with Paprosky Ⅲ or Ⅳ defects combined with periprosthetic fracture, application of plate and artificial bone can decrease operation time and trauma, fix femoral component stably and quickly, and allow patients to do early functional exercise. Related Articles | Metrics

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Digital anatomical position of the “point” in cervical vertebra fixed-point rotatory technique Yuan Yuan-xing, Wan Lei, Li Yi-kai, Chen Jing 2011, 15 (22):  4155-4159.  doi: 10.3969/j.issn.1673-8225.2011.22.040 Abstract ( 105 )   PDF (399KB) ( 288 )   Save BACKGROUND: Although the fixed-point cervical vertebra rotating reduction has a notable treatment effect, yet it has not been deeply studied in the medical field. Some clinical surgeons feel difficult to make an accurate control on the power and rotatory joint position while operating, even results in iatrogenic injury. OBJECTIVE: To discuss the action mechanism of rotatory technique based on the central rotatory point of cervical vertebra fixed-point rotatory technique. METHODS: Samples were scanned through a 64-row spiral CT working platform at 1-mm layer distance. The picture’s profilogram data were extracted from the image processing functional module in PHILIPS MEDICAL SYSTEMS, and then the three-dimensional structure of the upper cervical vertebra was reconstructed and displayed. Taking the axis spinous process peak (point A), odontoid process vertical axes (point B), and the midpoint (point C) of their link as the rotating axes (the rotating central point in simulation), spherical system on each point was set up. The intersection angle of the links between the axis’ spinous process peak and the lower jaw, and between the odontoid process vertical axes and the lower jaw before and after rotation were all measured. RESULTS AND CONCLUSION: While applying fixed-point rotation of the cervical spine, the rotatory centre is the vertical axle center of the odontoid process, rather than the handy axis spinous process peak. The rotatory angle of the axle centre is larger than the observation angle. A new concept of fixed-axis rotation should be accepted and its principle should be comprehended in order to appropriately apply the cervical rotatory technique. Related Articles | Metrics

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Effect of platform switching technique on bone loss in the posterior area of the mandible in the first year following dental implantation Feng Ai-ju, Wang Wei-ying, Xiao Fei, Guo Li-qiang, Zhao Bao-dong, Guo su-wei, Zhang Xue-jian 2011, 15 (22):  4160-4164.  doi: 10.3969/j.issn.1673-8225.2011.22.041 Abstract ( 126 )   PDF (375KB) ( 379 )   Save BACKGROUND: Peri-implant crestal bone resorption is considered as a normal reaction according to traditional butt-joint prosthesis around two-piece implants. OBJECTIVE: To evaluate bone loss around two-piece implants restored according to the platform switching concept in the posterior area of the mandible. METHODS: Eighty-eight implants were consecutively placed in 50 patients following submerged surgical protocol. In the test group, 40 Ankylos implants were placed using platform switching technique, while 48 3i implants using traditional butt-joint in the control group. All the implants were positioned at the crestal level. Definitive prosthesis was delivered after 3 months. RESULTS AND CONCLUSION: All implants were judged to be successfully osseointegrated. The success rate was 100%. Twelve months after restoration, radiographic analysis showed an average bone reduction level of (0.31±0.39) mm in the test group that was statistically significantly different (P < 0.01) from the average reduction in the control group [(0.94±0.43) mm]. In the follow-up time, no implants were loose or lost and healthy gingival was seen. These findings show that the platform switching technique can reduce peri-implant crestal bone resorption and preserve alveolar bone level around dental implants 12 months after restoration. Related Articles | Metrics

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Method and significance of measuring the slope of proximal tibiofibular joint with CT reconstruction Deng Hong-zhen, Zhang Yin-wang, Zhu Hai-bo, Zhu Jian-min, Tang Jie, Gu Wen-jun, Zhu Yi 2011, 15 (22):  4165-4170.  doi: 10.3969/j.issn.1673-8225.2011.22.042 Abstract ( 113 )   PDF (471KB) ( 287 )   Save BACKGROUND: Measuring the slope of proximal tibiofibular joint may elucidate the anatomical structure and type of proximal tibiofibular joint, and evaluate the stability of proximal tibiofibular joint. OBJECTIVE: To investigate the measurement methods and clinical significance of the joint slope by comparing the slope measurement of bilateral proximal tibiofibular joint surface on X-ray and 64-row spiral CT reconstruction. METHODS: One hundred normal adult volunteers, including 50 males and 50 females, aged 18-90 years, were photographed in double knees via internal rotation to 30°, 45° and 60°, respectively and scanned with 64-row spiral CT, tibiofibular bone (including knee joints) was reconstructed. The included angle between proximal tibiofibular articular surface and the longitudinal axis of the fibula shaft, between the proximal tibiofibular articular surface and the horizontal line, were measured using an angle square. RESULTS AND CONCLUSION: There were great variations of the data in the same proximal tibiofibular joint measured by X-ray and spiral CT. X-ray results are affected by the site of photograph position, and the slope of articular surface is estimated, so the 64-row spiral CT is an accurate and convenient method to reconstitute the slope of proximal tibiofibular joints. Spiral CT could be used to distinguish the dislocation and instability of the proximal tibiofibular joint, accordingly reduce the clinical misdiagnosis. Related Articles | Metrics

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Can the degeneration adjacent to herniated disc in patients with lumbar disc herniation cause low pack pain? Wang Gang, Liu Shang-li, Chen Zhi-wei, Guan Hong-gang, Han Dun-fu, Shi Yan-zhang 2011, 15 (22):  4171-4175.  doi: 10.3969/j.issn.1673-8225.2011.22.043 Abstract ( 120 )   PDF (501KB) ( 300 )   Save BACKGROUND: It is often difficult to determine the cause of low back pain (LBP) in the patients with lumbar disc herniation. The herniated disc has long been thought to be an important cause of the patient’s complaint about LBP and sciatica. Whether the adjacent degenerative disc results in LBP needs further confirmations.  OBJECTIVE: This study sought to determine whether the degenerative disc adjacent to the herniated disc in patients with LBP and radicular pain can result in discogenic LBP, as assessed by provocative discography, and to report the outcomes of the residual LBP when adjacent symptomatic disc were treated with methylene blue after microendoscopic discectomy. METHODS: Twenty lumbar disc herniation patients complaint about LBP and radicular pain underwent provocative discography. There was one degenerative herniated disc with one or more adjacent degenerative discs in their MRI. Provocative discography was performed on all degenerative discs and at least one normal disc for control. The severity of LBP and leg pain of all patients was assessed using visual analog scale before discography. All patients underwent microendoscopic discectomy at herniated level, and intradiscal injection of methylene blue was given at painful adjacent level in five patients after microendoscopic discectomy. RESULTS AND CONCLUSION: Discographies were performed on 64 discs of 20 patients, from L2-3 to L5-S1. There were 11 discs satisfying the positive response criteria, including 6 in degenerative segment adjacent to the herniated disc and 5 in the herniated disc that induced corresponding radiculopathy. The leg pains were evidently improved in all patients, while LBP was partially improved after microendoscopic discectomy. Six patients with symptomatic adjacent degenerative disc still had evident LBP, influencing their daily living. Five of them received intradiscal injection of methylene blue treatment and the LBP was relived. One patient refusing to the treatment still complained the LBP. Results evidenced that accompanying LBP for many LDH patients may come from the degenerative levels adjacent to the herniated disc. Related Articles | Metrics

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Effects of robot model design on gait in patients with spinal cord injury Guo Su-mei, Li Jian-min, Wu Qing-wen, Shen Hai-tao 2011, 15 (22):  4176-4180.  doi: 10.3969/j.issn.1673-8225.2011.22.044 Abstract ( 102 )   PDF (293KB) ( 318 )   Save BACKGROUND: Therapist-assisted treadmill training is good gait training, but it consumes great physical strength of therapists, and requires many persons. Clinical application was limited. Robot-assisted treadmill training has been paid great attention. OBJECTIVE: To summarize the role of robot in recovery of walking after spinal cord injury (SCI) and its influence on muscle activation patterns and kinematic patterns. METHODS: The data used in this review were obtained mainly by the first author from the studies on robot, Lokomat, body-weight support treadmill training and gait rehabilitation of SCI reported in PubMed database (http://www.ncbi.nlm.nih.gov/PubMed) from January 1995 to December 2010, using key words of “spinal cord injury, gait, walking, locomotor, locomotion, rehabilitation, robot, robotic, Lokomat”. The author excluded old, repetitive documents and remained 30 articles for summarizing. RESULTS AND CONCLUSION: Although there is currently no evidence that robot-assisted gait training improves walking function more than other locomotor training strategies. Several advantages of robotic devices are obvious for applications targeting gait rehabilitation. Robotic devices are passive in nature and focus primarily on repeated movements of the limbs via fixed kinematic trajectories. These types of training abolish the cycle-to-cycle variation in the kinematics and the sensorimotor pathways. They also cannot sensitively monitor important characteristics of the training as therapists do. Therapists need to know the robot devices, understand how to change parameters to continuously challenge the subjects, and are able to assess when the workload is inappropriate for the subject’s abilities so that they can maximize voluntary locomotor performance during assisted stepping to augment the recovery of functional walking. Related Articles | Metrics