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23 July 2011, Volume 15 Issue 30 Previous Issue    Next Issue

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A receptor pathway via the lumbar intervertebral disc Geng Zhu-sheng, Zhang Yun-hai, Lei Ling, Cui Ji-zheng, Zhang Xiao-bao, Yang Cong-ying, Li Yu, Xu Xin-tang 2011, 15 (30):  5511-5515.  doi: 10.3969/j.issn.1673-8225.2011.30.001 Abstract ( 149 )   PDF (1430KB) ( 616 )   Save BACKGROUND: Which skeletal muscle labeled peripheral neurons at attachment points of the lumbar facet and lamina can enter the disc? The receptor pathway via the lumbar intervertebral disc is unclear. OBJECTIVE: To observe the morphologic characteristics of the receptor pathway via the lumbar intervertebral disc. METHODS: Injection of fluorescent retrograde nerve tracer into the L3-4 segments of eight rabbits was performed for retrograde nerve tracing. The rabbits were divided into two groups: one group at 18 hours after injection, and the other group at 36 hours after injection. Consecutive frozen sections from different zones were taken for observation of nerve end, and the exposure time was recorded. REUSLTS AND CONCLUSION: Receptor pathway network of the lumbar intervertebral disc in rabbits was composed of sympathetic ganglia and postganglionic neurons, intestinal ganglion cells, and spinal ganglion. Targeted sites were lumbar disc annulus, lumbar intervertebral disc nucleus, lumbar synovial membrane, gastric mucosa, intestinal mucosa, fascia, etc., overlapped with the receptor pathway at the sympathetic ganglia and postganglionic neurons, intestinal ganglion cells, spinal ganglia. Disc administration can cause inflammatory reactions of many spinal ganglia. Related Articles | Metrics

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Dynamics analysis and application of the rehabilitation power assist robot for the leg Chen Feng, Tang Min, Ma Wei-guo, Liu Xian-fei 2011, 15 (30):  5518-5521.  doi: 10.3969/j.issn.1673-8225.2011.30.003 Abstract ( 130 )   PDF (604KB) ( 587 )   Save BACKGROUND: In 2005, the successful production of lower extremity rehabilitation robot system can co-promote the delivery of leg movement through the central control system as well as the gait and attitude control system so as to restore lower limb function. OBJECTIVE: To perform the mechanical analysis of the rehabilitation power assist robot. METHODS: Power assist exoskeleton is a complicated dynamical system composed of many joints and links, and it is a MIMO. Power assist robot dynamics is about the movement-force relationship, and its results of simulation are used to optimize the system. Through motion information perception, the rehabilitation power assist robot provides power for wearer hip joint to accomplish motion of flexion/extension, abduction/adduction and internal rotation/external rotation. RESULTS AND CONCLUSION: The dynamical equation is used to realize the hybrid control. The practitioner can fully completed functional recovery action, with promotion of practicer limb strength and action proficiency, the system gradually reduces the power support until the recovery. Related Articles | Metrics

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Constructing a finite element model of osteonecrosis of the femoral head Li Xiao-lin, Lü Zhi-peng, Liu Ying-jun 2011, 15 (30):  5522-5525.  doi: 10.3969/j.issn.1673-8225.2011.30.004 Abstract ( 116 )   PDF (534KB) ( 414 )   Save BACKGROUND: Osteonecrosis of the femoral head is a difficult and complicated case in clinical orthopedics. Its incidence and treatment are related to bio-mechanical problems, Biomechanical study plays a great role to further treatment of the disease. OBJECTIVE: To construct a three-dimensional finite element model of osteonecrosis of the femoral head based on CT images. METHODS: The 142-layer of 0.625-mm-thick consecutive CT Dicom format images of osteonecrosis of the femoral head making use of thin layer scanning technique was directly read into the Mimics software. The following procedures were: Defining bone organization threshold, withdrawing each outline, partitioning each edge of layer picture, editing selectively and repairing by hole processing. After redundancy data were cleaned, the three-dimensional geometry model of osteonecrosis of the femoral head was acquired. Then area mesh could be kept as the document Ansys named. lis as the suffix and be introduced into Ansys software directly to mesh body, and then the body mesh was transferred to Mimics to assignment on the basis of CT values, once again import Ansys to establish 3-D finite element model. RESULTS AND CONCLUSION: A realistic appearance and calculation accuracy three-dimensional finite element model of osteonecrosis of the femoral head was established. The results showed that based on sophisticated CT scanning technique and Mimics software can directly assign values, which make the establishment of three-dimensional finite element models of osteonecrosis of the femoral head faster and more accurate. Related Articles | Metrics

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A biomechanical study of three kinds of internal fixation methods in the treatment of lumbar burst fracture based on a finite element method Nong Lu-ming, Zhou Dong, Xu Nan-wei 2011, 15 (30):  5526-5530.  doi: 10.3969/j.issn.1673-8225.2011.30.005 Abstract ( 109 )   PDF (553KB) ( 439 )   Save BACKGROUND: No reports have been found about comparative study among three different methods to treat lumbar burst fracture through finite element model, which leads to the different ideas of treatment. OBJECTIVE: To introduce and evaluate the biomechanical features of different internal fixation for treatment of lumbar burst fracture based on a three-dimensional finite element model. METHODS: A youth volunteer without chronic low back pain and trauma of lumbar was chosen. The CT data were obtained by DICOM format. We used Mimics software to build a three-dimensional finite element model to mimic the fracture of L1 burst fracture, then three different approaches of posterior decompression internal fixation, anterior decompression combined with titanium mush implantation internal fixation and posterior decompression combined with anterior reconstruction internal fixation were performed by the three-dimensional finite element model. These three models were put into Abaqus finite element program, axial load 260N and 10NM torque were loaded, on central compression, flexion, extension, lateral bending respectively to study the corresponding stress and displacement. RESULTS AND CONCLUSION: The technique of posterior decompression combined with anterior reconstruction internal fixation, in the model of vertical compression, flexion, right lateral bending and left, stability was far more than other two methods. From stress distribution, the anterior combined with posterior approach was corresponding with the principle of load-sharing. The technique of posterior decompression combined with anterior reconstruction internal fixation is better than other two methods biomechanically. Related Articles | Metrics

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Finite element analysis of anti-impact loading of wrist protectors Dong Xie-ping, Wang Dong-mei, He Jian-ying, Zhou Li-yi, Wang Jin-cheng, Wu Xiao-hui 2011, 15 (30):  5531-5534.  doi: 10.3969/j.issn.1673-8225.2011.30.006 Abstract ( 108 )   PDF (393KB) ( 389 )   Save BACKGROUND: Skidproof wrist protection devices can well protect the waist. OBJECTIVE: To analyze the efficacy of wrist protectors against fracture using three-dimensional finite element analysis. METHODS: Based on original data of Mechanical Virtual Human of China, three-dimensional finite element models of wrist with normal soft tissues and wrist wearing protectors were established using Abaqus6.51 software. The model was subjected to loading of 2 m/s. Stress-strain distribution of finite element model of the wrist before and after protectors wearing was compared, and maximum stress variation with time in the distal ulna was analyzed. RESULTS AND CONCLUSION: Compared with wrist not wearing protectors, the equivalent stress at soft tissues of hypothenar eminence, dorsal wrist, inferior segment of the radioulna, and distal radioulna was significantly decreased, which the stress at the second and fourth metacarpal bone, proximal segment of the index finger, and hamate bone was significantly increased, indicating the wrist protector can disperse, or transfer some stress from the distal radius and ulna to the wrist, palm or digital bone, thereby playing a positive role in preventing dital radial and ulnar fractures. Related Articles | Metrics

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Automatic location and extraction method for phalangeal epiphyseal range of interest  Ran Long-ke, Song Fang-zhou, Tan Peng-cheng, Jin Jing 2011, 15 (30):  5535-5538.  doi: 10.3969/j.issn.1673-8225.2011.30.007 Abstract ( 146 )   PDF (674KB) ( 326 )   Save BACKGROUND: At present, several methods are dissatisfactory for extracting epiphyseal/metaphyseal region of interest (EMROIs), which leads to poor reorganization effects and assessment accuracy of bone age. OBJECTIVE: To overcome the difficulties of EMROI extraction and extraction method limitations based on k-cosine algorithm to local key points of the phalanx. METHODS: EMROI were extracted and filtered by anisotropic anisotropic diffusion. The statistics of phalanx images data were analyzed and found out the method for locating the central points of the phalanx. A third-order polynomial was used to fit the central axis line according to the central points, and epiphyseal ROIs were then extracted. RESULTS AND CONCLUSION: Great deals of experiments are showed that the central axis line located by this method is correct, which reflects the real skeleton of the phalanx. On this basis, EMROI can be extracted, and the success rate rises to 95%. And the method can be applied to evaluate EMROI in the following research. Related Articles | Metrics

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Integrated finite element modeling and simulation of entire musculoskeletal system weightlifting based on super-computer Wei Gao-feng, Tian Feng, Tang Gang, Wang Cheng-tao 2011, 15 (30):  5539-5542.  doi: 10.3969/j.issn.1673-8225.2011.30.008 Abstract ( 152 )   PDF (570KB) ( 474 )   Save BACKGROUND: Currently, finite element models are mostly established based on CT imaging to prepare a three dimensional triangular patch model, and then converted into a tetrahedral finite element mesh via commercial software. However, the finite element model has no solid model, and cannot be cut or used as implants. OBJECTIVE: Based on the anatomical three-dimensional models of China Mechanical Virtual Human Project, an integrated finite element model of entire human musculoskeletal system was built. The weightlifting motor task was implemented and simulated using the proposed finite element model based on the super-computer. METHODS: Firstly, the three-dimensional models of the musculoskeletal system were reconstructed from the cross-sectional images. Secondly, the segmental finite element model of human musculoskeletal system was built. The finite element model of the entire human musculoskeletal system was constructed through system integrating method. In the end, the motion capture experiment of weightlifting motor task was implemented. The finite element model of the entire human musculoskeletal system weightlifting was simulated and analyzed based on the super-computer Dawning 4000A in Shanghai Super-computer Center. RESULTS AND CONCLUSION: The integrated method of human musculoskeletal system finite element modeling was developed. An entire human musculoskeletal system finite element model was built. The weightlifting motor task was simulated and the stresses contours of entire musculoskeletal system were obtained. The proposed human musculoskeletal system model could describe the microcosmic mechanical phenomenon of human musculoskeletal system efficaciously and genuinely. It provides a new method for human musculoskeletal biomechanics analysis. Related Articles | Metrics

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Proliferation of mouse osteoblasts and expression of receptor activator of nuclear factor kappa B ligand and osteoprotegerin induced by cobalt and chromium ions Li Jun-ning, Yuan Xiao-jun, Xu Wen-hua, Fu Yun-gen, Cao Sheng-sheng 2011, 15 (30):  5543-5546.  doi: 10.3969/j.issn.1673-8225.2011.30.009 Abstract ( 125 )   PDF (554KB) ( 287 )   Save BACKGROUND: Metal-metal prosthesis can appear with corrosion or wear, and release nickel, cobalt, chromium, titanium, and some inflammatory factors locally. OBJECTIVE: To investigate the effects of cobalt (Co2+) and chromium (Cr3+) ions on the proliferation of mouse osteoblasts and expression of receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG). METHODS: Osteoblasts cultured in vitro were divided into two groups: control group with normal saline and ion group with cobalt and chromium ions. RESULTS AND CONCLUSION: The number of cells in the control group was increased remarkably at 1-6 days after intervention, while no changes occurred in the ion group. RT-PCR results showed that the expression of RANKL and OPG was increased as compared with control group at 24 and 48 hours after coculture, especially RANKL expression (P < 0.05). The ratio of RANKL/OPG mRNA was also improved. Co2+ and Cr3+ ions have the remarkable inhibitory action on osteoblast proliferation and can stimulate the expression of RANKL and OPG mRNA from osteoblasts. Related Articles | Metrics

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Clinical application of uncemented all-coated long stem prosthesis in mild and moderate femur bone defects during hip revision Wang Long-qiang, Wang Li-ming, Tang Cheng, Jin Cheng-zhe, Gu Qiang-rong 2011, 15 (30):  5547-5551.  doi: 10.3969/j.issn.1673-8225.2011.30.010 Abstract ( 78 )   PDF (580KB) ( 482 )   Save BACKGROUND: There is no uniform method to repair mild and moderate femur bone defects during hip revision. OBJECTIVE: To evaluate the clinical outcomes of uncemented all-coated long stem prosthesis in mild and moderate femur bone defect during hip revision. METHODS: Eleven patients had mild and moderate femur bone defects after primary hip arthroplasty, they all received uncemented all-coated long stem prosthesis treatment. Among the 11 patients, 8 patients underwent dried bone allograft particles. RESULTS AND CONCLUSION: All the incisions healed by the first intension. All patients were followed up for 10-60 months. There was significant difference in the mean Harris score between preoperation and postoperation (P < 0.01). X-ray examination showed that continuous radiolucent line of 3 mm occurred in 1 case, and no clinical symptoms were observed. Eight cases with dried bone allograft particles recovered within an average period of 5 months (3-9 months). The uncemented all-coated long stem prosthesis can provide initial stabilization in repair of mild and moderate femur bone defects during revision hip arthroplasty, and the short-term clinical effects are satisfactory. Related Articles | Metrics

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Measuring the deformation of the intramedullary nail for the femoral fractures under 200-400 N by the digital speckle method Wu Bang-guo, Yan Jia, Li Zhong-ming, Zhou Yi-ping, Kong Wei-yun, Chen Ying-jie 2011, 15 (30):  5552-5555.  doi: 10.3969/j.issn.1673-8225.2011.30.011 Abstract ( 88 )   PDF (623KB) ( 507 )   Save BACKGROUND: Intramedullary nail fixation for long bone fractures is easy to cause bone deformities due to screw breakage. The optical measurement technology used in the biomedical field can be more accurate to analyze the characteristics of screw breakage OBJECTIVE: To measure the deformation of femoral interlocking intramedullary nail with the digital speckle correlation method. METHEDS: Four femoral specimens of unknown grown-ups were taken. An intramedullary nail fixation model in the femur 1/2 was made. Four locking nails marked were from top to bottom 1, 2, 3, 4. Groups A, B, C and D were measured in order. Group A: the femur was not sawed with intramedullary nail placed inside the femur shaft marrow (simulation of the cured fracture); group B: the femur was sawed on the basis of A in order to simulating more complicated fracture (fractured twice on the femur 1/2, the center point of femoral shaft was sawed up firstly, the place 5 mm below the center point was sawed up secondly); group C: a nail of the upper end was removed on the basis of B; D: a nail of the lower end was removed on the basis of C; the deformation of the fourth nail in groups A-D was measured. Under 200, 300, 400 N, the related data were carried out to be measured by CSS-44100-electronic universal testing machine, and the deformation was calculated by digital speckle correlation method. RESULTS AND CONCLUSION: There was a statistical difference between group B and C with 300 N (P < 0.05). The remote nail for femoral interlocking intramedullary nail internal fixation is easily broken. Related Articles | Metrics

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Effects of bridge combined fixation system on healing of fractures in dogs  Xiong Ying, Lu Ji-peng, Li Qun-hui, Zhao Feng, Zhang Wu 2011, 15 (30):  5556-5560.  doi: 10.3969/j.issn.1673-8225.2011.30.012 Abstract ( 121 )   PDF (622KB) ( 572 )   Save BACKGROUND: In recent years, studies concerning internal fixation mainly emphasize on reducing stress-shielding effect and damage to blood supply. OBJECTIVE: To investigate the influence and mechanism of bridge combined fixation system (BCFs) on fracture healing. METHODS: Bilateral tibia of 20 adult dogs were osteotomized in the middle and fixed with BCFs (experimental group) on left or right side at random, another side fixed with plate (control group). Five animals in each group were sacrificed at 4, 8, 12, 16 weeks after operation and observed with pathological examination, X-ray examination, and light microscopy. RESULTS AND CONCLUSION: In the control group, fracture splitting, loose steel plate and steel fracture were found separately in one case at 3 weeks. While in the experimental group, flexural deformation was found in one case at 5 weeks. Callus could be observed with X-ray in the experimental group at 8 weeks, which was earlier than the control group. The X-ray grade of the experimental group were higher than that of the control group every period, and there were significant difference at 16 weeks (P <  0.05). Light microscopy showed that the quantity and quality of fibroblast, capillary vessel and callus of the experimental group were better than those of the control group. The hematoxylin-eosin stained grade of experimental group were higher than control group every period, there were prominent difference at 8 and 16 weeks (P  < 0.05). BCFs not only reduce the breakage of vessels near fracture part, but also afford firm and dynamic fixation for fracture fragment, which enhances healing and bone reconstruction. Related Articles | Metrics

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Implant treatment versus non-implant treatment for unstable fracture of the scapular neck　 Xu Jun-jie, Li Ye-hai, Liu Qing, Tang Hao-ran, Liang Jun-sheng, Yao Ji-rong, Liu He-feng 2011, 15 (30):  5561-5564.  doi: 10.3969/j.issn.1673-8225.2011.30.013 Abstract ( 111 )   PDF (500KB) ( 521 )   Save BACKGROUND: Treatment for Scapular neck fracture is controversial, some scholars believe that conservative treatment can obtain a satisfactory outcomes; while the other scholars believe that steel plate treatment is required. OBJECTIVE: To explore the effective methods for treatment of unstable fractures of the scapular neck. METHODS: A retrospective analysis of 25 patients with unstable fractures of the scapular neck was done. Twelve patients were treated by steel plate internal fixation and 13 patients were treated by conservative treatment from July 2005 to December 2009. RESULTS AND CONCLUSION: Twenty-five patients were followed up from 3 to 24 months. In the non-implant group, the Herscovici’s score was 8.46±3.20; 2 cases achieved the excellent result, 3 cases good, 6 cases fair and 2 cases poor, and the excellent and good rate was 38.5%; the X-ray film results showed that glenopolar angle (GPA) was (21.7±4.6)°. In the implant group, the Herscovici’s score was 11.75±2.60; 5 cases achieved the excellent result, 6 cases good, 1 case fair and none case poor, and the excellent and good rate was 91.7%; the GPA was (38.8±2.9)°. There were significant differences between two groups (P < 0.05). Implant treatment for unstable fractures of the scapular neck can reconstruct the stability and facilitate function of the shoulder joint. Related Articles | Metrics

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Less Invasive Stabilisation System plating and bone allograft for distal femoral fractures Wei Yong-kun, Ma Hui-ling, Liu Feng-hu, Yang Lei, Yu Yang, Yin Wei 2011, 15 (30):  5565-5568.  doi: 10.3969/j.issn.1673-8225.2011.30.014 Abstract ( 82 )   PDF (518KB) ( 494 )   Save BACKGROUND: Less Invasive Stabilisation System (LISS) plate can fix fractures microinvasively, reduce damage to the blood supply. LISS plate combined with bone allograft can improve the healing rate of fractures. OBJECTIVE: To observe the effects of LISS locking plate fixation and bone allograft on distal femur fractures. METHODS: Seventy-three patients received LISS locking plate fixation and bone allograft for treatment of comminuted fracture of the distal femur from 2009 to 2010, including 47 males and 26 females, aged 32-76 years. Sixty-one cases suffered from traffic accident, 9 suffered from falls, and 3 suffered from other reasons. There were 57 cases of blunt injury and 16 of open injury. According to AO typing, there were 19 of type A, 13 of type B, and 41 of type C. RESULTS AND CONCLUSION: Based on the Kolment evaluation standards, the effects were excellent in 27 cases, good in 39 cases, and poor in 4 cases. The excellent and good rate was 90.4%. The LISS locking plate fixation plus bone allograft is good for treatment of distal femur fractures. Related Articles | Metrics

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Meta analysis of 18F-deoxyglucose-positron emission tomography value in evaluation of response to therapy for primary bone and soft tissue sarcomas Ji Tao, Zhu Sai-nan, Guo Wei, Tang Xiao-dong, Tang Shun 2011, 15 (30):  5569-5572.  doi: 10.3969/j.issn.1673-8225.2011.30.015 Abstract ( 121 )   PDF (532KB) ( 262 )   Save BACKGROUND: 18 F-deoxyglucose-positron emission tomography (18FDG-PET) can be used for bone and soft tissue malignant tumor identification, lesion location, degree of malignancy evaluation, biopsy site identification, effect and prognostic assessment. OBJECTIVE: To assess the value of 18FDG-PET in the evaluation of preoperative therapy response of bone and soft tissue sarcomas by systematic review and meta-analysis. METHODS: Databases of PubMed, Embase, Cochrane, CNKI, WanFang and VIP databases were searched for articles about PET application in diagnosis and treatment of bone and soft tissue malignant tumor. RESULTS AND CONCLUSION: Nine non-randomized controlled clinical studies which met the inclusion criteria were included for Meta analysis. Qualitative analysis found recommendation grade B in three studies and C in seven studies. No bias was found in the nine studies. Pooled sensitivity and specificity of cut point 0.5 (SUV2/SUV1) for the prediction of tumor necrosis ≥ 90% were 0.82 (95% confidence interval, 0.72-0.89) and 0.61 (95% confidence interval, 0.49-0.71) respectively. The summary receiver operating characteristic curve (SROC) was 6.17 with 95% confidence interval of 2.84-13.39. Our results indicate that the SUVmax ratio before and after preoperative treatment can predict therapy response with compared high sensitivity, however lack of specificity. Evaluation of preoperative therapy should be determined with combination of 18FDG-PET and others. Related Articles | Metrics

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Biomechanical changes in patellar tendon following knee immobilization Xie Kun-ling, Yu Zheng-hong 2011, 15 (30):  5573-5576.  doi: 10.3969/j.issn.1673-8225.2011.30.016 Abstract ( 65 )   PDF (294KB) ( 297 )   Save BACKGROUND: Bone joint immobilization is often used to prevent the injured tissue from secondary injury. OBJECTIVE: To investigate the effects of knee immobilization on biomechanical changes in rabbit patellar tendon and ultrastructure morphology. METHODS: Twenty adult rabbits were assigned into two groups. The left hindlimbs of rabbits in the immobilized group (n = 10) were immobilized by plaster of paris and two adjustable aluminium splints for 6 weeks, while those left hindlimbs in the control group (n = 10) served as controls. Rabbit knees were immobilized in extension and the ankle was immobilized at 90°flexion for 6 weeks. Then the patellar tendon-bone complex was harvested to observe the biomechanical properties and ultrastructure changes of patellar tendon. RESULTS AND CONCLUSION: After 6-week immobilization, the tensile strength and tangent modulus of patellar tendon-bone complex were decreased to 64.44% and 53.08% of the control values (P < 0.01). However, there was no significant difference in the elongation at failure and the maximum load between the immobilized and control groups. The curves of stress and strain of patellar tendon based on the average material constant were greatly different. The cross-sectional area of patellar tendon was significantly larger in the immobilized group than in the control group (P < 0.01). Smaller collagen fibrils took the predominance in the immobilized group. These results showed that immobilization of knee joint could result in biomechanical changes of patellar tendon and produce influence on patellar tendon. Related Articles | Metrics

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Effects of different lumbar fusion modes on lumbar spine biomechanics Cheng Jun, Song Yue-ming, Chen Jun-rong, Chen Jing-yong, Li Zhong 2011, 15 (30):  5577-5581.  doi: 10.3969/j.issn.1673-8225.2011.30.017 Abstract ( 120 )   PDF (564KB) ( 565 )   Save BACKGROUND: Lumbar fusion has been widely used in treating lumbar diseases. However, the influence on adjacent segments is on debate, and the stability of fused segment and biomechanical effects on adjacent segments have not been well document. OBJECTIVE: To study the biomechanical properties of fused segments and adjacent segments. METHODS: New Zealand White rabbits were randomly assigned into anterior lumbar interbody fusion (ALIF) group (L5-6 discectomy, decortication of the vertebral end plates, autogeneuous iliac bone graft were performed), posterolateral fusion (PLF) group (autogeneuous iliac crest bone graft was placed over the bilateral decorticated L5-6 transverse processes), 360° fusion group (underwent ALIF firstly, and PLF L5-6 were performed after 1 week), or control group (treated without any operation). The spinal fusion was analyzed by radiography, manual palpation and mechanical testing at 12 weeks after operation. Each successful fusion specimen was tested in six pure moments (flexion and extension, left and right lateral bending, left and right axial rotation) to determine the stability of fused segments and the range of motion (ROM) of adjacent segments. RESULTS AND CONCLUSION: Compared with the control group, the ROM of flexion at L5-6 segment decreased significantly 86.24% (P < 0.05), 88.74% (P < 0.05), 73.10% (P < 0.05) for the ALIF group, 360° fusion group and PLF group, respectively. Accordingly, the ROM of flexion at L4-5 increased 52.22% (P < 0.05), 55.89% (P < 0.05), and 27.11% (P < 0.05). Three lumbar fusion methods can enhance the stability of fused segment significantly. The stability of 360° fusion is the highest, and that of PLF is the least. The ROM of flexion at proximal adjacent segment in ALIF and 360° fusion is no statistical difference, and that of the PLF is the least. Related Articles | Metrics

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Clinical anatomic study of lower cervical pedicle in a Chinese population by three dimensional reformations of multi-slice spiral CT Zhu Ruo-fu, Yang Hui-lin, Li Ji-gang, Hu Chun-hong, Wang Gen-lin, Tang Tian-si 2011, 15 (30):  5582-5586.  doi: 10.3969/j.issn.1673-8225.2011.30.018 Abstract ( 145 )   PDF (692KB) ( 432 )   Save BACKGROUND: Anatomic variations between individuals in the size and shape of cervical pedicles limit the application of pedicle screw. OBJECTIVE: To evaluate lower cervical pedicle (C3-7) dimensions in a Chinese population by multiplanar reformations (MPR) of multi-slice spiral CT. METHODS: The dimensions of the pedicles (C3-7) were determined in 60 patients with cervical spinal lesions from CT images. Measurements of pedicle height, width, pedicle axis length, effective length, and two angles of the pedicles, the distances from the projection point of the pedicle axis to the lateral edge of the lateral mass and the inferior edge of the superior facet were measured. RESULTS AND CONCLUSION: The outer pedicle width was smaller than the height in most of the pedicles. This measurement was significantly different between male and female patients in outer pedicle width of pedicle at C3 and C4. The distances from the projection point to inferior edge of the superior facet did not show uniform pattern of change from C3 to C7, whereas the distances from the projection point to the lateral edge of the lateral mass consistently increased from cephalad to caudal. The smallest pedicle transverse angle was at C7 in male and female. Transpedicular screw placement for the cervical pedicle of C3, C4 must be cautious in the Chinese female population before the exact pedicle transverse diameters are known. Most of cervical pedicle (C5-7) in a Chinese population is suited for pedicle fixation of 3.5 mm screw. Taking into consideration some variations between individuals, these data combined with evaluation of results of preoperative computed axial tomography are required before operation. Related Articles | Metrics

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Three-dimensional image for measuring morphological characteristics of cervical uncinate in the adolescent Wang Xing, Shi Jun, Zhang Shao-jie, Li Xiao-he, Ma Shi-feng, Li Zhi-jun, Zhang Yuan-zhi, Yu Jing-hong 2011, 15 (30):  5587-5590.  doi: 10.3969/j.issn.1673-8225.2011.30.019 Abstract ( 145 )   PDF (633KB) ( 449 )   Save BACKGROUND: Uncinate process is an important part of Luschka joint, and it direct impacts morphological stability and morbidity. OBJECTIVE: To discuss the morphological characteristics and development pattern of cervical uncinate in the youth by scanning and three-dimensional reconstruction imaging measurement. METHODS: Sixty-six young people aged 6 to 20 years were selected with the following standards: no trauma, neurological symptoms and signs. Then, thin line scans of multi-slice spiral CT (0.625-1.25 mm, scope: C1-T1) were carried out. The original data were imported to three-dimensional reconstruction software in DICOM format according to gender, age group for statistical analysis. RESULTS AND CONCLUSION: The basal length, width, height, spacing and angle of uncinate process from C1 to C7 showed an increasing trend, and also showed an increasing trend with age. However, these indicators were not significantly different in gender and side. Uncinate angle in all age groups had no obvious rules, but the variation was larger. Three-dimensional reconstruction of cervical uncinate process by image data reflects the variation of age and developmental characteristics of cervical disease diagnosis and provides detailed theoretical basis for clinical application. Related Articles | Metrics

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Low-field MRI is preferred in the diagnosis of occult traumatic fracture of the knee Liu Jing-jing, Wang Wei, Zhang Li 2011, 15 (30):  5591-5595.  doi: 10.3969/j.issn.1673-8225.2011.30.020 Abstract ( 104 )   PDF (685KB) ( 444 )   Save BACKGROUND: MRI examination can be applied to the early diagnosis of occult fracture. Except for the characteristics of conventional MRI, low-field MRI has other advantages, such as a proprietary coil to make image clearer. OBJECTIVE: To explore the value of low-field MRI for the diagnosis of occult traumatic fracture of the knee. METHODS: Forty-five patients with occult traumatic fracture of the knee confirmed by using surgery, arthroscopy or clinical examination were examined by MRI. RESULTS AND CONCLUSION: MR sequences included SE T1WI, GRE T2WI and STIR. The location, range, and morphology of fractures were analyzed. Thirty-four fractures in 45 cases were showed by MRI. Low-field MRI can sensitively display the characteristics and severity of occult traumatic fracture of the knee. Low-field MRI is accurate in diagnosis, and can find injuries of knee ligament, tendon, and cartilage. Related Articles | Metrics

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Micro CT observation on femoral metaphysis after spinal cord injury and immobilization in rats Yu Wen-chao, Liu Yan, Yuan Wen, Guo Yong-fei, Cao Zhen-yu, Zou Han-lin 2011, 15 (30):  5596-5599.  doi: 10.3969/j.issn.1673-8225.2011.30.021 Abstract ( 113 )   PDF (547KB) ( 394 )   Save BACKGROUND: Osteoporosis results from spine cord injury (SCI), due to a great deal of bone loss. OBJECTIVE: To make an observation and comparison on bone density and bone microstructure at the distal femora changes after both SCI in early stage and osteoporosis due to immobilization. METHODS: The SD rats were randomly divided into three groups. In the control group, T10 vertebrae plate resection was performed to rats without injuring dura mate of spinal cord and spinal cord. T10 vertebrae plate resection was also performed to rats in the SCI group with spinal cord injury by Allen’s method. Rats in the immobilization group were immobilized by limb-tail fixation at bilateral hindlimbs. The femoral metaphysis, ulna and radius were chosen for detection of bone density individuals and Micro CT scanning was performed to the other femoral metaphysis.  RESULTS AND CONCLUSION: Compared with the control group, bone density, bone mineral content, bone volume/ total volume (BV/TV) , trabecular thickness (Tb.Th), cortical bone area (Ct.Ar), cortical thickness (Ct.Th), trabecular number (Tb.N) in the distal femur of rats in the SCI group and immobilization group deceased dramatically respectively (P < 0.05). Structure model index (SMI), bone surface/ total volume (BS/TV), trabecular separation/spacing (Tb.Sp) in the distal femur of the SCI group was higher than that of the control group (P < 0.05 ). No bone density difference of significance was found in the elbow-bone and radius between the three groups. Above all, both SCI and immobilization can result in osteoporosis. SCI have resulted in significantly changes in the bone microstructure in early stage and compared with the immobilization group, the degree of changes was more seriously. Related Articles | Metrics

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Multi-Modality Medical Image Registration Using AM-FM and Entropy Graph Zhou Hui, Yang Yuan, Bai Li-min, Zhou Shou-jun, Lu Zhen-tai 2011, 15 (30):  5600-5603.  doi: 10.3969/j.issn.1673-8225.2011.30.022 Abstract ( 142 )   PDF (648KB) ( 364 )   Save BACKGROUND: Traditional mutual information (MI) based multimodal medical image registration evaluates probability density function by two-dimensional histogram or Parzen-window function, and then plug this estimation into the expression of MI. In this process, it just considers images intensity, but ignore spatial information of image, which leading to image mismatch. OBJECTIVE: To propose a new robust and fast registration method based on amplitude modulation-frequency modulation (AM-FM). METHODS: Firstly, we decomposed the image using AM-FM model so as to obtain the AM-FM features. Therefore, we got a series of high dimension features consisting of AM-FM features and intensity features. Finally, we computed mutual information using these high dimension features and entropy graph. It was an extension to the mutual information framework which incorporated spatial information about image structure into the registration process and had the potential to improve the accuracy and robustness of image registration, entropy graph was used to compute the mutual information. RESULTS AND CONCLUSION: In the experiment, we used 20 sets of data: T1-T2 weighted images and CT-PET images to compare the proposed method with MI. The results indicate that this algorithm is a more robust for image registration than conditional mutual information, even if the image in the context of low resolution and noise. This method is more accurate and robust while remaining computationally efficient. Hence, it is particularly suited to the clinical application. Related Articles | Metrics

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Three-dimensional reconstruction of medical images based on VTK Tao Zhi-jiang, Huang Hua, Zeng Jun 2011, 15 (30):  5604-5606.  doi: 10.3969/j.issn.1673-8225.2011.30.023 Abstract ( 239 )   PDF (451KB) ( 1273 )   Save BACKGROUND: VTK is a free but professional development platform for images three-dimensional (3D) reconstruction and processing. It is powerful, open-source, and users can customize their own needs by self-development of great flexibility. OBJECTIVE: To introduce the mostly used Surface Rendering and Volume Rendering technology in images 3D reconstruction, and their typical Marching Cubes and Ray Casting algorithms, and to investigate some applications and extensions on the reconstructed 3D medical images. METHODS: Based on the free VTK visualization development platform and Visual C++ 6.0 IDE development tools, through C++ language, using real people’s CT dataset, we realized the images 3D reconstruction and also its applications and extensions correspondingly. RESULTS AND CONCLUSION: Based on the VTK platform, through Surface Rendering and Volume Rendering methods, we realized medical images 3D visualization. The display effect of the reconstructed 3D image is well and intuitive. With the related operations such as measurement, virtual cutting and so on, the good results we desired could be achieved. Related Articles | Metrics

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Ultrasound image segmentation based on region-growing algorithm for reflection of vascular lesions Shui Xue, Liu Qi 2011, 15 (30):  5607-5610.  doi: 10.3969/j.issn.1673-8225.2011.30.024 Abstract ( 96 )   PDF (569KB) ( 555 )   Save BACKGROUND: It can reflect pathological changes of the blood vessel through the analysis of vascular images in ultrasound. OBJECTIVE: Based on region-growing algorithm to segment ultrasound images and analyze the boundary point relative displacement METHODS: Firstly, we decompressed video images into frames, transformed dynamic images into static, and then applied Gabor filtering and adaptive histogram quantization to reduce speckle noise in ultrasound images and segmented the images through region-growing algorithm. Combined with open and close operation and sobel edge detection, we have finally extracted two boundaries of the blood. RESULTS AND CONCLUSION: The method we proposed obtains the quite good segmentation result, and the method of region-growing meets the requirement of real-time in terms of processing speed. Furthermore, the boundary point relative displacement curve can reflect pathological changes of the blood vessel to some extent, which lays a solid foundation for researches on morphology of the blood vessel and haemodynamics and has important meanings for pathophysiology. 　 Related Articles | Metrics

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Design of portable music therapeutic instrument based on digital audio technology  Liu Qian-cheng, Jin Hao-yu, Zhou Sheng-yang, Zhuang Ting-chun 2011, 15 (30):  5611-5614.  doi: 10.3969/j.issn.1673-8225.2011.30.025 Abstract ( 154 )   PDF (606KB) ( 1332 )   Save BACKGROUND: Music electrotherapy is a fusion of music therapy and electrotherapy, which as a new rehabilitation technique has been concerned by medical workers. OBJECTIVE: To introduce a new portable music therapeutic apparatus based on digital audio technology. METHODS: The apparatus was developed with C8051F340 and MP3 module, it could offer electrical stimulation and music. Music could create a comfortable “therapeutic condition” in the process of treatment. RESULTS AND CONCLUSION: The therapeutic apparatus has been developed and passed the detection. The therapy becomes a kind of enjoyment to improve the therapeutic effect of electrical stimulation. Related Articles | Metrics

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Envelope extraction algorithm and phonocardiogram signal application based on wavelet transform Zhou Su, Judith Diengi Zeyi, Wu Xiao-ming, Huang Yue-shan 2011, 15 (30):  5615-5619.  doi: 10.3969/j.issn.1673-8225.2011.30.026 Abstract ( 200 )   PDF (785KB) ( 1749 )   Save BACKGROUND: The activity of heart valves can be reflected by cardiac sounds, even some heart disease can also find expression in the abnormal heart sounds. So heart sounds analysis has important clinical significance. OBJECTIVE: Through extraction envelope and analysis of the various features of heart sounds, to detect whether there is noise or not in phonocardiogram signals so as to improve the weakness of traditional auscultation technology such as high dependence on the doctors’ experience and the limited auscultation range. METHODS: Extraction envelope curve is one of the commonly used methods to analyze heart sounds. A new method based on wavelet transform to extract the heart sound signals envelope was presented, in contrast to the common methods as Hilbert-Huang transform (HHT), mathematical morphology and average Shannon energy. Through practice, the method was proved to contain many advantages: simple algorithm, smooth feature, outstanding feature point. RESULTS AND CONCLUSION: In order to test the accuracy of discriminating normal and abnormal heart sounds, 35 heart sounds were collected and analyzed. The experiment demonstrated that the accuracy performances were achieved by 95%, which is very useful in many aspects. Related Articles | Metrics

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Design on a pickup device for assistive reading robot Xu Zhao-hong, Song Cheng-li, Yan Shi-ju 2011, 15 (30):  5620-5622.  doi: 10.3969/j.issn.1673-8225.2011.30.027 Abstract ( 61 )   PDF (471KB) ( 749 )   Save BACKGROUND: Assistive rehabilitation device can realize the maximum self-care and participation in society activity in the disabled. OBJECTIVE: To design a newtype pickup device by analyzing the research status of assistive reading robots in home and abroad. METHODS: We designed a pick-up device to help the disabled obtain books from the shelves. RESULTS AND CONCLUSION: The simulation shows the pick-up book device is reliable and safe, effective and feasible based on the three-dimensional UG software. Related Articles | Metrics

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Mechanical properties of artificial hip stems Zhang Lan-feng, Ge Shi-rong, Liu Hong-tao 2011, 15 (30):  5623-5626.  doi: 10.3969/j.issn.1673-8225.2011.30.028 Abstract ( 181 )   PDF (797KB) ( 636 )   Save BACKGROUND: A total joint reconstruction is related to the stress distribution throughout the prosthesis, cement and femur. It is a significant progress for reducing the stresses in all components to minimize the risk of failure. OBJECTIVE: To summarize the investigative situation and progression about stress distribution of all components after total hip replacement. METHODS: The databases of CNKI, EI Village and ELSEVER (2001-01/2011-01) were retrieved to search the related articles about total hip replacement and stress distribution of stem. Putting stem, biomechanical, stress and finite element analysis as terms and then selecting some related articles. The keywords were “femoral stem, stress, total hip replacement” in Chinese and “stem, prosthesis, stress, total hip replacement” in English. Thirty-four articles and two books related to the stress distribution of stem were included. RESULTS AND CONCLUSION: The fixture problems of hip prosthesis are summarized. It is interface shear lag effect resulted from the heterogeneity stress distribution of all components, which has an effect on the interfacial loosening failure. The further study on the reason of femur-stem loosening failure and reinforcement mechanism of interfacial bonding strength is put forward. Related Articles | Metrics

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Prosthesis type and evaluation system of artificial total ankle replacement  Wu Jian, Liu Yan-xi, Zheng Yong, Bao Tong-zhu 2011, 15 (30):  5627-5630.  doi: 10.3969/j.issn.1673-8225.2011.30.029 Abstract ( 205 )   PDF (590KB) ( 508 )   Save BACKGROUND: Artificial total ankle joint replacement has carried out progressively at home and abroad, it does not give satisfactory medium-long term effect. The design and development of ankle joint prosthesis and optimization of efficacy evaluation system are closely related to medium-long term effect. OBJECTIVE: To explore the advance of design and development of artificial ankle joint prosthesis, and the advance of efficacy evaluation system in ankle joint replacement. METHODS: A computer online search was performed to find papers concerning review and research report of type of artificial ankle joint prosthesis and efficacy evaluation system published between 1980 and 2010 in databases of CNKI, Wanfang, VIP and PubMed. We retrieved the papers using the keywords of “ankle joint, replacement, prosthesis, evaluation system” in Chinese and English. The literature published in a short report on the latest or authoritative journals in a certain domain was selected. The advance in the style of ankle joint prosthesis, evaluation system, indication and contraindication was analyzed. RESULTS AND CONCLUSION: A total of 33 literatures were included in this study. Artificial ankle joint replacement is the exploring project in treating ankle pain, the medium-long term effect of ankle joint replacement depends on design of the ankle joint prosthesis and optimization of efficacy evaluation system, and we think ankle joint prosthesis should be improved and enhanced greatly, to get better effect and higher postoperative survival rate of prosthesis in the replacement of ankle joint, and the more reasonable and standard efficacy evaluation system are also needed. Related Articles | Metrics

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The advance in metal pedicle screw and its alternative biomaterials Zhang Lei, Yang Hui-lin, Zhu Xue-song, Li Ji-gang 2011, 15 (30):  5631-5635.  doi: 10.3969/j.issn.1673-8225.2011.30.030 Abstract ( 92 )   PDF (794KB) ( 497 )   Save BACKGROUND: Pedicle screw fixation systems are widely used in spinal fractures, degeneration diseases, cancer and other diseases, the materials, design of pedicle screws and biomaterials are in the great development. OBJECTIVE: To summarize the investigative situation and progression about design of pedicle screws at home and abroad. METHODS: Databases of CNKI (1994/2010) and PubMed (1959/2010) were selected to search the related articles about pedicle screws with keywords of “pedicle screw, biomechanics, design and biomaterial” in Chinese and English. Then, 36 articles related to pedicle screws were included in result analysis. RESULTS AND CONCLUSION: Using Titanium system, increased diameter and length of screws, special pedicle screws such as expendable screws, and pedicle screws augmentation with biomaterials can improve fixation rigidity. Besides, screw shape, thread shape, inclination angle, thread depth and pitch are closely related with fixation rigidity of pedicle screws. We should take more factors into considerations to design more reasonable pedicle screws. Related Articles | Metrics

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Research development of the bioresorbable intervertebral fusion cage Zhang Yi, Zhang Chao, Cao Cong, Dong Yu-qi 2011, 15 (30):  5636-5639.  doi: 10.3969/j.issn.1673-8225.2011.30.031 Abstract ( 263 )   PDF (589KB) ( 418 )   Save BACKGROUND: Bioabsorbable intervertebral fusion cage has similar strength and modulus of elasticity with bone tissues and possesses ray permeability. It can be absorbed gradually by human tissues which is apt to fusion. OBJECTIVE: To introduce the characters in different materials of the bioresorbable intervertebral fusion cage, illustrate results of animal researches and investigate effects of different fusion cages in clinical application. METHODS: Literatures about the bioresorbable intervertebral fusion cage published in English and those published in domestic core magazines were selected from PubMed, and those articles were analyzed, classified, summarized and reviewed. RESULTS AND CONCLUSION: With the development of materials science, absorbing materials in spinal surgery are widely applied. Although they have shown remarkable clinical result and prospect as an emerging technology, they still need to be gradually developed, and more research should be carried out. Related Articles | Metrics

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Biomechanical study of spinal pedicle screws Li Xian-ling, Li Xian-jin, Zhang Xue-jun, Lu Shou-yan, Zhao Ping, Li Cheng-xin, Sun Lin, Zhang Kun-ya, Zhang Qin-ming 2011, 15 (30):  5640-5645.  doi: 10.3969/j.issn.1673-8225.2011.30.032 Abstract ( 100 )   PDF (712KB) ( 900 )   Save BACKGROUND: Pedicle screw internal fixation after constant development and perfection has been advanced in spinal fixator field from aspect of biomechanics theory. OBJECTIVE: To review the biomechanical study of spinal pedicle screws. METHODS: CNKI and Pubmed (1986-01/2010-10) were retrieved to search the related articles about biomechanics of pedicle screws using the keywords of “pedicle screws, biomechanics” in Chinese and English. Finally 49 articles were included. RESULTS AND CONCLUSION: In the development process of pedicle screws, biomechanics not only provides theoretical foundation for the development of the internal fixation, but also is the ultimate basis and holder effect standard for testing and evaluation of new designs. Pedicle screw implantation point, implant orientation, screw size, screw shape, screw materials have a certain impact on spinal biomechanics. Related Articles | Metrics

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Influential factors for the stability of artificial total hip replacement Zhu Ming-sheng, Li Zhen-wei 2011, 15 (30):  5646-5649.  doi: 10.3969/j.issn.1673-8225.2011.30.033 Abstract ( 101 )   PDF (517KB) ( 266 )   Save BACKGROUND: Prosthesis loose appeared after artificial total hip replacement. To understand the factors that affect stability of artificial total hip joint is necessary for elevating the curative effect of artificial total hip replacement. OBJECTIVE: To summarize latest research progress of influential factors for stability of artificial total hip replacement, and to further understand the stability of artificial total hip joint. METHODS: We retrieved China National Knowledge Infrastructure (1997-01/2010-12) for articles addressing sterile prosthesis loose after artificial total hip replacement. The key words were “artificial joint, replacement, stability”. A total of 98 articles were retrieved, and 30 articles were included in accordance with inclusion criteria. RESULTS AND CONCLUSION: Influential factor and pathogenesis of the stability of artificial total hip replacement are complicated. The major factor is mechanics, followed by biology. Their effects lead to bone resorption, osteolysis, prosthesis loose and bone destruction. The process is strongly associated with the participation of many cytokines. We can prevent and cure the influential factors for the stability of artificial total hip joint from the aspects as follows: joint material, place angle, inhibition of worn particle motion, promotion of osteogenesis, and inhibition of bone resorption. Related Articles | Metrics

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Bionic effect of reciprocating gait orthosis Chen Wen-yuan 2011, 15 (30):  5650-5652.  doi: 10.3969/j.issn.1673-8225.2011.30.034 Abstract ( 122 )   PDF (445KB) ( 341 )   Save BACKGROUND: Reciprocating gait orthosis makes the paraplegia patients walking, but reciprocating gait orthosis can only perform walking rehabilitation training and simple walking, which was far from real walking function compensation. OBJECTIVE: To summarize and analyze construction features, action mechanism and bionic effect of reciprocating gait orthosis. METHODS: We retrieved PubMed Database and Wanfang Database for articles concerning features, bionic effect and clinical application of reciprocating gait orthosis published from January 1990 to December 2008. The key words were “reciprocation gait orthosis, walkabout, bionice”. A total of 32 articles were researched. RESULTS AND CONCLUSION: At present, unpowered reciprocating gait orthosis has been extensively utilized, but it can only perform walking rehabilitation training and simple walking, which was far from real walking function compensation for paraplegia patients. The bionic effects of reciprocation gait orthosis and walkabout were poor; gait lacked fidelity; physical ability was greatly consumed. However, the gait orthosis that requires outer energy for supplement can overcome the disadvantage of unpowered gait orthosis. With the wide usage of artificial intellectual technology in robot and many industry fields, its development can provide gait orthosis that has good function, safety, reliability, and bionics. Related Articles | Metrics

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A review of different extramedullary fixation devices in intertrochanteric fractures Shi Ming, Li Tao 2011, 15 (30):  5653-5656.  doi: 10.3969/j.issn.1673-8225.2011.30.035 Abstract ( 106 )   PDF (498KB) ( 355 )   Save BACKGROUND: With the aging of the population, the incidence of intertrochanteric fracture increases apparently. Such fracture is currently treated with surgery, and the dynamic hip screw (DHS) has always been considered as “gold standard”, but with the development of minimally invasive technique and extramedullary fixation technology, we should be fully aware of the characteristics of extramedullary fixation device, and strictly mastering the indications in order to reduce the surgical complications. OBJECTIVE: To discuss and compare traits, operative efficacy, complications and biomechanics of the extramedullary fixation devices in intertrochanteric fracture. METHODS: The first author retrieved PubMed and Wanfang databases for articles concerning operative efficacy, complications and biomechanics of the extramedullary fixation devices in intertrochanteric fracture published 1990/2010. RESULTS AND CONCLUSION: In treatment of intertrochanteric fracture, percutaneous compression plate and LCP with two or three femoral neck screw nails can reduce the incidence of complications, prevent hip varus, provide reliable fixation; minimally invasive technique can reduce operative time and the amount of exposure. Related Articles | Metrics

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Application of virtual reality technology in clinical virtual standardized patients Wang Xin-ping, Wang Li-hua, Sun Yao, He Ying 2011, 15 (30):  5657-5660.  doi: 10.3969/j.issn.1673-8225.2011.30.036 Abstract ( 115 )   PDF (774KB) ( 823 )   Save BACKGROUND: With the rapid development of computer technology, computer virtual reality technology is used in medicine more and more widely, and its unique simulation provides a new approach for the clinical diagnosis and research work. OBJECTIVE: To realize the reasonable utilization of virtual standardized patients (VSP) to assist clinical diagnosis and clinical research in the multidimensional information space that based on the virtual reality technique. METHODS: We investigated the situation of current virtual reality technique apply in clinic, and proposed one system structure model of clinical VSP and constructed one clinical VSP system based on the virtual reality technique, and analyzed the VSP communication mode and realization process. RESULTS AND CONCLUSION: Doctor could do the operation in the virtual environment of clinical VSP to assist the clinical diagnosis, training and teaching. Clinical VSP system provided one new platform for the clinical diagnosis, training and researching, and enhanced the clinical medical treatment level. Related Articles | Metrics

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Application of X-ray and CT three-dimensional reconstruction measure to reshaping and repair of maxillofacial region Luo Huan-jiang, Long Teng-he, Zhao Hai-bo, Liang Hong-feng 2011, 15 (30):  5661-5664.  doi: 10.3969/j.issn.1673-8225.2011.30.037 Abstract ( 100 )   PDF (635KB) ( 1104 )   Save BACKGROUND: Maxillofacial bone is the basis of facial soft tissue, and different in the individuals. It is necessary to study various measure methods to precisely measure maxillofacial region. OBJECTIVE: To compare application progress of X-ray and three-dimensional CT measure in reshaping and repair of maxillofacial region. METHODS: We retrieved PubMed Database and China National Knowledge Infrastructure. The key words were “maxillofacial, bone tissue, measurement of three-dimensional reconstruction” and searched in title and abstract. Finally 23 articles were included. RESULTS AND CONCLUSION: The advantage of X-ray three-dimensional measure was as follows: low price, low radiation dose, short data collection time; shortcoming was as follows: poor resolvability of mark point and fixed point. The advantage of CT three-dimensional measure was as follows: full measure content, high accuracy and precision, reliable method, repeatable, and extensive application; however, the cost was high, and the duration of examination was relatively longer compared with traditional plain film. At present, the radiation dose was more in patients receiving CT scanning compared with X-ray plain film. Related Articles | Metrics

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Bone defect repair in the surgical treatment of spinal tuberculosis Yang Zhi-xian, Peng Xiao-zhong, Wu Zhen-guo, Wei Han-yu, Lei Cheng-gang, Huang Zhan-zhu 2011, 15 (30):  5665-5668.  doi: 10.3969/j.issn.1673-8225.2011.30.038 Abstract ( 97 )   PDF (707KB) ( 542 )   Save BACKGROUND: How to repair damage to the vertebral body using surgical methods is important and difficult for treatment of spinal tuberculosis OBJECTIVE: To learn a variety of the methods to repair bone defects in spinal tuberculosis after lesions removal in China at present, and to find out the effective methods and new progress. METHODS: CNKI database was search for  the literature related to surgical treatment of spinal tuberculosis published 2006/2010-01-01. First, the key word of “spinal tuberculosis” was used and then “internal fixation”, “bone graft”, “synthetic bone (materials)”, “titanium mesh”, “bone cement”, “artificial vertebral body” were used as key words in the above data retrieval. According to selected conditions, the relevant literature with reported cases, surgical procedures (including bone repair method), effects (including cure rate, relapse rate, Cobb angle corrected) were selected for statistical analysis. RESULTS AND CONCLUSION: Autologous bone (iliac, ribs) is the major source of repaired bone defects in spinal tuberculosis, followed by titanium mesh and bone graft, and a small amount of synthetic bone and artificial vertebral body is used for clinical treatment. In the future, synthetic bone and the artificial vertebral body have a broad development space, being an ideal substitute. Related Articles | Metrics

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Vertebroplasty with bone cement injection to prevent catastrophic complications: Clinical analysis of 87 patients with 137 vertebrae Huang Wei-Guo, Yi Jun-fei, Bai Rui-fei, Liu You-jun, Chen Tong 2011, 15 (30):  5669-5674.  doi: 10.3969/j.issn.1673-8225.2011.30.039 Abstract ( 102 )   PDF (761KB) ( 762 )   Save BACKGROUND: Vertebroplasty treatment for osteoporotic vertebral compression fractures has exact effect, but some hot spots remain unclear. OBJECTIVE: To evaluate some key technologies of vertebralplasty in the treatment of osteoporotic vertebral compression fractures such as puncture injury, bone cement injected dose, multi-vertebroplasty and bone cement leakage. METHODS: Retrospective study of 87 patients with 137 vertebrae suffering from osteoporotic vertebral compression fractures which were treated with percutaneous vertebralplasty was performed. The patients received unilateral transpedicular puncture, bone cement injection at thin dense time and with volume from 3-7.5 mL with an average of 4.8 mL (thoracic: above 3 mL, lumbar: above 4.5 mL); all those multiple vertebral compression fracture were completed at one time. RESULTS AND CONCLUSION: All patients were followed up for at least 6 months (6-30 months). Visual analog scale score and Oswestry disability index score were lower postoperatively (P < 0.01). All patients had complete pain relief postoperatively. One patient had the bone cement symptom of poisoning, bone cement leakage happened in 28 patients, but no severe complication occurred. The bone cement seepage reached to or surpassed the median line of vertebrae in 119 vertebrae (87.2%). Percutaneous vertebralplasty provide significant pain relief in the treatment of osteoporotic vertebral compression fracture; bone cement injected at thin dense time get satisfy seepage. The injection of over three vertebral compression fractures can be finished once. Strict and regular operative technique is the most important method to prevent catastrophic complications caused by bone cement leakage. Related Articles | Metrics

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Multi-segmental cervical ossification of posterior longitudinal ligament treated by posterior decompression and internal fixation of cervical lateral mass screw Hu Zhao-hui, Li Ning-ning, Sun Hong-zhi, Li Xiao-biao, Xie Xiang-tao, Liang Bo-wei, Luo Tong-qing 2011, 15 (30):  5675-5678.  doi: 10.3969/j.issn.1673-8225.2011.30.040 Abstract ( 90 )   PDF (499KB) ( 356 )   Save BACKGROUND: Posterior decompression and lateral mass screw fixation can relieve the compression of ossification foci to the spinal cord and nerve root, expand the sagittal diameter of the the spinal canal. Meanwhile, the stable reconstruction is realized. OBJECTIVE: To verify the clinical efficacy of posterior decompression and internal fixation of cervical lateral mass screw for multi-segmental cervical ossification of posterior longitudinal ligament (OPLL). METHODS: Thirty-six patients with multi-segmental OPLL were treated by cervical posterior decompression and internal fixation of cervical lateral mass screw. Among these patients, 3 cervical segments were involved in 9 cases, 4 in 20 cases, and 5 in 7 cases. RESULTS AND CONCLUSION: All the cases were followed up for 6 months to 26 months. The mean recovery rate based on the scoring system of the Japanese Orthopaedic Association JOA was 51% (from 5.2 score to 10.2 score). The mean cervical physiological curvature was from (3.6±0.5) mm preoperatively to (9.1±0.7) mm postoperatively. No severe complications such as injuries of vertebral artery, nerve root and spinal cord or aggravation of spinal cord injury occurred. The satisfactory decompression of spinal cothe rd can be achieved by total laminectomy for multi-segmental OPLL and the internal fixation cervical lateral mass screw can perfectly reconstruct and maintain the cervical stability. Related Articles | Metrics

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Effects of body position on vital signs and blood oxygen saturation of patients during percutaneous vertebroplasty Lin Xue-yang, Zhang Liang, Gao Liang-bin, Zhang Zhi, Yin Biao 2011, 15 (30):  5679-5683.  doi: 10.3969/j.issn.1673-8225.2011.30.041 Abstract ( 94 )   PDF (719KB) ( 393 )   Save BACKGROUND: Although some scholars have affirmed the effect and safety of lateral position for percutaneous vertebroplasty. But impact of surgical position on the changes in the vital signs during the operation has not been reported. OBJECTIVE: To observe the effects of different body position in vital signs and blood oxygen saturation of patients during percutaneous vertebroplasty. METHODS: Thirty cases of thoracolumbar osteoporotic vertebral compression fractures (OVCF) were divided into two groups randomly: the prone position group (15 cases) and the lateral position group (15 cases), both of them are given local anesthesia for percutaneous vertebroplasty. Record of vital signs and blood oxygen saturation for each patient in the following time points were observed, including supine position before surgery (T1), 5 minutes after body position changing (T2), the process of needle puncturing (T3), the process of injection of bone cement (T4), at the end of bone cement injection (T5), the supine position after surgery for 5 minutes (T6). RESULTS AND CONCLUSION: In the prone position group, the heart rate and respiratory rate were higher than those of the lateral position group (P < 0.05) in the time points including T1, T2, T3, T4, T5. The artery systolic pressure in the prone position group was lower than that of the lateral position group (P < 0.05) in the time points including T2, T3. The blood oxygen saturation in the prone position patients group was lower than that of the lateral group (P < 0.05) in the T5 time point. The above shows that the lateral position has less effect on the patient’s vital signs and oxygen saturation than the prone position, which is also conducive to improve the tolerance operation of patients during the percutaneous vertebroplasty.  Related Articles | Metrics

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Rotating-arm self-locking intramedullary nail for tibial fractures in 29 cases Zhao Wei, Zhang Ji-rong 2011, 15 (30):  5684-5688.  doi: 10.3969/j.issn.1673-8225.2011.30.042 Abstract ( 89 )   PDF (616KB) ( 316 )   Save BACKGROUND: Because of the special nature of anatomical tibial, there are many therapies after fractures and each has its own advantages and disadvantages. There is no an ideal method of internal fixation. OBJECTIVE: To study the clinical efficacy of rotating arm self-locking intramedullary nail (RSIN) fixation on tibial fractures. METHODS: Twenty-nine patients with tibial fractures were selected from Qianxinan Orthopedic Hospital of Guizhou Province, including 26 cases of closed fracture, and 3 cases of open fracture (all GustiloI type). RSIN fixation was used. X-ray observation was performed for fracture healing and complications. RESULTS AND CONCLUSION: All the 29 patients were followed up for 12-24 months. Incision healing reached to phase Ⅰ. After 6 to 18 months, X-ray film showed that fracture line disappeared, callus grew well. Complications such as wound infection, traumatic synovitis, nail loose and nonunion did not occur after surgery. Knee-ankle-joint flexion and extension function and walking were normal. According to Johnr-Wruh standard, among the 29 cases, 11 cases were excellent, 16 cases were good, and 2 cases were middle and the good rate was 93.3%. The results suggest that RSIN fixation is reliable, simple to operate, and has a high rate of fracture healing, which is the ideal method to treat tibial fractures. Related Articles | Metrics

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Delayed union and nonunion associated with obstructive sleep apnea Zhang Jian-guo, Wang Dong, Song Lu 2011, 15 (30):  5689-5692.  doi: 10.3969/j.issn.1673-8225.2011.30.043 Abstract ( 112 )   PDF (621KB) ( 524 )   Save BACKGROUND: Obstructive sleep apnea (OSA) can affect the expression of regulatory proteins associated with bone and/or osteoclasts and bone healing, so the factures are difficult to heal and even aggravated. OBJECTIVE: To observe the association of OSA and nonunion. METHODS: Randomly selected in our hospital from June 2005 to June 2010 were 338 cases of fractures, of which 228 were patients with bone healing and 110 were patients with nonunion (11 cases combined with OSA confirmed by a portable sleep screening instrument). Monitoring data and relevant clinical data were analyzed. RESULTS AND CONCLUSION: Compared to patients with bone healing, OSA prevalence was higher in nonunion patients (P < 0.05), odds ratio(OR)=2.422, 95% confidence index (CI)=0.996-5.891; in the nonunion with OSA group, the healing time was correlated negatively with minimum oxygen saturation during the night (LSaO2) and average oxygen saturation (MSaO2) (r=0.40, 0.38, P < 0.05), and the X-callus score was correlated positively with LSaO2 and MSaO2 (r=0.34, 0.47, P < 0.05).OSA may be the new risk factors of nonunion. Related Articles | Metrics

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Application of three-dimensional CT reconstruction in traumatic atlantoaxial destabilization Yu Hai-long, Xiang Liang-bi 2011, 15 (30):  5693-5696.  doi: 10.3969/j.issn.1673-8225.2011.30.044 Abstract ( 127 )   PDF (783KB) ( 397 )   Save BACKGROUND: The three-dimensional CT reconstruction has an exact role in precise evaluation of complex anatomical structures such as head and neck, spine, pelvis, limbs. OBJECTIVE: To evaluate the three-dimensional CT reconstruction in diagnosis and treatment of traumatic atlantoaxial destabilization. METHODS: Twenty-one cases of traumatic atlantoaxial destabilization were reviewed. Each case was examined with the three-dimensional CT reconstruction to diagnose and analyze traumatic atlantoaxial destabilization and was operated according to the three-dimensional CT reconstruction images. RESULTS AND CONCLUSION: The three-dimensional atlantoaxial images were reconstructed clearly with the three-dimensional CT reconstruction techniques. According to the three-dimensional images, there was no damage to the spinal cord, vertebral artery and nerve root during operation. All patients got healing of bone fracture and bony fusion during follow-up period (6-15 months, averagely 9 months) and the atlantoaxial destabilization was effectively corrected. It is helpful to diagnose and treat  traumatic atlantoaxial destabilization with the three-dimensional CT reconstruction images. Related Articles | Metrics

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Tibial-inlay technique used in reconstruction of posterior cruciate ligament with concomitant ipsilateral tibial shaft fracture in 8 cases Zhang Yi-long, Li Ning, Li Zhi-huai, Liu Jian-feng, Song You-xin, Sun Zhi-jie 2011, 15 (30):  5697-5700.  doi: 10.3969/j.issn.1673-8225.2011.30.045 Abstract ( 85 )   PDF (482KB) ( 267 )   Save BACKGROUND: The reconstruction of posterior cruciate ligament (PCL) by tibial tunnel method is limited in treating PCL tear with concomitant ipsilateral tibial shaft fracture which is operated by internal fixation firstly, because there is the internal fixation in the proximal tibia, which can interfere with the making of tibial tunnel. OBJECTIVE: To evaluate the Tibial-inlay technique effects on reconstruction of PCL combined with concomitant ipsilateral tibial shaft fracture. METHODS: Eight knees with PCL tear and concomitant ipsilateral tibial shaft fracture in 8 patients were verified with physical examination, medical image and arthroscopy. All the damaged PCLs were reconstructed with allograft tendons by Tibial-inlay technique under arthroscopy 1-6 months after the first internal fixation. The instability degree of post draw test and the Lysholm score of the knees were recorded before operations and at follow-up. RESULTS AND CONCLUSION: All of them were followed up for 12 to 24 months. The tibial retropositions of 5 cases were from 10 mm to 15 mm, and those of 3 cases were more than 15 mm before reconstructions. The tibial retropositions of 6 cases were no more than 5 mm, and those of 2 cases were from 5 mm to 10 mm at the final follow-up. The Lysholm score was remarkably improved from 63.50±5.83 preoperatively to 87.50±2.33 at follow-up (P < 0.05). The reconstruction of PCL by Tibial-inlay technique, with regard to PCL tear and concomitant ipsilateral tibial shaft fracture, has advantages of non-limitation by tunnel of proximal tibia, no interference to internal fixation of tibia and reliable satisfactory outcome. Related Articles | Metrics