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    22 January 2013, Volume 17 Issue 4 Previous Issue    Next Issue
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    Whether the cells of different lumbar discs can produce interleukin-1 beta
    Hu Bao-shan, Xu Xi-jun, Guo Yuan-li, Rui Gang
    2013, 17 (4):  571-575.  doi: 10.3969/j.issn.2095-4344.2013.04.001
    Abstract ( 365 )   PDF (446KB) ( 542 )   Save

    BACKGROUND: The studies found that there are cytokines and inflammatory cytokines in the degenerative intervertebral disc, but it is still unknown that whether they come from the outer intervertebral disc or inner intervertebral disc.
    OBJECTIVE: To investigate whether the cells of different lumbar discs can produce inflammatory cytokine interleukin-1β.
    METHODS: The cells of rabbit lumbar disc were isolated and cultured and then identified. The cells were induced with Fn120 fibronectin fragments, and PBS was used in the control group. The expression of interleukin-1β was detected by immunofluorescence method and reverse transcription-PCR.
    RESULTS AND CONCLUSION: In the experimental group, the cartilage cells of intervertebral disc and fibroblasts of annulus fibrosis could produce the interleukin-1β. The results showed that cartilage endplate cells and the fibroblasts of annulus fibrosis can produce interleukin-1β.

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    Interbody fusion and internal fixation for lumbar spondylolisthesis: Changes of spnio-pelvic parameters
    Chen Tao, Jia Shi-qing, Chen Wu, Li Pin-quan
    2013, 17 (4):  576-581.  doi: 10.3969/j.issn.2095-4344.2013.04.002
    Abstract ( 528 )   PDF (402KB) ( 765 )   Save

    BACKGROUND: Abnormality of spnio-pelvic parameters is closely related to the occurrence and progress of lumbar spondylolisthesis.
    OBJECTIVE: To explore the change and clinical significance of spino-pelvic parameters in lumbar spondylolisthesis patients after internal fixation.
    METHODS: A retrospective analysis was conducted on 60 patients with lumbar spondylolisthesis undergoing posterior lumbar interbody fusion and internal fixation. The pre-and post-operative lumbarlordosis, pelvic projectional angle, sacralslope angle, pelvic tilting angle, sagittal balance, slip degree, slip angle and height of intervertebral disc were measured on X-ray film. These parameters were analyzed using t-test between pre- and post-operation. Linear correlations between these parameters were analyzed.
    RESULTS AND CONCLUSION: There were significant differences between pre- and post-operative slip degree, slip angle, height of intervertebral disc, lumbar lordosis, pelvic tilting, sacral slope and sagittal balance (P < 0.01). The restoration of height of intervertebral disc showed significant correlation with the change of lumbar lordosis, pelvic tilting, sacral slope, slip degree and slip angle. The change of lumbar lordosis was significantly correlated with the change of slip angle, slip degree, pelvic tilting and sacral slope. It indicates that posterior lumbar interbody fusion and internal fixation can significantly improve the sacral slope, pelvic tilting, lumbar lordosis and sagittal balance of the patients with lumbar spondylolisthesis. Therefore, when treating lumbar spondylolisthesis patients with posterior lumbar interbody fusion and internal fixation, compensatory mode of pelvis with different pelvic projectional angles must be considered, and surgical surgeons should restore the height of intervertebral disc individually.

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    External spinal fixation and percutaneous vertebroplasty using bone cement for thoracolumbar fracture in the elderly
    Peng Cheng-zhong, Zhou Chun-fang, Zeng Zhao, Zhang Yong-jun
    2013, 17 (4):  582-587.  doi: 10.3969/j.issn.2095-4344.2013.04.003
    Abstract ( 763 )   PDF (487KB) ( 775 )   Save

    BACKGROUND: Treatment of thoracolumbar fracture with open reduction and internal fixation has been used widely. It is bleeding and injury. As a new technology in the field of minimally invasive, application of external fixation has been aroused wide concern in spinal fractuers.
    OBJECTIVE: To explore the clinical effect for the treatment of thoracolumbar fracture of the elderly with external fixation and percutaneous vertebroplasty.
    METHODS: Thirty-three patients of thoracolumbar compression fractures of the elderly were treated by using spinal external fixator and percutaneous vertebroplasty from January 2009 to January 2012. The patients were treated with spinal external fixator and then treated with percutaneous vertebroplasty. The changes of Cobb angle, anterior height of the vertebral body, the rate of spinal stenosis and visual analogue scale score were measured before and after operation and last follow-up. The clinical effect was observed during follow-up.
    RESULTS AND CONCLUSION: The anterior height of the vertebral body, Cobb angle, rate of spinalstenosis and visual analogue scale score post-operation and last follow-up were improved when compared with those pre-operation, and the difference was significant (P < 0.01). There were no significant differences in the indicators above (except visual analogue scale score) between post-operation and last follow-up (P > 0.05). Four patients had bone cement leakage; one had cerebro-spinal fluid leakage (healing after tight suture). Spinal external fixator combined with percutaneous vertebroplasty is a safe and an effective mini-trauma method for the treatment of thoracolumbar fracture of the elderly.

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    Three-dimensional parametric modeling during unicompartmental knee arthroplasty
    Chen Zhen-qiu, Zhang Qiu-xia, Zhou Guang-quan, Pang Zhi-hui, Wei Qiu-shi
    2013, 17 (4):  588-593.  doi: 10.3969/j.issn.2095-4344.2013.04.004
    Abstract ( 349 )   PDF (541KB) ( 623 )   Save

    BACKGROUND: The models of unicompartmental keen athroplasty used for the surgical training and drilling cannot meet the individual requirements due to the size and the fixation.
    OBJECTIVE: To provide a three-dimensional parametric modeling method for the digital research ofunicompartmental keen athroplasty.
    METHODS: The three-dimensional knee arthritis model was established by three-dimensional reconstruction technique, then, a unicompartmental prosthesis which matched with the osseous model was designed with parametric software Pro/e 5.0. At last, unicompartmental keen athroplasty was simulated and the three-dimensional finite element analysis was performed.
    RESULTS AND CONCLUSION: Three-dimensional parameteric modeling method was high-performance, and it could make the design of unicompartmental prosthesis automated and high-performanced. The model established based on three-dimensional parametric modeling method had realistic shape and high precision. Three-dimensional parameteric modeling method provides new model-basis and experimental ideas for biomechanical study of unicompartmental keen athroplasty.

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    Application of “reinforced concrete” in acetabular reconstruction
    Wang Zi-fu, Shang Xi-fu
    2013, 17 (4):  594-598.  doi: 0.3969/j.issn.2095-4344.2013.04.005
    Abstract ( 354 )   PDF (457KB) ( 622 )   Save

    BACKGROUND: In total hip arthroplasty, acetabular defects are common, for the reconstruction of a stable and solid acetabulum, the acetabular reconstruction is often required during the replacement process.
    OBJECTIVE: To investigate the early effect of the short term results of titanium mesh fixed by screws combined with a cemented acetabular cup in acetabular reconstruction.
    METHODS: Twenty-three patients treated with acetabular reconstruction by screw fixed titanium mesh combined with a cemented acetabular cup were selected. The pain history was 1 to 3 years. Harris scores before operation were 20-48 with an average score of 34. X-ray plain film was used to evaluate theacetabular prosthesis loosening standards after reconstruction for the radiographic evaluation and Harris score of regular follow-up.
    RESULTS AND CONCLUSION: All the patients were followed-up for 1-3 years and average in 24 months without losing. The Harris score at 3 months after operation was higher than that before operation, and the hip activity at 2 years after operation was higher than that before operation, and the difference was significant (P < 0.05). Two patients still had leg length discrepancy, one patient with dislocation after squatting, and recovered after conservative treatment. The last follow-up showed there were no early infection, dislocation and pelvic discomfort. Radiographic results showed that there was no aseptic loosening and displacement of the acetabular cap and there was no fracture on titanium mesh. Screw fixed titanium mesh combined with a cemented cup is satisfactory process in the treatment of hip revision in over 65 years old patients, and the long-term effects are needed to be further followed-up and observed.

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    Early evaluation of one-stage bilateral knee joint and unilateral knee joint replacement
    Fang Rui, Liang Zhi-quan, Meng Qing-cai
    2013, 17 (4):  599-603.  doi: 10.3969/j.issn.2095-4344.2013.04.006
    Abstract ( 500 )   PDF (369KB) ( 616 )   Save

    BACKGROUND: There is a controversy on one-stage bilateral knee joint and unilateral knee joint replacement.
    OBJECTIVE: To evaluate early clinical efficacy and SF-36 health survey differences on the patients with bilateral knee disease after bilateral knee joint replacement and selective unilateral knee joint replacement.
    METHODS: A total of 144 patients (190 knees) were treated with bilateral knee joint replacement (bilateral group) and selective unilateral knee joint replacement (unilateral group), the prostheses were made by Smith & Nephew (GenesisTM ‖ smith & nephew). The range of motion, hospital for special surgery (HSS) score and visual analogous scale score, as well as the postoperative complications and postoperative SF-36 survey results were observed.
    RESULTS AND CONCLUSION: After one-year follow-up, 9 cases were lost and 135 patients entered the final analysis. In the bilateral group, there was 1 case of transient peroneal nerve palsy, 1 case of acquired immunodeficiency syndrome and 1 case of poor wound healing; in unilateral group, there were 2 cases of poor wound healing. At 1 year after replacement, SF-36 survey results showed that there was a significant difference of physiological function between two groups (P < 0.05), and there was no significant difference of the other seven factors between two groups (P > 0.05); there was no significant difference of range of motion and HSS score between two groups (P > 0.05); the visual analogous scale score in the bilateral group was lower than that in the unilateral group (P < 0.05). Results show that the early visual analogous scale score in the bilateral group is lower than that in the unilateral group, however, there is no significant difference of the SF-36 survey, HSS score and range of motion between two groups.

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    Augmentation plating with bone grafting for nonunions of femoral shaft fractures after intramedullary nail fixation
    Ru Jiang-ying, Cang Hai-bin, Hu Chuan-liang, Hu Yu-hua
    2013, 17 (4):  604-611.  doi: 10.3969/j.issn.2095-4344.2013.04.007
    Abstract ( 510 )   PDF (560KB) ( 692 )   Save

    BACKGROUND: For the patients with nonunions of femoral shaft comminuted fractures, non-isthmus and bone defects after treated with intramedullary nail fixation, the clinical efficacy of replacing the intramedullary nail is not satisfactory.
    OBJECTIVE: To observe the therapeutic effect of augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedullary nail fixation through a retrospective analysis of 18 cases.
    METHOIDS: All the 18 cases with aseptic nonunions of femoral shaft fractures after intramedullary nail fixation were selected from Jiangsu Provincial Corps Hospital of the Chinese People’s Armed Police Force from April 2001 to June 2011. All patients retained the original intramedullary nail, augmentation plating of 6 to 11 holes dynamic compression plate or locking compression plate, wrenching 2 to 4 screws (locking or common, single or double cortex) in the proximal or distal end. All cases undertook the autogenoas iliac crest bone grafting at the same time. The follow-up results were used to observe the fracture healing of the patients. The clinical effect of augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedullary nail fixation was evaluated according to the Tohner-Wrnch standard.
    RESULTS AND CONCLUSION: All cases were followed-up for 6-21 months, average in 16 months. X-ray film showed that the bone healing rate was 100%; among the cases, 13 cases achieved osseous union within 6-9 months, while the other five patients achieved osseous union within 10-11 months. Tohner-Wrnch standard assessment results showed the bone healing rate of augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedullary nail fixation was 100%, no corrosion, breakage or hosting reaction of implant was found in all patients. Retaining the original intramedullary nail and augmentation plating with bone grafting for aseptic nonunions of femor

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    Finite element analysis of different tibial shaft fracture fixed by Locking compression plate under different movement gait
    Li Yun-gang, Chen Wei-jian, Li Gui-tao, Sun Hong-tao, Yan Jian-hao, Wang Xiong-chang, Wang Jing
    2013, 17 (4):  612-619.  doi: 10.3969/j.issn.2095-4344.2013.04.008
    Abstract ( 404 )   PDF (583KB) ( 704 )   Save

    BACKGROUND: In recent years, the finite element analysis has been widely used in the mechanical analysis of human fracture internal fixation model, but studies on the finite element analysis are often under the static state, the reports on the finite element analysis under physiological state are few.
    OBJECTIVE: To explore the stress distribution of different tibial shaft fractures fixed by locking compression plate under different movement gaits through three-dimensional finite element analysis.
    METHODS: CT scan was performed to obtain the thin layer scanning image of normal adult tibiofibula and foot; three-dimensional models were established by relative software, and then transverse, oblique, spiral, comminuted fractures were imitated on the models and combined with the locking plate to generate the experimental models. The models in each group were subjected to the same axial compression load of 600 N. The stress distribution of the models under heel-strike phase, the midstance phase and the push-off phase was analyzed with software Ansys 12.0.
    RESULTS AND CONCLUSION: Under this experimental model, the stress distribution of tibia in four groups from small to large was heel-strike phase < midstance phase < push-off phase; the stress distribution of locking compression plate in the tibial transverse, oblique and comminuted fractures from small to large was the midstance phase < the heel-strike phase < the push-off phase; stress distribution of locking compression plate in the tibial spiral fracture group from small to large was the push-off phase < the midstance phase < the heel-strike phase. Under the physiological state, the largest stress of the locking compression plate and the tibia were in the push-off phase. The stress distribution of the locking compression plate focused on the middle or edge of itself; while the stress distribution of the tibia focused on the proximal end above the fracture line and on the end under the fracture line. From the overall of the tibia, the stress distribution focused on both ends, and scattered on the middle.

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    Finite element model of rabbit tibial fracture
    Li Xiao-lin, Ren Bo-xu, Xu Zi-sheng
    2013, 17 (4):  620-624.  doi: 10.3969/j.issn.2095-4344.2013.04.009
    Abstract ( 409 )   PDF (442KB) ( 552 )   Save

    BACKGROUND: The original data of the medical biomechanics finite element analysis often come from body CT images. Wide range CT scanning can cause damage to human.
    OBJECTIVE: To establish a three-dimensional finite element model of rabbit tibial fracture.
    METHODS: A 1-year-old male New Zealand white rabbit was selected, sawing the middle of the left tibia by surgery. Reading the 135-layer of 0.625 mm thick consecutive CT DICOM3.0 format images of rabbit left tibial with the MIMICS10.01 software directly. The surface mesh model was established by images positioning, images organizing, interpolated processing and surface smoothing processing, then the meshmodel was introduced into ANSYS10.0 software directly to mesh body, and then transferred the body mesh to MIMICS10.01 for assignment on the basis of CT values.
    RESULTS AND CONCLUSION: A realistic appearance and calculation accuracy three-dimensional finite element model of rabbit tibial fracture was established. The model was real and effective by applying load and analyzing. The result showed the three-dimensional finite element model of rabbit tibial fracture could be made faster and more accurate by applying MIMICS10.01 software and ANSYS10.0 software. The establishment of the model lays a foundation for rabbit further biomechanical analysis of fracture healing.

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    Comparison between cross-sectional anatomy and CT scanning for observing thoracolumbar vertebrae structure
    Gong Teng, Wang Jing-gui
    2013, 17 (4):  625-632.  doi: 10.3969/j.issn.2095-4344.2013.04.010
    Abstract ( 516 )   PDF (601KB) ( 560 )   Save

    BACKGROUND: Simple CT three-dimensional reconstruction data cannot keep safety of the surgery completely, and celloidin embedding cross-sectional slice has been widely used in the research on skull, fossa orbitalis and knee joint. There are few reports on the spinal cross-section slice treated with celloidin embedding.
    OBJECTIVE: To investigate the diagnostic value of sectional slices and CT scanning three-dimensional reconstruction in observing and measuring structural parameters of thoracolumbar intervertebrae.
    METHODS: Forty adult thoracolumbar vertebrae specimens were enrolled for CT scanning and reconstruction, and the anatomic parameters were measured with imageology software called ‘e-flim’. Meanwhile, above-mentioned samples were made into serially coronal, sagittal and horizontal sections with upgraded celloidin embedding technique. Corresponding anatomic features were surveyed and re-established via Amira4.1 software.
    RESULTS AND CONCLUSION: Sectional slices were more convenient for direct-viewing the adjacent relationship of individual structures which exist in vertebral canal or intervertebral canal than CT two-dimensional images; there were significant differences in measuring height, width of intervertebral canals, oblique diameter of vertebral canal and diameter of spinal cord between two methods; there was no significant difference in measuring the length of intervertebral canal, vertical and transverse diameter of vertebral pedicle. Due to the influence of soft tissue or bone window width, window level and resolving power, the CT two-dimensional images could not precisely identify the structure of soft tissues, however, sectional slices cold distinctly discriminate the distribution of lumbosacral spinal cord, nerve root, accompanying vessel, intervertebral canal ligament, etc. Reconstruction for sectional slices could clearly identify the osseous structure and non-osseous structure, and helpful to observe the different structure parameters of vertebral canal or intervertebral canal adhered with soft tissues, while the CT scanning reconstruction can only observe the parameters of bone architecture. But the bone architecture data observed by these two methods were similar. CT scanning and sectional slice reconstruction showed the same results in observing simultaneous variation of target structures.

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    Interrelationship between location phase and opening morphologic parameters of acetabulum evaluated with multislice spiral CT
    Shu Rong-bao, Luo Xiao, He Fang
    2013, 17 (4):  633-638.  doi: 10.3969/j.issn.2095-4344.2013.04.011
    Abstract ( 445 )   PDF (458KB) ( 605 )   Save

    BACKGROUND: The improper selection of phase and sizes of acetabular cup of total hip arthroplasty can cause fixation failure of the acetabular component.
    OBJECTIVE: To analyze the interrelationship between location phase and opening morphologic parameters of acetabular with multislice CT.
    METHODS: The normal hip joints of 63 patients (126 hips) were selected in the study, removed the femoral head to observe the morphology of the acetabular anterior and posterior wall on CT reformation VR image,the center of the acetabulum levels of the MPR standard coronal and axial CT image were measured, including acetabular ridge height difference posterior and anterior, anteroposterior diameter, anteversion angle, suprainferior diameter, transverse diameter, the abduction angle, and the difference between left and right side, male and female, as well as the parameters with the same gender and different ages were analyzed. The correlation and regression analysis was used to draw the interrelationship between location phase and opening morphologic parameters of acetabular rim.
    RESULTS AND CONCLUSION: Anterior acetabular ridge shapes were divided into curved type (54/126, 44.44%), linear type (30/126, 23.80%), irregular angles type (22/129, 17.46%) and angled type (18/126, 14.28%). There was no significant difference of the location phase and opening morphologic parameters of acetabular rim between different sides and ages (P > 0.05). The suprainferior diameter and anteroposterior diameter of male patients were significantly larger than those in female patients (P < 0.01), but there were no significant differences of abduction angle and anteversion angle between different genders (P > 0.05). The anteversion angle of male and female patients was positive correlated with acetabular ridge height difference posterior and anterior and suprainferior diameter, but the abduction angle was negative correlated with the transverse diameter. The anteversion angle and the acetabular ridge height difference posterior and anterior was highly correlated, significantly lowly correlated with the anteroposterior diameter, and the anteversion angle≈acetabular ridge height difference posterior and anterior numerically; the male anteroposterior diameter was positive correlated with suprainferior diameter and transverse diameter, the female abduction angle was significantly positive correlated with anteroposterior diameter. The remaining parameters were not obvious. There was correlation between acetabular opening morphological parameters and location phase which matched with each other and had guidance effect on the design of acetabular prosthesis and formulation of total hip arthroplasty.

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    Accuracy and reliability of peripheral stepping angiography for full lower extremity alignment measurement
    Wu Hao1, Shi Ze-feng, Li Rong-zhu, Yin Dong, Zhou Yan-fang, Dong Hui-ping, Liang Hong, Chen Jun
    2013, 17 (4):  639-646.  doi: 10.3969/j.issn.2095-4344.2013.04.012
    Abstract ( 375 )   PDF (341KB) ( 545 )   Save

    BACKGROUND: Accurate and reliable measurement of full lower extremity alignment is very important for preoperative planning and postoperative assessment in corrective knee surgery such as high tibial osteotomies and arthroplasties.
    OBJECTIVE: To discuss the effectiveness of peripheral stepping angiography disposable exposure imaging method for full lower extremity alignment measurement.
    METHODS: The full lower extremity alignment images of 13 patients suffered from knee osteoarthritis and varus were obtained by the peripheral stepping angiography. Two ways of images were taken, standing and supine position. Orthopedic surgeons measured the angle of limb alignment using a protractor on hard-copy X-ray radiographs, while radiologists measured the angle of limb alignment on the computer screen. Differences and the correlation coefficient research between the data were performed.
    RESULTS AND CONCLUSION: The peripheral stepping angiography disposable exposure imaging method for full lower extremity alignment measurement had high accuracy and reliability, and there was good correlation between manual measurement and computer-assisted digital image measurement (r=0.638-0.975). Peripheral stepping angiography for

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    Changes of the structure of normal female pelvic floors based on magnetic resonance imaging at rest and during maximal pelvic strain
    Han Yuan-yuan, Li Yong, Zhong Jing-lian, Pan Heng, Wang Dong-ye, Shi Jie
    2013, 17 (4):  647-652.  doi: 10.3969/j.issn.2095-4344.2013.04.013
    Abstract ( 442 )   PDF (439KB) ( 574 )   Save

    BACKGROUND: Magnetic resonance imaging can accurately evaluate the entire structure of pelvic floor due to its advantages of non-radioactivity, good soft tissue contrast and multi-level and multi-axial scan imaging.
    OBJECTIVE: To study the changes of structure of normal female pelvic floors based on magnetic resonance imaging at rest and during maximal pelvic strain in order to establish normal criteria for the evaluation of pelvic floor dysfunction.
    METHODS: Twenty-three asymptomatic female and female patients with other pelvic disorders were examined with pelvic dynamic magnetic resonance imaging at rest and during maximal pelvic strain. The distance of bladder neck, cervix and the anorectal to pubococcygeal line in different conditions in mid-sagittal plane, and the length of H-line (from anorectal to the lower edge of pubic symphysis) and M-line (from anorectal to pubococcygeal line) of the HMO system were measured, the change of the levator angle in coronal plane through the middle of the anal canal, and the change of the area of diaphragmatic hiatus in the axial view through the lower edge of pubic symphysis were measured.
    RESULTS AND CONCLUSION: Compared with rest condition, the connections of bladder neck, cervix and the anorectal were decreased during maximal pelvic strain; the levator angle and the area of diaphragmatic hiatus were increased during maximal pelvic strain; the length of H-line and M-line was slightly increased during maximal pelvic strain, and there was significant difference (P < 0.05). The position of the pelvic organs of normal female at rest and during maximal pelvic strain changed, in the pubococcygeal line system and HMO system measurement, the decreasing degree of pelvic organs was not more than the normal range degree. In pelvic dynamic magnetic resonance imaging, the levator angle and the area of diaphragmatic hiatus were slightly increased.

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    Detection of ST segment in electrocardiogram signal based on two-dimensional cloudy model theory
    Liu Xin-xu, Su Zhi-jian, Gao Zhen-kui, Liu Yan-tao, Xia Zhen-hong, Liu Na
    2013, 17 (4):  653-657.  doi: 10.3969/j.issn.2095-4344.2013.04.014
    Abstract ( 415 )   PDF (456KB) ( 547 )   Save

    BACKGROUND: There is no precise classificated mathematical model and identification standard for the morphological characteristics of abnormal ST segment, and therefore, the improvement of automatical recognization will be limited in some cardiovascular diseases diagnoses.
    OBJECTIVE: To find a new method meeting the medical diagnosis logical thinking for analyzing the ST segment in electrocardiogram signal, and to provide new ideas for real-time analysis of the changes ofelectrocardiogram of ST segment.
    METHODS: A new algorithm for detecting ST segment in electrocardiogram signal based on two-dimensional cloudy model theory was proposed in view of the fuzziness and randomness of electrocardiogram signal. And then, it estimated the membership grade of two-dimensional cloud generator and identified the morphology of ST segment in electrocardiogram.
    RESULTS AND DISCUSSION: The algorithm was simulated with Matlab, and the algorithm accuracy was verified by standard ECG database (European Community CSE database). The statistical results showed that the algorithm had a high identification rate of ST segment, and it was shortcut and effective for processing the large amount of data which provide a new method for the accurate analysis of the ST segment.

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    Optimization design of posterior lumbar interbody fusion cage
    Li Qing-chun, Qin Ge-ji, Qiao Zhen, Liu Da-cheng, Li Tong, Huang Yong-ling
    2013, 17 (4):  658-662.  doi: 10.3969/j.issn.2095-4344.2013.04.015
    Abstract ( 358 )   PDF (566KB) ( 759 )   Save

    BACKGROUND: Posterior lumbar interbody fusion cage is one of the main means for the treatment of disc disease. The application of posterior lumbar interbody fusion can cause cage subsidence and othercomplications due to improper design, besides improper indication selection and improper surgical operation.
    OBJECTIVE: To optimize the cage design by reviewing the development of cage and concluding the other scholars’ biomechanical research on the application of posterior lumbar interbody fusion cage.
    METHODS: A computer-based searched was performed in CNKI full-text database for the articles on optimize design of posterior lumbar interbody fusion cage from January 1990 to February 2012. The key words were “posterior lumbar interbody fusion cage, sinkage, design, bone graft fusion, biomechanical”. The literatures of irrelevant purpose and repetitive content were eliminated, and then 18 literatures were included and checked the Modern Spine Surgery and Spinal Internal Fixation Operation and other related books for further analysis.
    RESULTS AND CONCLUSION: After optimization, the cage implanted in the interbody could acquire sufficient strength, which can support the end-plate and prevent cage from the early subsiding within the vertebral body. At the same time, the optimization can greatly increase the fusion area, further reduce the stress shielding, improve the fusion rate, accelerate the fusion process, reduce the subsidence, displacement and other complications, and all this will get a satisfactory clinical effect.

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    Research progress of the fixity and fixation method for tibia and fibula fracture
    Xu Jia-ming, Ai Zi-sheng, Zhang Chang-qing
    2013, 17 (4):  663-671.  doi: 10.3969/j.issn.2095-4344.2013.04.016
    Abstract ( 581 )   PDF (714KB) ( 960 )   Save

    BACKGROUND: Studies have shown that there is a controversy between blood supply and the fast fracture fixation. Selection of the suitable fixation method for the patients with tibia and fibula fracture is the important issue in face of every clinician.
    OBJECTIVE: To review various types of research literatures on tibia and fibula fracture fixation in recent years, in order to provide reference and evaluation criteria for objective and reasonable selection of tibia and fibula fracture fixation method.
    METHODS: A computer-based online search was performed in the PubMed database and the China National Knowledge Infrastructure database for the clinical and basic experimental research papers on the surgical fixation of tibia and fibula fracture from January 1990 to May 2012. The key words were “tibiofibular fracture, fixation method, research progress” in Chinese and English. The articles published earlier and repetitive researches were excluded.
    RESULTS AND CONCLUSION: ①Due to the special anatomy structure and physiologic function of tibia and fibula, the first step in the treatment of the fracture is to consider how to balance the blood supply and stability, and the functional exercise must be practiced as soon as possible after fixation, which will rely on a stable fixation in a large extent. ②Various factors for the adequate fixation of tibia and fibula fractures need to be considered, according to the fracture site, tibia and fibula fracture type, the degree of contamination and the degree of soft tissue injury. ③Strictly implement and understanding of the AO and biological fracture fixation improvement theory is very important. A new range of steel plate and external fixator also worth for study and the application of the external fixator combined with limited internal fixation as well as the sequential therapy require further study with large amount samples. ④Arthroscopy or arthroplasty for severe cases of replace difficulties or joint injury can effectively improve fracture prognosis and postoperative life. The indirect reduction technique of percutaneous plate osteosynthesis indirect reduction can reduce the poor wound healing, infection, delayed union and nonunion, and it is gradually become the best choice for comminuted fracture of the distal tibia, while with the biological osteosynthesis principle designed locking compression plate equipment to make percutaneous plate osteosynthesis a worth to be promoted fixation technique.

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    Different limb salvage reconstruction methods for limb malignant bone tumor
    Li Yong-hong, Yu Xin-sheng, Yang Huai-he
    2013, 17 (4):  672-677.  doi: 10.3969/j.issn.2095-4344.2013.04.017
    Abstract ( 614 )   PDF (604KB) ( 563 )   Save

    BACKGROUND: At present, the salvage treatment has become the standard method for the treatment of limbs malignant bone tumor, and the purpose of the surgery is not only to improve the survival rate, but also to save the good limb function.
    OBJECTIVE: To review several salvage treatments, such as artificial joint replacement and allograft bone graft for the treatment of limbs malignant bone tumor.
    METHODS: The PubMed database from January 1992 to October 2012 and China National Knowledge Infrastructure database from January 1994 to December 2012 were searched by the first author for the articles on the treatment of malignant bone tumor with salvage treatment with the key words of “malignant bone tumor, salvage treatment, allograft bone graft, prosthesis and microwave” in English and Chinese. The repetitive articles and the Meta analysis were eliminated, and finally, a total of 31 articles were included for the review.
    RESULTS AND CONCLUSION: ①For the malignant bone tumor on limbs, especially around the joint, the artificial joint replacement, allograft bone graft and microwave inactivation treatment were the main methods. ②The allograft bone graft has a high complication incidence, and the microwave inactivation has new progress. The new progress needs further research. ③Tumor segment devitalization and replantation and alcoholic devitalization and replantation are more applicable to the primary hospital.

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    Evaluation on X-ray measurement methods of hallux valgus angle and 1-2 intermetatarsal angle after hallux valgus surgery
    Sun Wei-dong, Wu Shou-chang, Wen Jian-min
    2013, 17 (4):  678-682.  doi: 10.3969/j.issn.2095-4344.2013.04.018
    Abstract ( 409 )   PDF (629KB) ( 463 )   Save

    BACKGROUND: The key to the measurement of hallux valgus angle and 1-2 intermetatarsal angle after hallux valgus after surgery is to determine the first metatarsal axis. Different methods to determine the axis of the first metatarsal result in the difference values of two angles. That lead the measurement data incomparable between different clinical studies. At present, there have no recognized standard method at home and abroad on X-ray measurement methods of hallux valgus after surgery.
    OBJECTIVE: To review the progress of different measurement methods of hallux valgus angle and 1-2 intermetatarsal angle after hallux valgus surgery and to provide a reference for the measurement and evaluation after hallux valgus surgery.
    METHODS: An online search was performed on PubMed database, China National Knowledge Infrastructure database and Wanfang database by the first author for literatures in February 2012. The key words were “hallux valgus, angles, radiographic measurements” in English and Chinese. A total of 29 articles were included to summarize.
    RESULTS AND CONCLUSION: The point must be easy to determine and repeatability, it should avoid the impact of the osteotomy site and anatomic variations of metatarsal. That would be the best measurement. At present, the center head/center base measurement method is used widely in the X-ray measurement methods after hallux valgus surgery. It would be a growing trend that the measurement of professional software taking over the manual measurement in X-ray measurement after hallux valgus surgery.

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    Image synthesis of the cone projection based on C-arm super short scan path
    Xie Qin, Li Zi-qiang, Yan Shi-ju
    2013, 17 (4):  683-687.  doi: 10.3969/j.issn.2095-4344.2013.04.019
    Abstract ( 393 )   PDF (629KB) ( 608 )   Save

    BACKGROUND: The merit of CT imaging quality not only depends on the precision and advance of the instrument, but also depends on the reconstruction algorithm. Developing from the two dimensional fan bunch scan to the three-dimensional cone bunch scan is the development trend of CT technology. Therefore, looking for a suitable cone bunch reconstruction algorithm has a great significance.
    OBJECTIVE: To explore the cone projection image synthesis based on C-arm super short scan path in order to provide the algorithm support for the realization of C-arm based two-dimensional projection image and three-dimensional model rebuilding.
    METHODS: The PubMed database, CNKI database and Wanfang database were searched by the first author from March 2012 to May 2012 for the related articles published from 1990 to 2011. The key words were “C-arm, super short scan path, FDK algorithm, limited cone angle of three-dimensional reconstruction, super short scanning fan bunch of reconstruction algorithm”, the language of the retrieved articles were Chinese and English. A total of 58 articles were obtained after initial screen, and finally 19 articles that met the inclusion criteria were included.
    RESULTS AND CONCLUSION: The three-dimensional model reconstruction based on C-arm two-dimensional projection image must be treated with three-dimensional model reconstruction. Currently, the most widely used three-dimensional image reconstruction method was FDK algorithm. However, the FDK algorithm only suitable for the whole pathway, and cannot directly used for super short scan path. The short scanning trajectory FDK cone bunch reconstruction algorithm obtained through extending the two-dimensional fan bunch reconstruction algorithm to the three-dimensional space could reconstruct the interest region of the collected cone bunch projection data. Future studies may explore the effect of noise reducing and other interference data on the reconstruction quality.

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    Locking plate for the treatment of 3-part and 4-part fracture of proximal humerus
    He Xiao-jian, Zhuang Jian, Zhou Kai-hua, Chen Ming-ji, Gao Ru-feng, Zheng Fen, Pan Fu-gen
    2013, 17 (4):  688-695.  doi: 10.3969/j.issn.2095-4344.2013.04.020
    Abstract ( 550 )   PDF (671KB) ( 633 )   Save

    BACKGROUND: The locking plate is a new type of internal fixation plates which can improve the clinical treatment effect of proximal humeral fractures.
    OBJECTIVE: To explore the effect of locking plate fixation for the treatment of 3-part and 4-part fracture of proximal humerus, and to explore the incidence of complications.
    METHODS: Thirty-one proximal humeral fracture patients (13 males and 18 females, aged from 28 years to 81 years, averaged in 56.4 years) treated with locking plate fixation were selected from Department ofOrthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University between January 2008 and December 2009. The clinical data of the 31 patients was retrospectively analyzed. The type of fracture was classified with Neer classification, and found that 19 patients had 3-part fracture and 12 patients had 4-part fracture. The internal fixation was performed with pectoralis major deltoid interscalene approach and then the proximal humeral locking plate fixation was performed. The literatures on the locking plate for the treatment of 3-part and 4-part fracture of proximal humerus were searched to analyze the incidence of complications. The efficacy of clinical cases and in the incidence of complications the retrieved documents were comprehensively analyzed, and the features of locking plate for the treatment of 3-part and 4-part fracture of proximal humerus were obtained.
    RESULTS AND CONCLUSION: All the 31 patients mentioned above were followed-up for 13-49 months, average in 19.8 months. The fracture of all the patients were healed without fixation failure and the clinical healing time was 8-16 months. The shoulder function was assessed according to the Constant assessment criteria, and found that excellent in 11 patients, good in 16 patients, average in 3 patients and poor in 1 patient. Locking plate fixation is the reliable and effective method for the treatment of 3-part and 4-part fracture of proximal humerus. But the screw loosening, humeral head necrosis and other related complications may also occur. Therefore, we should pay attention to protect the blood supply of the humeral head during fixation and reset the medial humeral neck fracture and firmly fixed, in order to reduce the complications and improve the treatment effect of fixation.

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    Intramedullary nail internal fixation for the treatment of humeral fracture
    Wang Yi-min, Xu Kai-ming, Huang Xing-zhong, Huang Ai-jun, Li Zhong-tan, Ma Shu-qiang
    2013, 17 (4):  696-703.  doi: 10.3969/j.issn.2095-4344.2013.04.021
    Abstract ( 802 )   PDF (786KB) ( 601 )   Save

    BACKGROUND: At present, for the treatment of humeral fracture, there has not yet been formed uniform treatment mode which is fixed and accepted by most scholars, and there are disagreements on the indications and surgical timing of humeral fracture treated with intramedullary nail internal fixation.
    OBJECTIVE: To analyze the pathological anatomy, healing process and injury typing of humeral fracture and to investigate the indications and surgical timing of humeral fracture treated with intramedullary nail internal fixation.
    METHODS: The purpose of the treatment of complex humeral fractures was to restore the necessary functional or anatomical bits, achieve stable fixation and placement, thus get the early-stage functional exercise. The articles concerning the treatment of humeral fractures with intramedullary nail internal fixationwere summarized to find out the cases with the similar treatment objects and the same curative effect evaluation criteria for the comparative study, in order to provide basis for the clinical treatment of humeral fractures.
    RESULTS AND CONCLUSION: For the treatment of humeral fractures, it is important to critically assess the type of fracture and bone quality and to select the suitable intramedullary nail during the treatment of humeral fractures. Understanding the type of intramedullary nail and the manner of internal fixation, recognizing the value of different types of intramedullary nail placement for the treatment of humeral fractures as well as taking the effective measures to prevent the related complications during the treatment of humeral fractures with intramedullary nail internal fixation can help to obtain the satisfactory results during the treatment of humeral fractures.

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    Mechanical analysis of metal implants for the treatment of humeral condylar fractures
    Yang Jia-de, Chen Gui-rong, Zhang You-wen
    2013, 17 (4):  704-711.  doi: 10.3969/j.issn.2095-4344.2013.04.022
    Abstract ( 543 )   PDF (836KB) ( 781 )   Save

    BACKGROUND: Humeral condylar fracture is a kind of trauma fracture that difficult to deal, and caused with direct or indirect violence. Internal fixation is the commonly used surgical treatment method.
    OBJECTIVE: To explore the mechanical characteristics of humeral condylar fracture after treated with different metal implants as well as the elbow function after treated with different methods.
    METHODS: Thirty-two child patients with supracondylar Gartland Ⅲ fractures and treated with crossKirschner wire fixation were selected from May 2005 to August 2010. All the patients were treated with osterior incision cross Kirschner wire fixation and antecubital “8” bandage wrapping fixation through elbow rear single incision approach. The downstream fracture was treated withanatomic reduction and cross Kirschner wire fixation. Antecubital “8” bandage wrapping fixation was performed after operation.
    RESULTS AND CONCLUSION: All the 32 patients were followed-up for 10-28 months, average, in 14 months, and the fracture was healed at 4-7 weeks. According to the Flynn assessment standards, excellent in 19 patients, good in 11 patients, average in 2 patients, and the excellent and good rate was 93.75%. The posterior approach of elbow fully revealed the fracture site, easy for anatomic reduction and easy for Kirschner wire to accurate drill into the fracture site and fixation. And the antecubital “8” bandage wrapping fixation after operation can help to obtain the better efficacy. Due to the mechanics characteristics of humeral condylar fracture, the metal implants treatment should be performed in accordance with the patient’s actual condition, for example, the humeral condylar comminuted fracture should be treated with cross Kirschner wire fixation and the small condylar fracture should be treated with plate internal fixation.

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    Clinical application of absorbable materials in the fracture fixa
    Wang Yong-ping, Liu Xiao-rong, Jiang Yao
    2013, 17 (4):  712-719.  doi: 10.3969/j.issn.2095-4344.2013.04.023
    Abstract ( 634 )   PDF (773KB) ( 1154 )   Save

    BACKGROUND: It is important to select the suitable fixity for the treatment of fractures, otherwise, it is easy to lead to the treatment failure. In clinic, the fixity used for the treatment of fractures is mainly the metal materials, but the metal materials are prone to corrosion and stress shielding cause cortical bone osteoporosis in human body; in addition, second surgery is needed to remove the materials after fracture healing which can cause the secondary fracture.
    OBJECTIVE: To analyze the biological properties of the absorbing material and the indications of fracture treatment, and to compare the characteristics of absorbable materials in the fracture internal fixation.
    METHODS: The articles related to the absorbable materials for the treatment of fractures were selected to find out the cases with the similar treatment objects and the same curative effect evaluation criteria for the comparative study.
    RESULTS AND CONCLUSION: The absorbable materials for the treatment of fractures have significant advantages, removed without second surgery, little injury to the surrounding tissues of the joint and joint itself, good histocompatibility and fewer complications, and it has become one of the development directions for the internal fixation of fractures.

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    Deep vein thrombosis after hip replacement
    Yan Gu-ning, He Liang-liang
    2013, 17 (4):  720-727.  doi: 10.3969/j.issn.2095-4344.2013.04.024
    Abstract ( 395 )   PDF (738KB) ( 510 )   Save

    BACKGROUND: Deep vein thrombosis is a common complication after hip replacement. With the extensive application of the hip replacement, the incidence of deep vein thrombosis is gradually increased.
    OBJECTIVE: To study the risk factors and mechanism of deep vein thrombosis after hip replacement as well as the effect of drug treatment, in order to provide better prevention and treatment options for clinical patients.
    METHODS: The patients with hip replacement were followed-up to analyze the incidence rate and related risk factors of deep vein thrombosis. The expressions of inflammatory cytokines and cell adhesion molecules before and after hip replacement were detected with immunohistochemical detection method to identify the mechanism of deep vein thrombosis, and give the low molecular weight heparin for prevention and treatment as well as to indentify the application effect of prevention and treatment.
    RESULTS AND CONSLUSION: Elderly, females, obesity, bilateral hip replacement, general anesthesia in the treatment, application of bone cement prosthesis, long-time bed rest, merged with various metabolic diseases are the risk factors of deep vein thrombosis after hip replacement. Most studies have shown that O-blood type is the protective factor. The expression levels of inflammatory cytokines and cell adhesion molecules can indicate the incidence of deep vein thrombosis after hip replacement. Low molecular weight heparin can reduce the incidence of deep vein thrombosis after hip replacement, which has a good effect in the prevention and treatment of deep vein thrombosis.

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    Mechanical analysis of locking compression plate fixation for the treatment of tibial fracture
    Sun Xiang, Kan Shi-lian, Yuan Tian-xiang
    2013, 17 (4):  728-735.  doi: 10.3969/j.issn.2095-4344.2013.04.025
    Abstract ( 456 )   PDF (822KB) ( 882 )   Save

    BACKGROUND: Locking compression plate combines with traditional steel plate and bracket principle, which has locking threaded screws on head and mounting bracket lock unit composed with steel locking nail holes, aswell as the internal fixation bracket pressurized unit composed with traditional screws and dynamic compression holes. So the locking compression plate has many advantages in the treatment of fracture fixation.
    OBJECTIVE: To analyze the biomechanical characteristics and effect of locking compression plate in the treatment of tibial fracture.
    METHODS: Locking compression plate could achieve the fracture fixation depended on the angular stability of steel plate and screws and the pullout strength between crews and bone. When the marrow cavitsy was small, the top of the screw should be avoided to damage the proximal cortical bone threaded, and then the screws should be changed into the bicortical self-tapping screws at least in order to obtain the pullout strength from the contralateral cortical bone. Screw implantation for the treatment of osteoporosis, due to the reduced working length of unicortical screw fixation, the bicortical self-tapping screws were used in all the fracture fragments to improve the working length of the screws. When the alignment between the long bone axis and steel plate was not in order, implanting the long self-tapping screws or changing the angle to implant the standard screws were preferred. The locking compression plate should select a appropriate length. The length of the locking compression plate depended on the length and the density of the plate and screw. The stress between plate and screw was also affected by the number and the position of the screw.
    RESULTS AND CONCLUSION: Locking compression plate fixation can be used for the treatment of backbone or metaphyseal simple fracture, comminuted fracture, intra-articular and periarticular fractures, delayed fracture healing, closed or open osteotomy and the shaft fracture which is not suitable for intramedullary nailing. And for the fixation of osteoporotic fractures and periprosthetic fractures, the locking compression plate has good angular stability and pullout strength. Locking compression plate fixation for the treatment of tibial shaft fractures has achieved satisfactory results, which in line with the biomechanics fixed principles. Surgeons need to be familiar with the fixation techniques of locking compression plate, in order to avoid mistakes-caused failure fixation.

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    Intramedullary nails versus extramedullary fixation in the repair of intertrochanteric fractures: A Meta-analysis
    Wang Ben, Ge Zhen-xin, Yang Guo-yue, Zhang Dong-zheng, Zhang Yin-guang, Tian Wei, Liu Zhao-jie, Jia Jian
    2013, 17 (4):  736-743.  doi: 10.3969/j.issn.2095-4344.2013.04.026
    Abstract ( 374 )   PDF (760KB) ( 675 )   Save

    BACKGROUND: The choice of intramedullary nails versus extramedullary fixation in surgical treatment of intertrochanteric fractures remains controversial.
    OBJECTIVE: To evaluate the efficacy of intramedullary versus extramedullary fixation for the treatment of intertrochanteric fractures.
    METHODS: A computer-based search was performed on the MEDLINE database, EMBASE database, Cochrane Library, CBM database, CNKI database and other commonly used electronic database, supplemented by manual searches to find the randomized controlled trials on the comparison of intramedullary versus extramedullary fixation for the treatment of intertrochanteric fractures at home and abroad. All randomized controlled trials comparing the efficacy of intramedullary versus extramedullary internal fixation for the treatment of intertrochanteric fractures were included. The included studies were evaluated with the modified Jadad quality scale, and the software Stata 12.0 and RevMan 5.1 were used for data analysis. The statistical method was the Mantel-Haenszel method.
    RESULTS AND CONCLUSION: A total of 31 randomized controlled trials were included, including 5 217 patients. According to the modified Jadad quality scale, 19 literatures of methodological quality showed high quality, and low quality of 12 literatures. The intraoperative femoral fractures [relative risk (RR)=4.00, 95% confidence interval (CI) (1.80-8.86), P < 0.01], postoperative femoral fracture [RR=3.57, 95%CI (1.68-7.60), P < 0.01], cut out [RR=1.61, 95%CI (1.02-2.52); P=0.04], reoperation risk [RR=1.58, 95%CI (1.09-2.30); P=0.02], and residual hip or thigh pain in the follow-up period [RR=1.31, 95%CI (1.09-1.57), P < 0.01] in the Gamma nail group was significantly higher than those in the sliding hip screw group. The intraoperative blood loss in the proximal femoral nail anti-rotation group was significantly less than that in the sliding hip screw group, and the hip joint Harris score was higher, but the intraoperative radiation time was longer [mean difference (MD)=2.11, 95%CI (1.78-2.43), P < 0.01]. The intraoperative blood loss in the intramedullary hip screw group was significantly less than that in the sliding hip screw group, but the radiation time was longer [MD=1.20, 95%CI (0.88-1.52), P < 0.01]. For stable intertrochanteric fracture, both screw-plate system and intramedullary fixation have good outcome, but the dynamic hip screw as the representative of extramedullary fixation system is preferred. The intramedullary system is better than extramedullary fixation system in the treatment of unstable intertrochanteric fractures.

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    Meta-analysis on double-bundle versus single-bundle autoallergic hamstring for the reconstruction of anterior cruciate ligament
    Xu Ming-ming, Yu Xiao-hua, Luo Xi, Ma Chuan-yu, Zhao Zhu-ying
    2013, 17 (4):  744-749.  doi: 10.3969/j.issn.2095-4344.2013.04.027
    Abstract ( 435 )   PDF (475KB) ( 436 )   Save

    BACKGROUND: Doctors often use autoallergic hamstring double-bundle and single-bundle for the reconstruction of anterior cruciate ligament, but there is a controversy on which method is better.
    OBJECTIVE: To evaluate the clinical outcome of double-bundle versus single-bundle autoallergic hamstring for the reconstruction of anterior cruciate ligament.
    METHODS: Randomized controlled trials about comparing double-bundle with single-bundle autoallergic hamstring for the reconstruction of anterior cruciate ligament were collected from PubMed database, Cochrane library, Springerlink database, CNKI database and CBM database. The Jadad’s scale was usedto assess the methodological quality of the randomized controlled trials and Cochrane collaboration’s RevMan 5.0 software was used to perform the Meta analysis.
    RESULTS AND CONCLUSION: Fifteen randomized controlled trials totally 1 008 patients met the inclusion criteria and included. Meta-analysis results showed that there was statistical difference of postoperative KT-1000 or KT-2000 arthrometer mesurement between double-bundle and single-bundle reconstruction [weighted mean difference (WMD)=-0.51, 95% confidence interval (CI) (-0.74, -0.28), P < 0.000 1], there was significant difference of the negative pivot-shift testing [relative risk (RR)=1.27,95%CI(1.11,1.45), P=0.000 3], as well as the postoperative Lysholm scores [WMD=-2.10, 95%CI(-3.65, -0.55), P=0.008]. But there was no statistical differences of IKDC final score [RR=1.04,95%CI(0.99, 1.06), P=0.10]. The double-bundle autoallergic hamstring is superior to single-bundle for anterior cruciate ligament reconstruction on recovering stability of knee joint, but they are similar in recovering the functions of knee joint.

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    Intraarticular clonidine versus morphine for analgesia after arthroscopic knee surgery: A Meta-analysis
    Sun Rao, Tian Hong-liang, Li Lun, Yang Ke-hu, Zhang Ze-qian, Li Xiu-xia
    2013, 17 (4):  750-754.  doi: 10.3969/j.issn.2095-4344.2013.04.028
    Abstract ( 417 )   PDF (437KB) ( 596 )   Save

    BACKGROUND: Both intraarticular clonidine and morphine can provide analgesic effect, but the efficacy and safety of them are uncertain.
    OBJECTIVE: To evaluate the efficacy and safety of intraarticular clonidine versus morphine for postoperativeanalgesia following arthroscopic knee surgery.
    METHODS: PubMed database, EMBASE database, Cochrane Library, ISI Web of knowledge, CBM database, VIP database, CNKI database and Wanfang database were searched from their start year up to January 2012 for relevant randomized clinical trials on the intraarticular clonidine versus morphine for postoperative analgesia following arthroscopic knee surgery. Randomized clinical trials met the inclusion criteria were screened and included, and the quality was evaluated using seven-point Jadad scale and the data was analyzed using RevMan 5. 1.
    RESULTS AND CONCLUSION: Four randomized clinical trials including 156 patients were included. The results of the Meta analysis showed: ①Visual analogue scale scores: there was no difference between intraarticular clonidine and morphine on the visual analogue scale scores at 1, 2, 4, 6, 12 and 24 hours after intraarticular; ②Effective analgesia: intraarticular clonidine could provide longer effective analgesia than morphine [mean difference (MD)=200.34, 95% confidence interval (CI)(177.67, 223.00), P < 0.01]; ③Rate of postoperative analgesic requirements: there was no significant difference of the rate of postoperative analgesic requirements between the two drugs relative risk (RR)=1.05, 95%CI(0.67, 1.65), P=0.83]; ④The incidence of side effects had no significant differences. The current evidence shows that there is no difference between intraarticular rejection of clonidine and morphine on the pain intensity and the rate of postoperative analgesic requirements, but intraarticular clonidine provides longer effective analgesia, and the incidence of side effects is similar. Yet more randomized clinical trials with large sample size are required to explore the question clearly.

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    Factors influencing the prognosis of elderly patients with hip fracture after nonoperative management
    Yang Zi-bo, Xiang Shan-shan, Zhang Zhi-qi, Liu Jin, Zhang Zi-ji, Kang Yan, Liao Wei-ming, Fu Ming
    2013, 17 (4):  755-760.  doi: 10.3969/j.issn.2095-4344.2013.04.029
    Abstract ( 410 )   PDF (466KB) ( 374 )   Save

    BACKGROUND: Hip fracture is common fracture type in the elderly patients, and most of the patients were treated with operation. But there are still a lot of patients treated with non-operation therapy for a variety of reasons.
    OBJECTIVE: To explore the factors that influence the prognosis of elderly patients with hip fracture treatednon-surgically.
    METHODS: Sixty-one elderly patients aged more than 60 years with hip fracture were collected from January 2001 to December 2007 and treated non-surgically, and the clinical data of the patients were retrospectively analyzed. Data of comorbidities, Harris hip score and other important data were collected. The SPSS 13.0 software was used to analyze the prognostic factors through univariate and multivariate method in order to find the factors that could affect the survival of the elderly patients with hip fracture treated non-surgically.
    RESULTS AND CONCLUSION: After followed-up to July 2008, 19 patients survived. The result of Harris hip score in 19 survival case was 43.58 in average. Among the 19 survival cases, 11 patients < 70 years old and the Harris hip score was (55.81±29.59); 8 patients > 70 years old and the Harris hip score was (26.75±23.58). There was a significant difference of Harris hip score between them (P < 0.05). The 1, 2 and 5 years survival rates of the 61 cases were 0.803±0.051, 0.607±0.063 and 0.301±0.072, respectively. Based on univariate log-rank analysis, age, posture (bedridden or non-bedridden) and the serum albumin concentration had great significance on the prognosis (P < 0.05). COX multivariate regression analysis showed that age and posture (bedridden or non-bedridden) had independent prognostic significance (P < 0.05). It showed that for the elderly patients over 70 years old with hip fracture treated non-surgically, age and posture (bedridden or non-bedridden) were the main factors to affect the survival rate.

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