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23 December 2012, Volume 16 Issue 52 Previous Issue    Next Issue

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Comparison of the early effect of ceramic-on-ceramic with metal-on-polyethylene total hip prosthesis replacement Yang Li-qing, Li Xi, Fu Qin 2012, 16 (52):  9691-9696.  doi: 10.3969/j.issn.2095-4344.2012.52.001 Abstract ( 390 )   PDF (459KB) ( 509 )   Save BACKGROUND: Ceramic joint has been used in the clinic due to its excellent wear resistance, high hardness and good biocompatibility. But the comparative studies at home and abroad on ceramics-on-ceramic and traditional metal-on-polyethylene total hip arthroplasty are rare. OBJECTIVE: To retrospectively observe the therapeutic effects of ceramics-on-ceramic and traditional metal-on-polyethylene total hip prosthesis replacement for the treatment of adult hip disease. METHODS: In the period of October 2007–September 2010, a total of 42 patients (44 hips) received total hip arthroplasty, and 20 patients (22 hips) received ceramics-on-ceramic total hip prosthesis replacement, 22 patients (22 hips) received traditional metal-on-polyethylene total hip prosthesis replacement. All the surgical methods were the standard posterolateral approach, then given the routine postoperative anticoagulation treatment and the corresponding functional exercise. Regular postoperative clinical and radiographic follow-up was performed for at least six months. Range of motion was measured both before replacement and 6 months after replacement, and the hip joint function was evaluated according to Harris score. RESULTS AND CONCLUSION: The clinical effects of all patients were good without dislocation, loosening, infection, deep venous thrombosis and other complications. The Harris scores and the range of motion of ceramics-on-ceramic group was significantly improved (P < 0.05). There was no significant difference of Harris scores and the range of motion between ceramics-on-ceramic group and traditional metal-on-polyethylene group (P > 0.05). The effect of ceramic-on-ceramic prosthesis is good and the results are satisfactory for short-term follow-up. There is no difference of improving symptoms and hip range of motion between ceramics-on-ceramic and metal-on-polyethylene total hip prosthesis. However, its advantages and the long-term efficacy remain to be further observed. Because of the wear resisting, ceramics-on-ceramic total hip prosthesis will be a good choice for the young patients undergoing hip replacement surgery. Related Articles | Metrics

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Drug combination for preventing venous thromboembolism before and after total hip arthroplasty Sun Ying-hua, Ren Jin-ting, Wang Li, Wang Fu-chao, Li Bing, Jiao Zhao-de 2012, 16 (52):  9697-9701.  doi: 10.3969/j.issn.2095-4344.2012.52.002 Abstract ( 301 )   PDF (457KB) ( 549 )   Save BACKGROUND: Currently, the antithrombotic are commonly used for the prevention of venous thromboembolism after total hip arthroplasty, but there is still a certain incidence of venous thromboembolism. Is it possible to reduce the incidence of venous thromboembolism better while not increasing the risk of bleeding if some drugs are applied combinedly before and after operation? OBJECTIVE: To compare the efficacy and safety of preventing venous thromboembolism after total hip arthroplasty by applying preoperation vitamin E combined with postoperation rivaroxaban versus postoperation rivaroxaban alone. METHODS: Totally 3 656 patients undergoing total hip arthroplasty in four hospitals, including Affiliated Yidu Central Hospital of Weifang Medical University from January 2010 to March 2012 were randomly divided into experimental group (n=1 830) and control group (n=1 826). The experimental group was given preoperation vitamin E combined with postoperation rivaroxaban therapy, while the control group was given preoperation placebo combined with postoperation rivaroxaban therapy. RESULTS AND CONCLUSION: Compared with the control group, the incidence of total venous thromboembolism event was lower in the experimental group (P < 0.01), but the incidence of major bleeding event was approximate in two groups (P > 0.05). It indicates that preoperation vitamin E combined with postoperation rivaroxaban can be more effective after total hip arthroplasty than only postoperation rivaroxaban applying in preventing venous thromboembolism, without an extra risk of bleeding. Related Articles | Metrics

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Significance of canal flare index measurement in total hip arthroplasty Li Yi-zhong, Li Jian-long, Lin Jin-kuang,Yao Xue-dong, Zhuang Hua-feng, Yu Hai-ming, Pan Yuan-cheng, Guo Liang-rui 2012, 16 (52):  9702-9706.  doi: 10.3969/j.issn.2095-4344.2012.52.003 Abstract ( 480 )   PDF (392KB) ( 489 )   Save BACKGROUND: Survival rate of the femoral stem in patients with total hip arthroplasty is closely related with the femoral canal type classified with canal flare index. OBJECTIVE: To study the canal flare index distribution in the patients with different ages and in the patients with total hip arthroplasty treated for femoral neck fracture, femoral head necrosis or osteoarthritis. METHODS: The retrospective evaluation of the X-ray film of the proximal femur was performed on 100 patients with total hip arthroplasty. The canal flare index was measured and compared among the age groups and common three diseases. RESULTS AND CONCLUSION: The canal flare index was 3.82±1.20 in the group aged < 50 years, 3.46±0.99 in the group aged between 50 and 59 years, 3.28±0.75 in the group aged between 60 and 69 years, 2.95±0.69 in the group aged between 70 and 79 years, and 2.94±0.59 in the group aged ≥ 80 years. The canal flare index was 2.74±0.53 in femoral neck fracture group, 3.45±1.04 in the group of femoral head necrosis and 3.50±0.69 in the osteoarthritis group. The canal flare index is helpful to the preoperative selection of the prosthesis in total hip arthroplasty. Related Articles | Metrics

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Impact factors for the bilateral knee osteoarthritis patients without total knee arthroplasty at second stage Jia Heng, Liang Zhi-quan, Fang Rui, Deng Ying-jie, Meng Qing-cai 2012, 16 (52):  9707-9711.  doi: 10.3969/j.issn.2095-4344.2012.52.004 Abstract ( 284 )   PDF (415KB) ( 433 )   Save BACKGROUND: Most of the patients with bilateral knee osteoarthritis will not receive the contralateral total knee arthroplasty due to many factors. OBJECTIVE: To analyze the factors for the bilateral knee osteoarthritis patients undergoing a selective unilateral total knee arthroplasty without contralateral knee arthroplasty at second stage. METHODS: A toal of 28 bilateral knee osteoarthritis patients (28 knees) treated with unilateral total knee arthroplasty were included, the prostheses were the Smith & Nephew ordinary type. All the patients did not receive the second stage contralateral knee arthroplasty within 1 year after unilateral total knee arthroplasty. The HSS score and range of motion of knee were recorded before and after replacement; at the same time, the 28 patients that did not receive the second stage contralateral knee arthroplasty were questionnaired for the factors. RESULTS AND CONCLUSION: Two cases were lost, 2 cases underwent contralateral total knee arthroplasty at the other hospital. And finally, 24 patients (24 knees) received the final follow-up, the average follow-up time was 12.6 months (12 to19 months). The range of motion and the HSS score after replacement were improved compared with those before replacement, the difference was statistically significant (P=0.007, P=0.409). Questionnaire survey was performed to analyze the factors for second stage surgery, single factor follow-up results showed that perioperative pain was the main reason that accounting for more than 95%; multivariate follow-up results showed that perioperative pain accounted for 95.8%, psychological factors accounted for 87.5%, conditions of the hospital's software accounted for 70.8%; the average of the three reasons accounted for 84.7%. It indicates that perioperative pain, psychological factors and conditions of the hospital's software are the dominate reasons for the 24 patients (24 knees) without second stage ontralateral knee arthroplasty. Related Articles | Metrics

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Clinical outcomes between fixed-bearing and mobile-bearing total knee arthroplasty Luo Wei, Cheng Ming-hua, Xiao Xun-gang 2012, 16 (52):  9712-9716.  doi: 10.3969/j.issn.2095-4344.2012.52.005 Abstract ( 323 )   PDF (431KB) ( 417 )   Save BACKGROUND: Recently, there are different opinions for the knee function improvement after fixed-bearing and mobile-bearing total knee arthroplasty. OBJECTIVE: To compare the clinical outcomes between fixed-bearing and mobile-bearing for total knee arthroplasty. METHODS: Ninety patients with osteoarthritis were treated by fixed-bearing total knee arthroplasty (n=47) or mobile-bearing total knee arthroplasty (n=43). All the data were analyzed including the total knee score, pain score, patient function score, patellar score and motion of the knee joint before total knee arthroplasty, 1, 3 and 6 months and 1 year after total knee arthroplasty, and there was no significant different before replacement between two groups. RESULTS AND CONCLUSION: There was no significant difference between the two groups in the total knee score, pain score, patient function score and patellar score at 1 and 3 months after replacement (P > 0.05). After 6 months and 1 year, the total knee score, pain score, patient function score and patellar score in the mobile-bearing group were significantly higher than those in the fixed-bearing group (P < 0.05). It indicates that both mobile-bearing and fixed-bearing total knee arthroplasty can improve the knee function, and recent study found that the effect of mobile-bearing is better than that of fixed-bearing. Related Articles | Metrics

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Short-term effect of multimodal pain relief in total knee arthroplasty Zhang Bo, Qu Tie-bing, Fang Chao-hua, Wen Hong, Pan Jiang, Lin Yuan 2012, 16 (52):  9717-9721.  doi: 10.3969/j.issn.2095-4344.2012.52.006 Abstract ( 364 )   PDF (439KB) ( 546 )   Save BACKGROUND: Clinicians have pay more and more attention to the perioperative pain relief recently, and some domestic hospitals have been carried out multi-modal analgesic therapy and other perioperative analgesic measures and gained remarkable achievement, but systematic perioperative pain relieve protocol is still deficient in most of the hospitals. OBJECTIVE: To compare the short term clinical effects of the perioperative pain relief protocol between the multimodal and the non-multimodal pain relief protocols, and to investigate the more effective and normative perioperative pain relief protocol. METHODS: From October 2010 to October 2011, forty patients who undertook the primary total knee arthroplasty in the Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University were selected, and randomly divided into two groups according to different pain relief protocols: multimodal pain control group (n=20) and non-multimodal pain control group (n=20). Patients in the non-multimodal group adopted the conventional epidural control analgesia, and orally took non-steroidal anti-inflammatory drugs after the operation. However, the patients in the multimodal pain control group received the pre-emptive analgesia and femoral nerve block tube would also be done for the initial sustained and post-loading dose analgesia. RESULTS AND CONCLUSION: The visual analog scale scores in the multimodal pain control group were lower than those in the non-multimodal pain control group at 6, 12 and 24 hours after operation, but there was no significant difference of the visual analog scale score between the two groups (P > 0.05). The activity pain in multimodal pain control group was lower than that in the non-multimodal pain control group at 2 days after operation, and the difference was significant between the two groups (P < 0.01). From the third day to the seventh day, the activity and rest pain in multimodal pain control group were lower than those in non-multimodal pain control group, and there was significant difference between two groups (P < 0.01). From the second day to the seventh day, range of motion of the knee joint in the multimodal pain control group was bigger than that in the non-multimodal pain control group, and the difference was significant between the two groups (P < 0.05). The multimodal pain control protocol can relieve the perioperative pain of the total knee arthroplasty effectively in short term, and can lead to a quick functional recover in patients. Related Articles | Metrics

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Anatomical basis of minimally invasive pedicle screw implantation in thoracolumbar segments Wang Xue-jun, Li Kai-nan, Zheng Jiang, Mu Jian-song, Zhang Jin-jun, He Zhi-yong, Lan Hai 2012, 16 (52):  9722-9726.  doi: 10.3969/j.issn.2095-4344.2012.52.007 Abstract ( 253 )   PDF (441KB) ( 586 )   Save BACKGROUND: Pedicle screw technology has been widely used in a variety of spinal surgeries, and it generally uses the classic back midline surgical approach. But in recent years, studies have found that some complications will be caused by this surgical approach. OBJECTIVE: To provide the anatomical basis for minimally invasive spinal surgery under the localization method through spinal process peak. METHODS: Five formalin-fixed normal human thoracolumbar specimens were selected, and the rear structure of thoracolumbar spine was anatomize layer by layer under anatomical microscope magnified for 10 times, especially the origin, branch and distribution of the branch and posterior ramus of spinal nerves and the dorsal branches of the segmental artery and vein. RESULTS AND CONCLUSION: The segmental arteries were mainly divided into the intercostals artery, anterior branch and posterior branch. The posterior branch emerged from the intervertebral foramen posterior to the superior articular process of the vertebral below and divided into their terminal medial and lateral branches. The dorsal branches of the segmental veins paralleled with their corresponding arteries. When the minimally invasive pedical screw internal fixation would be performed, the safe range of the enter point was about 5 mm, and inserting the connective bar through the inner side of the enter point is safest. The percutaneous pedical screw under the location method of spine process peak is approximately in the vertical operation without lateral traction; inserting the connective bar from inner side will reduce the chances of posterior branch and blood vessel damage, which is an important technology for minimally invasive spine surgery. Related Articles | Metrics

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Clinical significance of lower thoracic vertebral segment blood vessel with digital three-dimensional measurement Li Xiao-he, Hou Er-fei, Li Zhi-jun, Wang Hai-yan, Wang Jian-wei, Ji Xiao-jun 2012, 16 (52):  9727-9731.  doi: 10.3969/j.issn.2095-4344.2012.52.008 Abstract ( 338 )   PDF (520KB) ( 462 )   Save BACKGROUND: The diseases of lower thoracic vertebral segment are common, but it’s anatomical structure is complex, and there lacks of the studies on segmental blood vessel. OBJECTIVE: To analyze the structure of lower thoracic vertebral segment blood vessel with digital three-dimensional reconstruction measurement. METHODS: We selected 32 cases without thoracolumbar fracture from 2010 to 2011. Intravenous injection of iohexol was performed with high pressure injector, and at 24-30 seconds after injection, CT machine was used for the continuous horizontal scan, then the scanning data were imported to the Mimics software for the three-dimensional reconstruction of lower thoracic vertebral segment blood vessel structure and the measurement of distance of segmental blood vessel. The difference of sides, genders and height was compared, as well as the relationship between them. RESULTS AND CONCLUTION: The location and distribution of lower segment of thoracic blood vessel werehomeostasis, and with the increasing of spinal segments, the distance was gradually increased; the left and the right blood vessels in the same segment were distributed symmetrically, but the segmental vessels spacing of the male patients was bigger than that of the female patients, and the difference was significant, the segmental vessels spacing was positive correlated with height. It indicates that when we clinically select the lateral anterior point as the placement point for the screw, as well as the nail rods or steel plate, we have to lighten the length of the nail rods and the steel plate in order to avoid the injury with the increasing of the spinal segment. The male patients with higher height should select the longer nail rods and steel plate to avoid the segmental blood vessel reasonably Related Articles | Metrics

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Parameters of bi-cortical pedicle screws implantation in the lumbar vertebrae with digital orthopedic technology Lu Jian-hua, Wang Zhi-gang, Huang Li, Cheng Gang, Zhu Jian-wei, Li Can, An Ning 2012, 16 (52):  9732-9736.  doi: 10.3969/j.issn.2095-4344.2012.52.009 Abstract ( 398 )   PDF (468KB) ( 687 )   Save BACKGROUND: To improve the lumbar stability after operation, inserting bi-cortical pedicle screws in the vertebrae is viable when the patients associated with osteoporosis. But the bi-cortical pedicle screws improperly invert may lead to serious complications such as spinal cord, nerve root, abdominal aorta, inferior vena cava and organs damage. So it is important to measure the parameters of inverting the screws pre-operation. OBJECTIVE: To measure the preoperative individual parameters of inserting bi-cortical pedicle screws in the lumbar vertebrae with CT and digital orthopedic technique. METHODS: The image data of L1-4 that scanned by CT was imported into the Mimics 10.0 software and GE workstation, and L1-4 three-dimensional image was reconstructed. The individual parameters of inserting bi-cortical pedicle screws in the L1, 3 were measured. RESULTS AND CONCLUSION: The three-dimensional CT lumbar image was reconstructed clearly, and the placement of bi-cortical pedicle screws on the crista lambdoidalis was simulated by Mimics10.0 software. The minimum diameter, sagittal angle of simulated inserting bi-cortical pedicle screws, leaning angle (horizontal angle) and the horizontal depth were measured by the Mimics 10.0 software. Meanwhile, the limited depth of the screws when parallel to vertebral end-plate was calculated. It is a reliable method to get individual parameters of inserting bi-cortical pedicle screws in the lumbar vertebrae and it can improve the safety and accuracy of screw fixation. Related Articles | Metrics

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Magnetic resonance imaging of lumbar intervertebral discs degeneration：Analysis of the imaging manifestations related to Modic changes Liu Zhen-zhen, Chen Jian-yu, Zhong Jing-lian, Jiang Xin-hua, Cai Zhao-xi, Zhang Ya, Yang Ze-hong, Lei Li-chang 2012, 16 (52):  9737-9743.  doi: 10.3969/j.issn.2095-4344.2012.52.010 Abstract ( 334 )   PDF (759KB) ( 547 )   Save BACKGROUND: Part of the discogenic low back pain patients’ MRI shows Modic changes, but the relevant factors of Modic changes and the causal relationship between Modic changes and disc degeneration remain unclear. OBJECTIVE: To explore the distribution of the Modic changes of lumbar intervertebral discs in patients (gender and age) suffering low back pain and to explore the correlated factors of the Modic changes. METHODS: 634 patients (2 536 lumbar intervertebral discs) suffering low back pain were examined by Magnetic resonance imaging scan. The distribution character of the Modic changes of lumbar intervertebral discs among different ages and between different genders were analyzed, and the correlation between Modic changes and lumbar intervertebral disc herniation, Schmorl nodes, lumbar instability, lumbar segments, and the degeneration degree of lumbar intervertebral discs were analyzed, too. RESULTS AND CONCLUSION: Among 634 patients, the occurrence rate of Modic Ⅱ and Modic Ⅲ in female was higher than that in male, but the occurrence rate of Modic I in female was lower than that in the male (P < 0.001). The occurrence rates of Modic Ⅰ-Ⅲ among people over 40 years were higher than that in people aged under 40 years (P < 0.001). Among 2 536 lumbar discs, the occurrence rates of Modic Ⅰ-Ⅲ among people who have lumbar instability or Schmorl nodes or lumbar intervertebral disc herniation were all higher than those in the people who do not have the performance (P < 0.001). The occurrence rates of ModicⅠ-Ⅲ in the segment L4/5 and L5/S1 (the lower level) were higher than those in the segment L2/3 and L3/4 (the higher level) (P < 0.001). The more serious the lumbar discs degeneration changes are, the higher the occurrence rates of Modic Ⅰ-Ⅲ will be (P < 0.001). There were markedly correlation among the degeneration degrees of lumbar intervertebral discs, Schmorl nodes and Modic changes. There are correlations between Modic changes and patients’ age, patients’ gender, lumbar intervertebral disc herniation, Schmorl nodes, lumbar intervertebral instability, lumbar segments, and the degeneration degree of lumbar intervertebral discs. The degeneration degrees of lumbar intervertebral discs and Schmorl nodes have highly correlation with Modic changes, and the degeneration degree of lumbar intervertebral discs has a higher correlation with Modic changes than Schmorl nodes. Related Articles | Metrics

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Effect of dynamic stress plate and AO plate on the healing of sheep femoral shaft fractures Tan Yuan-chao, Zhou Ji-ping, Yan Hu, Zhang En-zhong, Zhang Qiu-ling 2012, 16 (52):  9744-9749.  doi: 10.3969/j.issn.2095-4344.2012.52.011 Abstract ( 301 )   PDF (535KB) ( 518 )   Save BACKGROUND: Stress shielding can influence the healing of fracture in the treatment of fracture healing by plate fixation. OBJECTIVE: To observe the effect of dynamic stress plate (CO plate) and the normal stress plate (AO plate) on sheep femoral shaft fracture healing. METHODS: Twenty-four healthy adult sheep were prepared for establishing the femoral shaft fracture model. After modeling, the models were divided into two groups: AO plate group and CO plate group. The fractures in the two groups were fixed with AO and CO plate respectively. The femurs with the internal fixation were picked out at 1, 2 and 3 weeks; conventional X-ray and MRI scanning were performed. RESULTS AND CONCLUSION: X-ray film showed that there was no significant change at the fracture broken ends in two groups, and the fracture line was clear at 1 week after fixation; at 2 weeks after fixation, there was no significant change at the fracture broken end in AO plate group and the fracture line was clear, while in the CO plate group, the bone mineral density at the fracture broken end was increased and the fracture line began to blur; at 3 weeks after fixation, the bone mineral density at the fracture broken end in the AO plate group was increased, the bone mineral density in the CO plate group was increased continuously with the cloud-shaped external callus. MRI scanning showed that at 1 week after fixation, the T1 weighted imaging of the fracture broken end in two groups presented a high signal and the T2 weighted imaging on the fat saturation sequence presented a low signal, but the PDIR-TSE of the fracture broken end in the AO plate group showed a low signal and showed a high signal in CO plate group; at 2 weeks after fixation, T1 weighted imaging of the fracture broken end in two groups presented an equal or higher signal and the T2 weighted imaging on the fat saturation sequence presented a equal or lower signal, while the PDIR-TSE of the fracture broken end in the AO plate group showed a low signal and showed a high signal in CO plate group; at 3 weeks after fixation in the AO plate group, clearly fracture line could be seen, the T1 weighted imaging of the fracture broken end presented an equal or lower signal and the T2 weighted imaging on the fat saturation sequence presented an equal or lower signal, while the PDIR-TSE of the fracture broken end showed a low signal; at 3 weeks after fixation in the CO plate group, the fracture line at the fracture broken end was blur, the T1 weighted imaging of the fracture broken end presented an equal or higher signal and the T2 weighted imaging on the fat saturation sequence presented an equal or lower signal, while the PDIR-TSE of the fracture broken end showed an equal or higher signal. The blood circulation and the bone callus content at the fracture broken end in the CO plate group were higher than those in the AO plate group. Related Articles | Metrics

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Locking compression plate and anatomical type plate fixation for the treatment of complex fracture of tibial plateau Cai Wei-bin, Hu Hong-xuan, Guo Xin-hui, Yang Jun, Cai Wei-bo 2012, 16 (52):  9750-9755.  doi: 10.3969/j.issn.2095-4344.2012.52.012 Abstract ( 438 )   PDF (478KB) ( 831 )   Save BACKGROUND: Both locking plate and ordinary steel plate internal fixation can be used for the treatment of the complex fracture of tibial plateau. OBJECTIVE: To observe the effect of locking plate and ordinary anatomical type plate internal fixation for the treatment of complex fracture of tibial plateau. METHODS: 118 cases of complex fracture of tibial plateau were treated with proximal tibial plate from June 2007 to June 2010. Forty-six cases were treated with locking compression plate and 72 cases were treated with anatomical type plate. The healing time and the recovery of knee function were compared after locking compression plate and atomical type plate internal fixation for the treatment of complex fracture of tibial plateau. RESULTS AND CONCLUSION: All the fractures of tibial plateau were healed, and the healing time was 10 to 25 weeks, the average healing time in locking plate group was 14 weeks and the the average healing time in anatomical type plate group was 16 weeks; there was no significant difference of the healing time between two groups (P < 0.01). There were two cases of open fractures incision infection in each group and healed after antibiotics application and change dressing; one case had fascia compartment syndrome in anatomical type plate group after internal fixation, and the fracture was gradually healed after incision and decompression. There were two cases of mild knee varus in anatomical type plate group and one case in locking plate group. According to the Karlstrom evaluation standard, the excellent and good rate of locking plate group was 93% and the anatomical type plate group was 79%, the excellent and good rate of locking plate group was significantly better than that of the anatomical type plate group (P < 0.05). For the treatment of complex fracture of tibial plateau, the locking plate has more advantages than ordinary anatomical type plate anatomical type plate. Related Articles | Metrics

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Bone healing of distal radius comminuted fracture treated with three different fixation methods Shi Zhan-ying, Zhao Liang-jun, Li Bai-chuan, Hu Ju-zheng 2012, 16 (52):  9756-9760.  doi: 10.3969/j.issn.2095-4344.2012.52.013 Abstract ( 335 )   PDF (384KB) ( 499 )   Save BACKGROUND: Studies have suggested that conservative treatment of distal radius fractures has a significant impact on wrist functional recovery, clinical treatment often focus on the anatomical reduction of the articular surface of the distal radius, restore palmar inclination and ulnar inclination, thus benefit to the functional recovery of the wrist. OBJECTIVE: To evaluate the recuperative effects of wrist in distal radius comminuted fracture with three fixation methods, and its advantages and disadvantages. METHODS: Eighty-eight patients of distal radius comminuted fractures were selected, 35 patients underwent closed reduction and plaster external fixation, 28 patients underwent external fixing frame, and 25 patients underwent open reduction and plate fixation. The healing time, wrist bone anatomical structure and functional recovery were retrospectively analyzed. RESULTS AND CONCLUSION: All the patients were treated for union. The healing time of fracture was average (11.2±2.8) weeks in plaster fixation group, the time was average (11.8±3.0) weeks in external fixing frame group, and average (10.8±2.6) weeks in plate fixation group. There was no significant difference of fracture healing time compared with plaster fixation group (P > 0.05). The X-ray film at 6 months after operation showed the palmar inclination and ulnar deviation of distal radius in the plate fixation group were higher than those in the external fixing frame group and plaster fixation group, and the differences were significant (P < 0.05). The excellent and good rate of wrist function was evaluated with the modified Gartland and Werley standards. The excellent and good rate of plaster fixation group was 54%, the external fixing frame group was 75%, and the plate fixator group was 92%. There were significant differences of the excellent and good rate of distal radius compared with plate fixation group (P < 0.05). The results showed that there was no significant difference of the healing time of distal radialis comminuted fracture among three methods of fixation. The bone anatomical structure of distal radialis fracture was effectively maintained with plate fixation, and the recovery of wrist joint function with plate internal fixation was better than external fixing frame or plaster fixation. Related Articles | Metrics

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Local factors of nonunion of fractures after fixation using different internal fixators in limbs Xu Ke-lin, Yin Qu-dong, Gu San-jun, Sun Zhen-zhong, Wu Yong-wei, Kong You-yi, Shou Kui-shui 2012, 16 (52):  9761-9765.  doi: 10.3969/j.issn.2095-4344.2012.52.014 Abstract ( 333 )   PDF (485KB) ( 520 )   Save BACKGROUND: Although open reduction and internal or external fixation can reduce complications of fractures, however, there are still 5%-10% nonunions occurred. The causes of nonunion are composed of systemic factor, local factor and medication factor, among them, the local factor is the main reason. OBJECTIVE: To investigate the local factors of nonunion of fractures after fixation using different fixators in limbs. METHODS: Eighty-seven cases of nonunion of fractures after fixation with different fixators in limbs between January 2005 and June 2011 were analyzed retrospectively. Analyzing and judging the specific local factor and calculating its proportion. The iatrogenic local factors included: invalid fixation, ignoring protecting the blood supply, ignoring bone graft, fracture reduction below the standard, postoperative infection and lacking proper rehabilitation guidance; patient-related factors included: severe injury, special location and early excessive activity. RESULTS AND CONCLUSION: The iatrogenic factors accounted for 73.0%, the patient-related factors accounted for 27.0%. In the iatrogenic factors from high to low were: ignoring bone graft 26.1%, lacking proper rehabilitation guidance 23.9%, invalid fixation 21.7%, fracture reduction below the standard 15.2%, ignoring protecting the blood supply 8.7%, postoperative infection 4.3%. In the patient-related factors from high to low were: early excessive activity 50.0%, severe injury 32.4%, special location 17.6%．Among the general factors, the objective factors accounted for 13.5% and the subjective factors accounted for 86.5%. Reducing the iatrogenic factors is an important part of reducing the nonunion of fractures after internal fixation treatment. Related Articles | Metrics

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Complications of osteoporotic vertebral compression fractures treated with bone cement enhancement technology Li Da-gang, Su Pei-ji, Chen Gan-feng, Chen Shi-zhong, Gao Heng 2012, 16 (52):  9766-9770.  doi: 10.3969/j.issn.2095-4344.2012.52.015 Abstract ( 337 )   PDF (305KB) ( 338 )   Save BACKGROUND: Both vertebroplasty and kyphoplasty are minimally invasive surgeries for the treatment of osteoporotic vertebral compression fractures. OBJECTIVE: To evaluate the safety of vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures. METHODS: A search was conducted using Medline database, EMBASE database, CNKI database, Wanfang database and VIP database from January 1990 to January 2012 for the articles on the complications after osteoporotic vertebral compression fractures treated with vertebroplasty and kyphoplasty. RESULTS AND CONCLUSION: A total of 62 studies and 8 993 patients met the inclusion criteria. There was no significant difference of puncture complications and other complications between vertebroplasty and kyphoplasty. The rates of cement leakage and new vertebral compression fractures of vertebroplasty were higher than those of kyphoplasty (P=0.000 06, P=0.02); there was no significant difference of adjacent vertebral fractures rate between vertebroplasty and kyphoplasty. The results demonstrate that vertebroplasty and kyphoplasty are two minimally invasive methods for the treatment of osteoporotic vertebral compression fractures. There was no significant difference of adjacent vertebral fractures rate, puncture complications and other complications between vertebroplasty and kyphoplasty, but the cement leakage and new vertebral compression fractures of kyphoplasty were lower than those of vertebroplasty. So, future prospective studies with a large number of patients are needed for the systematic review. Related Articles | Metrics

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Biomechanical stability of the knee joint after fibula head composite flap surgery Liu Xue-tao, Li Zhong, Wang Cheng-qi 2012, 16 (52):  9771-9775.  doi: 10.3969/j.issn.2095-4344.2012.52.016 Abstract ( 417 )   PDF (437KB) ( 420 )   Save BACKGROUND: Biceps femoris tendon and lateral collateral ligament are two important components of the knee posterolateral complex, and play important roles in maintaining the stability of knee posterolateral complex. OBJECTIVE: To study the impact of biceps femoris tendon and lateral collateral ligament attachment point reconstruction on the stability of the knee joint after the fibula head composite flap surgery. METHODS: Ten cases of male fresh frozen knee cadaver specimens were selected; biomechanical torsion testing machine was used to measure the tibial external rotation angle at different torques before fibula head composite flap surgery and after biceps femoris tendon and lateral collateral ligament attachment point reconstruction. RESULTS AND CONCLUSION: Under the condition of the same torque, the tibial external rotation angle was increased with extension of knee flexion angle, and there was significant difference of the tibial external rotation angle before fibula head composite flap surgery and after biceps femoris tendon and lateral collateral ligament attachment point reconstruction; under the condition of the different torques, there was a positive correlation between external rotation angle and knee flexion angle. After the fibula head composite flap surgery, biceps femoris tendon and lateral collateral ligament attachment point reconstruction will not influence the stability of the knee joint. Related Articles | Metrics

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Three-dimensional finite element analysis on the effect of sleeping position and pillow height on cervical spine stress Wu Feng-xia, Feng Zu-de 2012, 16 (52):  9776-9781.  doi: 10.3969/j.issn.2095-4344.2012.52.017 Abstract ( 413 )   PDF (627KB) ( 559 )   Save BACKGROUND: At present, the study of sleeping position and the height of pillow are mainly concentrated in the clinical aspects using survey, measurement and imaging methods. However, the study on the effect of sleeping position and the height of pillow on cervical spine stress by three-dimensional finite element method is rarely reported. OBJECTIVE: To explore the effect of sleeping position and pillow height on the stress of cervical spine by using the mathematical simulation method. METHODS: Mimics 10.0, Geomagic Studio 11.0 and Hypermesh 10.0 softwares were used to establish the three-dimensional finite element model of the whole cervical spine based on the raw data from CT images of a normal human’s head and neck. The stress properties of cervical spine under different pillow heights were analyzed by Abaqus 6.10 while sleeping on the back and side, respectively. RESULTS AND CONCLUSION: Both sleeping position and pillow height exhibited a significant influence on the stress of cervical spine. The maximum stress value of intervertebral disc under supine lying was higher than that of side lying with the same pillow height. The stress of cervical vertebrae and intervertebral disc increased with the increasing of pillow height under the same sleeping position. From the viewpoint of biomechanics of cervical spine stress, side lying was more helpful to cervical health than supine lying, and the pillow height under supine lying should be lower than that of side lying. Related Articles | Metrics

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Biomechanical comparison of double-tunnel and three-tunnel double-bundle anterior cruciate ligament reconstructions Li Yong, Huang Yong-hui, Zhao Yi-wen, Sun Yan, Zuo Hua 2012, 16 (52):  9782-9786.  doi: 10.3969/j.issn.2095-4344.2012.52.018 Abstract ( 296 )   PDF (377KB) ( 478 )   Save BACKGROUND: Arthroscopic anterior cruciate ligament reconstruction can effectively solve the symptoms of knee instability caused by anterior cruciate ligament injury, while double-tunnel double-bundle (single tibia tunnel-single femoral tunnel) and three-tunnel double-bundle (single tibia tunnel-double femoral tunnel) anterior cruciate ligament reconstruction are common repairing methods in clinic. OBJECTIVE: To investigate the effect of double-tunnel double-bundle and three-tunnel double-bundle anterior cruciate ligament reconstructions on the instability of knee joint. METHODS: Eight fresh-frozen human cadaveric knee specimens were selected and treated with double-tunnel double-bundle and three-tunnel double-bundle anterior cruciate ligament reconstructions respectively, and the instability of knee joint under an anterior tibial load (134 N) and internal tibial torques load (5 N•m) at 0°, 15°, 30°, 60 ° and 90 °of flexion were tested using MTS-809 biomechanics test system. RESULTS AND CONCLUSION: ①Anterior tibial load: the displacement of two reconstruction groups under five angles stated above were larger than that of anterior cruciate ligament intact group, and the difference was not significant (P > 0.05); while the anterior tibial replacement in double-tunnel double-bundle anterior cruciate ligament reconstruction group was larger than that in the three-tunnel double-bundle anterior cruciate ligament reconstruction group, and the difference was not significant (P > 0.05). ②Tibial torques load: under five angles stated above, the anterior tibial replacement of anterior cruciate ligament intact group was smallest, and there was no significant difference of anterior tibial replacement under 0°, 15° and 90° flexion between double-tunnel double-bundle anterior cruciate ligament reconstruction group and three-tunnel double-bundle anterior cruciate ligament reconstruction group (P > 0.05), while the anterior tibial replacement under 30° and 60° flexion in the three-tunnel double-bundle anterior cruciate ligament reconstruction group was smaller than that in the double-tunnel double-bundle anterior cruciate ligament reconstruction group, and the difference was significant (P < 0.05); there was no significant difference of anterior tibial replacement between three-tunnel double-bundle anterior cruciate ligament reconstruction group and anterior cruciate ligament intact group (P > 0.05). The anterior-posterior and rotational stability of knee joint could be improved by double-tunnel double-bundle and three-tunnel double-bundle anterior cruciate ligament reconstructions. But compared with double-tunnel double-bundle anterior cruciate ligament reconstruction, three-tunnel double-bundle anterior cruciate ligament reconstruction can effectively provide more rotational stability of knee joint. Related Articles | Metrics

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Changes of insulin-like growth factor 1 levels in rabbits with steroid-induced femoral head necrosis after treatment with Huoxuetongluo method Zhang Chi, Yang Zhi-wei, Duan Xiao-ying 2012, 16 (52):  9787-9791.  doi: 10.3969/j.issn.2095-4344.2012.52.019 Abstract ( 357 )   PDF (488KB) ( 434 )   Save BACKGROUND: Huoxuetongluo method is an effective prescription for the treatment of steroid induced femoral head necrosis in clinic, and Huoxuetongluo can promote osteonecrosis tissue repair. OBJECTIVE: To investigate the effect of Huoxuetongluo method on the level of insulin-like growth factor-1 in the steroid induced femoral head necrosis rabbit model. METHODS: The rabbits were randomly divided into five groups, and the rabbits in four groups were used to establish the steroid induced femoral head necrosis model through injecting the glucocorticoid. The rabbits in the high, moderate and low dose groups were administered intramuscularly with 10.0, 5.0 and 2.5 mL/kg Huoxuetongluo decoction, rabbits in both the model group and the blank control group were administered intramuscularly with 10 mL/kg normal saline and lasted for 8 weeks. RESULTS AND CONCLUSION: Histomorphometric examination showed that the femoral head necrosis in the model group was severe, while the femoral head necrosis in the high, moderate and low dose groups was mild necrosis. The data of empty lacuna in the model group was significantly higher than that in the blank control group (P < 0.01), and the level in the high, moderate and low dose groups was lower than that in the model group (P < 0.05); the level of insulin-like growth factor-1 in the model group was higher than the in the blank control group (P < 0.05) and the level in the high, moderate and low dose groups was higher than that in the model group (P < 0.01), while there was no significant difference between the every two Huoxuetongluo groups (P > 0.05). Huoxuetongluo decoction can promote the repairing and reconstruction of femoral head necrosis through increasing the level of insulin-like growth factor-1, but the level of insulin-like growth factor-1 will not increased with the increasing of the dose of Huoxuetongluo decoction when the dose reached to a certain level. Related Articles | Metrics

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Expression of matrix metalloproteinase 2 in rabbit models of hip joint capsule cut-healing after chitosan intervention Guo Jun-bin, Li Zhao-zhu 2012, 16 (52):  9792-9796.  doi: 10.3969/j.issn.2095-4344.2012.52.020 Abstract ( 350 )   PDF (502KB) ( 474 )   Save BACKGROUND: The developmental dislocation of the hip is a kind of common orthopaedics deformity. Function practice is the main measure to prevent articular adhesion after operation. But the right time choice depends on the healing degree of the capsule of hip joint. OBJECTIVE: To observe the morphology of hip joint capsule cut-healing model of the rabbits and the expression of matrix metalloproteinase 2 after chitosan induction, so as to explore the healing mechanism of hip capsule. METHODS: New Zealand white rabbit was used to establish the hip joint capsule cut-healing model, the left hip joint capsule (experimental group) was injected with 1 mL chitosan before closure, and the right hip joint capsule (control group) was closed after cutting without chitosan induction. The capsules were immediately obtained after executed the rabbit, then the collagen analysis was performed by Masson staining, and the expression of matrix metalloproteinase 2 was detected by ABC immunohistochemical method. RESULTS AND CONCLUSION: The collagen staining showed that collagen distribution and arrangement in these two groups were gradually changed to the better trend from 3 days to 28 days, but the early edema and fracture were obvious. The integrity of the collagen fiber morphology, the fracture gap and arrangement dense and regularity level in the control group were worse than those in the experimental group. Detection of the matrix metalloproteinase 2 showed that the expression of matrix metalloproteinase 2 was positive in both groups and grown stronger with the time increasing, but not fully synchronized. The expression of matrix metalloproteinase 2 in the control group was decreased at 7 days after operation and finally weaker than that in the experimental group, while the expression in the experimental group was continued increasing and stronger than that in the control group, excepted for the 3rd day after operation. Matrix metalloproteinase 2 participates in the reconstruction process through digesting degenerated collagen, and the reconstruction process should be longer than 28 days. Chitosan can promote healing process through delaying tissue necrosis degeneration and depressing inflammatory reaction. Related Articles | Metrics

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Application of three-dimensional virtual punctuation simulation in cervical nerve block Cao Jia-ming, Fu Dong 2012, 16 (52):  9797-9801.  doi: 10.3969/j.issn.2095-4344.2012.52.021 Abstract ( 491 )   PDF (454KB) ( 590 )   Save BACKGROUND: Neck nerve block anesthesia could easily cause a serious anesthetic accidents and complications. Till now, we are in the clinical exploration stage in establishment of three-dimensional visual model of the cervical nerve and virtual simulation of cervical nerve block. OBJECTIVE: To explore the application of three-dimensional virtual punctuation simulation in cervical nerve block. METHODS: Continuous CT angiography and MRI myelography sectional images were selected from the cervical part of one healthy volunteer, half-auto cut and reconstruction were taken to skeleton, muscles, artery, veins, thyroid gland, laryngeal cartilages and spinal cord etc. with the Mimics software. Medical computer-aided design module was used to reconstruct the nerve and other small anatomical structures. Three-dimensional model of cervical nerves and its surrounding relational local anatomic structure were successfully displayed and cervical nerves punctuation were virtual emulated, including simulation of superficial cervical plexus block, deep cervical plexus and stellate block. RESULTS AND CONCLUSION: Superficial cervical plexus block, deep cervical plexus and stellate block were successfully simulated, three-dimensions adjoin relation of the virtual pin with skeleton, carotid arteries, jugular veins, muscles, spinal cord, cervical plexus and stellate ganglion were successfully displayed, and pin’s safe angle, depth or optimization path were measured. A three-dimensional virtual punctuation simulation can provide visualized morphologic data for cervical nerve block. Related Articles | Metrics

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Design of the intraoperative imaging navigation system based on the near-infrared fluorescence properties of indocyanine green Lü Tie-jun, Li Wen-ke, Li Kai-yang 2012, 16 (52):  9802-9806.  doi: 10.3969/j.issn.2095-4344.2012.52.022 Abstract ( 338 )   PDF (433KB) ( 1072 )   Save BACKGROUND: In recent years, indocyanine green has been used in some medical imaging because of its unique physical properties and near-infrared spectral characteristics. OBJECTIVE: To design an intraoperative imaging navigation system based on the near-infrared fluorescence properties of indocyanine green. METHODS: The optical part, hardware part and software part were designed according to the principle. The imaging efficacy of system was identified through early experiment. RESULTS AND CONCLUSION: Conventional method of providing intraoperative anatomical information was used to transfer the preoperative image data of specific tissues to intraoperative situation. However, that was difficult in some cases. So, it was important to provide real-time information for the biological tissues by intraoperative imaging. The experimental results of human blood in imaging system show the intraoperative imaging navigation system based on the near-infrared fluorescence properties of indocyanine green has high fluorescence induction, apparent distinct and better imaging quality, which indicates the feasibility of the design proposal. Related Articles | Metrics

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Three-dimensional pulmonary ventilation imaging based on four-dimensional computed tomography at peak-exhale and peak-inhale phases Zhang Guo-qian, Zhang Shu-xu, Yu Hui, Lin Sheng-qu, Tan Jian-ming, Han Peng-hui, Wang Lin-jing 2012, 16 (52):  9807-9812.  doi: 10.3969/j.issn.2095-4344.2012.52.023 Abstract ( 410 )   PDF (541KB) ( 804 )   Save BACKGROUND: Traditional pulmonary functional imaging techniques have great inconvenience. Using the ventilation information in four-dimensional computed tomography to rapidly obtain the pulmonary functional imaging has important value for the diagnosis and treatment of lung diseases. OBJECTIVE: To investigate the feasibility of getting the pulmonary ventilation imaging distribution based on paired four-dimensional computed tomography images at the peak-exhale and peak-inhale phases by means of three-dimensional deformable image registration. METHODS: The computed tomography data of thoracic undergoing free breathing were acquired in Cine mode, and the previously developed four-dimensional computerized tomography software was used for the four-dimensional reconstruction. Computed tomography images at the peak-exhale and peak-inhale phases were obtained, the process of lung segmentation, three dimensional image registration based on deformable image registration algorithm, and quantization analysis of three-dimensional pixel displacement vector were in progress, and the regional ventilation images were obtained finally. RESULTS AND CONCLUSION: By means of three-dimensional deformable image registration, the goal that extracting pulmonary ventilation images include transverse, coronal and sagittal based on paired four-dimensional computed tomography at the peak-exhale and peak-inhale phases was realized. Related Articles | Metrics

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Construction and application of wrist finite element model Zhang Hao, Ma Nan, Zhu Jian-min 2012, 16 (52):  9813-9817.  doi: 10.3969/j.issn.2095-4344.2012.52.024 Abstract ( 373 )   PDF (560KB) ( 469 )   Save BACKGROUND: At present, the mature three-dimensional finite element analysis at home and abroad is more concentrated in the spine and hip biomechanics researches, and the finite element analysis on the wrist is rare. OBJECTIVE: To investigate the construction and application of wrist finite element model. METHODS: The Wanfang database and PubMed database were searched for the articles published from January 1970 to December 2010 by the first author. The key words were “mechanical analysis, finite element, wrist joint” in Chinese and English. The articles on the finite model establishing method, the reliability and influencing factors were selected. Finally, 21 articles were included for the analysis. RESULTS AND CONCLUSION: Hand portion is a composite mechanical structure, so during the biomechanical analysis using the finite element method, consider the effect of bone, articular surface, ligaments and tendons should be considered. The current studies are focus on performing the mechanical loading on the wrist finite element model in the static state, it is still difficult to achieve the dynamic simulation, analysis, and give the wrist completely and true physiological loading conditions. But with the continuous development of computer technology and finite element theory, people can simulate a variety of realistic clinical situations and establish the specific finite element models which can provide more effective help for the study of complex hand function, disease, treatment, and daily life. Related Articles | Metrics

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Theoretical research and treatment progress of anterior lumbar interbody fusion Zhu Ai-guo, Zhang Feng, Chen Xiang-dong, Cao Yong, Chen Yun 2012, 16 (52):  9818-9822.  doi: 10.3969/j.issn.2095-4344.2012.52.025 Abstract ( 345 )   PDF (529KB) ( 652 )   Save BACKGROUND: Anterior lumbar interbody fusion has become a standard technique for interbody fusion. Now it is widely used for the treatment of many degenerative diseases, such as isthmic spondylolisthesis, lumbar discogenic pain and lumbar instability. OBJECTIVE: To summarize research progress of species and application of anterior lumbar interbody fusion device as well as the species of internal fixation devices. METHODS: The PubMed database (1979-01/2012-01) was retrieved with the key word of “anterior lumbar interbody fusion” in English and the Wanfang database (1979-01/2012-01) was also retrieved with the key word of “anterior lumbar interbody fusion” in Chinese. Literatures were limited to English and Chinese languages. RESULTS AND CONCLUSION: Totally 567 literatures were obtained from the initial computer screen, and 39 documents of them were involved for analysis according to the inclusion and exclusion criteria. Recently, we have obtained significant development on the application of anterior lumbar interbody fusion, as well as the appearance and the material of interbody fusion device, the interbody fusion rate developed continuously. A variety of internal fixation devices have applied in clinic to enhance the stability of anterior fusion; the clinical application of small-incision surgery and the development of laparoscopic surgery make the surgery tend to minimal invasion. Related Articles | Metrics

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Finite element analysis of the dental implant based on the CT images Yang Wei-jiang, Zhao Hai-bo, Wang Guo-dong, Liu Quan 2012, 16 (52):  9823-9827.  doi: 10.3969/j.issn.2095-4344.2012.52.026 Abstract ( 505 )   PDF (656KB) ( 608 )   Save BACKGROUND: The emergence of multi-slice spiral CT and post-processing techniques can establish the standardized values for the simulation and measuring of the surgical site and the surgical area before dental implant surgery. OBJECTIVE: To evaluate the research and clinical value of spiral CT-based finite element analysis in implant dentistry. METHODS: A computer-based retrieval was performed for the related articles with the key words of “CT, finite element, dental implants, stress analysis” in Chinese and English from January 2002 to January 2012. The related articles of the dental implant finite element analysis were included; the repeatitive studies or Meta-analysis articles were excluded. The research and application of finite element analysis in implant dentistry were discussed focused in 7 articles. RESULTS AND CONCLUSION: The finite element analysis of jaw DICM image spiral CT acquisition image was performed after modeling, which provides more comprehensive and reliable image data for the operation, and the clinical dentists can design the surgery program based on the finite element model in order to measure the data required in the surgery, simulate the surgical process and reduce the pain of the patients. Reasonable combination of biomechanics researches of the CT image and the digitized modeling establishing and finite element analysis, and the analysis of the relationship between dental implant position and the surrounding structures, can provide allround image data and mechanical analysis basis for the clinical dentists. Related Articles | Metrics

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Expression and application of cytokines in osteoarthritis Ren Hong-ge, Cui Feng-de 2012, 16 (52):  9828-9835.  doi: 10.3969/j.issn.2095-4344.2012.52.027 Abstract ( 330 )   PDF (653KB) ( 860 )   Save BACKGROUND: Osteoarthritis is a kind of normal disease, results from a complex system of interacting mechanical, biological, biochemical, molecular and enzymatic feedback loops. Cytokines are closely related to the pathological process of osteoarthritis. OBJECTIVE: To summarize the research progress of cytokines in the occurring and development of osteoarthritis. METHODS: An online search of Wanfang database and PubMed database was performed by the first author for articles published between 2000 and 2012 that related to cytokines and osteoarthritis. RESULTS AND CONCLUSION: A total of 69 articles on the application of cytokines in osteoarthritis were included. Cytokines play an important role in the occurring and development process of osteoarthritis; cytokines can promote the degradation of osteoarthritic cartilage, synovitis and resorption of subchondral bone. Some cytokines also have an inhibitory effect in the development of osteoarthritis. Matrix metalloproteinase is related to catabolism; transforming growth factor, bone morphogenic protein, insulin-like growth factor, fibroblast growth factor and vascular endothelial growth factor are related to anabolism. Inflammatory factors which affect the function of joint cells include interleukin, chemokine and tumor necrosis factor. But the mechanisms of cytokines in the occurring and the development of osteoarthritis and clinical application of cytokines need further study. Related Articles | Metrics

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Selection and application of bone substitute materials for repair of bone defects Zhang Zhi-hong, Liu Zhi-li, Gao Zhi-zeng, Chen Ming, Yang Dong, Huang Shan-hu, Shu Yong 2012, 16 (52):  9836-9843.  doi: 10.3969/j.issn.2095-4344.2012.52.028 Abstract ( 542 )   PDF (852KB) ( 987 )   Save BACKGROUND: In the treatment of bone defects, there has been a series of major scientific breakthroughs in the field of bone repair substitute materials in recent years, and a lot of bone repair substitute materials have been made. At present, there are many kinds of bone repair substitute materials in clinic, and each kind of material has its advantages and disadvantages. Proper selection and application are the practical problems faced to the trauma orthopedic surgeons, and that is worthy for discussion and scrutiny. OBJECTIVE: To evaluate the biological properties of three kinds of bone repair substitute materials through relative analysis on the application of autologous bone, allograft bone and bone substitute materials which is conductive for the orthopedic surgeons a better understanding of physicochemical and biological properties of several bone repair substitute materials and further improve the diagnosis and treatment. METHODS: Artificial bone materials play an irreplaceable role in the repairing of bone defects and have achieved a great clinical effect, but, the recent clinical effect was not the final result of the comparison with traditional materials. There still lacked of experimental evidence on the verification of the security and stability of the artificial bone material, and yet long-term clinical observation was needed to identify the exact effect. Looking for the artificial bone material suppression with good biological characteristics was the orthopedic research hot spot. The experimental data of the comprehensive comparison of physicochemical and biological properties and security of three kinds of bone repair substitute materials, including the autologous bone, allograft bone and artificial bone material were analyzed. RESULTS AND CONCLUSION: ①In the bone defects repairing, we measured from the repair quality, immune rejection and the spread of the disease, and finding the autologous bone is the best choice and has become the gold standard of bone graft. However, the disadvantages of limited sources, complications on the harvesting area and the trauma of second surgery area caused by bone harvesting have limit its clinical application. ②The source of allograft bone is larger than autologous bone, but it has the disadvantage of the immune rejection between the host, and it may cause the infectious diseases such as hepatitis virus. ③The artificial bone van is formed rapidly, and with the help of computer-aided design and auxiliary production, it can better synthesis the bone repair substitute materials which are close to the morphology of the defected bone. But the osteoinductive and of the artificial bone materials are not satisfied. ④There are some shortages of the existing bone substitute materials which are unable to fully meet the needs of clinical quality. The substitute materials which can replace the natural bone and repair the bone defects in the future should be the preponderant combination and be the development trend of bone repair substitute materials. Related Articles | Metrics

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Limbs length discrepancy after artificial hip replacement Yan Jian-feng, Fu Pei-liang, Li Qiang, Yang Zong-hua, Zhang Xi-feng 2012, 16 (52):  9844-9851.  doi: 10.3969/j.issn.2095-4344.2012.52.029 Abstract ( 370 )   PDF (720KB) ( 494 )   Save BACKGROUND: Limbs length discrepancy is a common complication after hip arthroplasty, comprehensive measures for preventing limbs length discrepancy can obtain the better clinical results. OBJECTIVE: To evaluate the clinical application effect of comprehensive measures for preventing limbs length discrepancy after total hip arthroplasty. METHODS: 128 patients (136 hips) were selected from the Department of Orthopedics, Changshu No.2 People’s Hospital for analysis, and all the patients received the comprehensive measures to prevent the limbs length discrepancy after total hip arthroplasty. Preoperative limb length assessment, preoperative template plan, intraoperative measurement and comprehensive adjustments were performed to prevent the limbs length discrepancy after total hip arthroplasty. The articles related to the limbs length discrepancy after total hip arthroplasty from 2002 to 2011 were searched in the domestic and foreign databases, and the data were analyzed based on the results of database searches. RESULTS AND CONCLUSION: The limbs length discrepancy before treatment of 128 patients was range between 0-4.0 cm, averagely 1.6 cm. The length of limbs was measured at 7 days after total hip arthroplasty, and found that 2 patients have the limbs length discrepancy of 1.0-2.0 cm, 12 patients have the limbs length discrepancy of 0.5-1.0 cm, 55 patients have the limbs length discrepancy of 0.3-0.5 cm, and 59 patients have the limbs length discrepancy < 0.3 cm. The average limbs length discrepancy was 0.4 cm. Clinical analyses showed that comprehensive measures can prevent the limbs length discrepancy after total hip arthroplasty effectively. The results of domestic and foreign databases retrieval showed that the domestic and foreign literatures in this field were rare, but the number of foreign foundation supported literatures was more than that of domestic foundation supported literatures. Related Articles | Metrics

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Effects of radionuclide bone imaging in differential diagnosis of prosthesis loosening and infections after artificial joint replacement Tan Wei-qin, Yang Shi-jun, Cui Jian-he 2012, 16 (52):  9852-9859.  doi: 10.3969/j.issn.2095-4344.2012.52.030 Abstract ( 303 )   PDF (827KB) ( 583 )   Save BACKGROUND: Prosthetic loosening and infection is a frequent cause of failure of artificial joint replacement, therefore, it is important to distinguish between prosthetic loosening and infection. Because, most of the patients have no typical clinical presentation and the tresting and confirming methods of other laboratories are very limit, radionuclide bone imaging, CT and magnetic resonance imaging and X-ray inspection have become the commonly used method for the diagnosis of prosthetic loosening and infection. But which method can be more effective to check out the lesions, there has been a controversy. OBJECTIVE: To analyze the literatures on the radionuclide bone imaging, CT and magnetic resonance imaging and X-ray in the diagnosis of prosthetic loosening and infection after artificial joint replacement, to optimize these methods in order to provide basis for the selection of clinical treatment options and the diagnosis of prognosis. METHODS: The literatures on the radionuclide bone imaging, CT and magnetic resonance imaging and X-ray in the diagnosis of prosthetic loosening and infection after artificial joint replacement were selected, and its imaging performance was retrospective analyzed. The advantages and disadvantages of several methods of imaging diagnosis were compared. RESULTS AND CONCLUSION: The clinical manifestations of prosthesis loosening and infection after artificial joint replacement are not easy to distinguish, and not yet form the abnormal periprosthetic bone structure in the early loosening of the prosthesis and the periprosthetic smaller translucent band is obscured which affect the X-ray or CT diagnosis, so the diagnosis is often misdiagnosed. In addition, the joint prostheses are mostly metallic materials, and CT or magnetic resonance imaging may form artifacts which also affect the judgment of prosthetic loosening and infection. Radionuclide bone imaging can accurately position and qualitative diagnose the patients with prosthesis loosening and infection after artificial joint replacement, and has more clinical significance in prognosis. Related Articles | Metrics

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Positive correlation between serum leptin and lipid levels in patients with nontraumatic femoral head necrosis Wang Hui, Li Hui-jie, Zheng Yue, Yang Xiang-lei 2012, 16 (52):  9860-9866.  doi: 10.3969/j.issn.2095-4344.2012.52.031 Abstract ( 317 )   PDF (543KB) ( 534 )   Save BACKGROUND: As the leptin has close relationship with the incidence of osteoporosis, so it may relates to the incidence of femoral head necrosis. OBJECTIVE: To study the correlation between serum leptin, serum lipid and osteonecrosis of femoral head. METHODS: From June 2011 to March 2012, 65 patients with nontraumatic osteonecrosis of the femoral head were selected from Department of Orthopedics, the Third Hospital of Hebei Medical University, and 60 healthy adults were selected as controls. The levels of serum leptin, total cholesterol, triglyceride, low and medium-density lipoprotein, high-density lipoprotein and apolipoprotein A1 and B were measured. RESULTS AND CONCLUSION: In osteonecrosis of the femoral head group, the levels of serum leptin, total cholesterol, triglyceride, low and medium-density lipoprotein and apolipoprotein B were significantly higher than those in the control group (P < 0.05), while the levels of high-density lipoprotein and apolipoprotein A1 were significantly lower than those in the control group (P < 0.05). The level of serum leptin in the female patients was higher than that in the male patients (P < 0.05). The level of serum leptin was positively correlated with serum lipid. ①The increasing of the serum leptin level in patients with nontraumatic osteonecrosis of the femoral head plays a role in the process of the disease. ②The serum leptin concentrations are positively correlated with the development of nontraumatic osteonecrosis of the femoral head. Related Articles | Metrics

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Cost-effectiveness analysis on the treatment of knee osteoarthritis by glucosamine hydrochloride and glucosamine sulfate Zhang Bai-dang, Liang Zu-jian, Zhang Huan-tian, He Ming-tao, Li Dong-sheng 2012, 16 (52):  9867-9872.  doi: 10.3969/j.issn.2095-4344.2012.52.032 Abstract ( 668 )   PDF (458KB) ( 931 )   Save BACKGROUND: Most patients of knee osteoarthritis need a long-term medication, so the costs are very high. Therefore, it is much important to choose the rational treatment project. OBJECTIVE: To compare the cost-effectiveness of glucosamine hydrochloride and glucosamine sulfate for the treatment of knee osteoarthritis and to perform the economic evaluation in order to present more effective and utility strategy to treat osteoarthritis. METHODS: Totally 78 outpatients with knee osteoarthritis were randomly divided into A group (n=39, treated with glucosamine hydrochloride) and B group (n=39, treated with glucosamine sulfate). The Western Ontario McMaster index as well as Lequesne pain and function index were observed at 3 and 6 weeks after treatment, and the cost-effectiveness analysis was performed with medical economical study. RESULTS AND CONCLUSION: Comparison of the curative effect of two groups after treatment: ①Total effective rates: the total efficiencies for the treatment of osteoarthritis in group A and group B at 3 weeks after treatment were 83.8% and 82.1% respectively (P > 0.05), and at 6 weeks after treatment, the total efficiencies were 91.9% and 90.7% respectively (P > 0.05); ②Cost-effectiveness analysis: the cost-effectiveness ratios in group A and group B at 3 weeks after treatment were 6.24 and 5.37 respectively, and at 6 weeks, the cost-effectiveness ratios were 11.38 and 9.70 individually. ③Sensitiveness analysis: effective sensitiveness degrees in the two groups at 3 weeks after treatment were 5.30 and 4.55, and at 6 weeks were 9.67 and 8.24 respectively. This shows that both glucosamine hydrochloride and glucosamine sulfate have the capacity to improve Western Ontario McMaster index and knee joint function of the patients with knee osteoarthritis markedly, but the cost-effectiveness ratio of glucosamine sulfate is better than that of glucosamine hydrochloride. Therefore, glucosamine sulfate costs less medical resources and gain more effectiveness. Related Articles | Metrics

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Percutaneous vertebroplasty for the treatment of old symptomatic osteoporotic vertebral fracture in the elderly Xin Wei-wei, Cheng Guang-qi, Feng Yu, Chen Bin 2012, 16 (52):  9873-9880.  doi: 10.3969/j.issn.2095-4344.2012.52.033 Abstract ( 256 )   PDF (517KB) ( 662 )   Save BACKGROUND: The researches on the treatment of osteoporotic vertebral fractures by percutaneous vertebroplasty are mainly based on the fresh osteoporotic compression vertebral fractures, and the reports on the treatment of old symptomatic osteoporotic vertebral fractures are rare. OBJECTIVE: To investigate the effect of percutaneous vertebroplasty in the treatment of old symptomatic osteoporotic vertebral fractures in elderly. METHODS: The patients with old symptomatic osteoporotic vertebral fractures in elderly were selected from Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine during January 2007 to December 2010, and all the 12 patients (14 vertebras) were treated with percutaneous vertebroplasty. The Visual Analogue Scale score, Oswestry disability index and local sagittal Cobb’s angles were measured before percutaneous vertebroplasty, and 1 month and 1 year after percutaneous vertebroplasty. RESULTS AND CONCLUSION: There was no infection, toxic effect of bone cement, pulmonary embolism or leakage of bone cement in the patients with old symptomatic osteoporotic vertebral fractures. After percutaneous vertebroplasty, there was one case with loss of follow-up, one case of death, and the death has nothing to do with the surgery. The Visual Analogue Scale score and Oswestry disability index of the patients with old symptomatic osteoporotic vertebral fractures after percutaneous vertebroplasty were significantly lower than those before percutaneous vertebroplasty (P < 0.01), and there was no significant difference of local sagittal Cobb’s angles before and after percutaneous vertebroplasty (P > 0.05). It suggests that percutaneous vertebroplasty can relieve the pain and improve the life quality of the patients with old symptomatic osteoporotic vertebral fractures. Related Articles | Metrics