Table of Content

26 March 2013, Volume 17 Issue 13 Previous Issue    Next Issue

For Selected:

Download Citations EndNote Reference Manager ProCite BibTeX RefWorks

Toggle Thumbnails

Select

Reaction of soft tissue to artificial bone in posterior vertebral bone fusion operation Jin Wen-jie, Shen Kang-ping, Tao Hai-rong, Wu Yu-jie, Zhu Chao, Liu Xing-zhen 2013, 17 (13):  2281-2288.  doi: 10.3969/j.issn.2095-4344.2013.13.001 Abstract ( 845 )   PDF (712KB) ( 483 )   Save BACKGROUND: Posterior vertebral bone fusion is a very common operation. Artificial bone can promote bone fusion, However, because the soft tissue may present some abnormal reactions to artificial bone, it is rarely used in posterior vertebral operation. OBJECTIVE: To investigate a way to lower the reaction of soft tissue to artificial bone through a posterior vertebral bone fusion experiment in rabbits. METHODS: Thirty-six adult male rabbits were randomly divided to absorbable hemostatic gauze group and control group. All rabbits were given a posterior vertebral bone fusion operation. The β-tricalcium phosphate artificial bone was implanted on the surface of L2-3 decorticating vertebral plate, and absorbable hemostatic gauze was laid between back soft tissue and β-tricalcium phosphate artificial bone in the absorbable hemostatic gauze group, while there was nothing between soft tissue and artificial bone in the control group. The C-reaction protein expression was detected at different time points after implantation, the skin healing and subcutaneous tissue healing at 1 and 12 weeks after implantation were recorded. The creeping substitution of artificial bone at different time points was recorded with CT. RESULTS AND CONCLUSION: At 1 week after implantation, the back subcutaneous fascia of all rabbits in the absorbable hemostatic gauze group was well-healed, while among the nine rabbits in the control group, only seven rabbits were well-healed and two rabbits below the standard. At 12 weeks after implantation, among the nine rabbits in the absorbable hemostatic gauze group, the back subcutaneous fascia of eight rabbits was well-healed and one healed poorly; among the nine rabbits in the control group, the back subcutaneous fascia of six rabbits was well-healed and two was poorly healed, one rabbit suffered slight infection. At 1 week after implantation, there was muscle tissue congestion and inflammatory cell infiltration in two groups, but the inflammatory cell infiltration and local congestion in the absorbable hemostatic gauze group was less than those in the control group. At 12 weeks after implantation, granulation tissue hyperblastosis could be observed in the muscle tissue of two groups, but the inflammatory cell infiltration in the absorbable hemostatic gauze group was less than that in the control group, and necrosis tissues could be found in the control group. There was no significant difference of C-reaction protein expression between two groups immediately, 1 and 4 weeks after implantation. At 12 weeks after implantation, the CT results showed that there was significant absorption in the artificial bone adjacent to grafting interface, and there was almost no absorption in the artificial bone adjacent to soft tissue. There was no significant difference in absorption of artificial bone between two groups. Artificial bones should be put to contact with the grafting interface as much as possible, which can help the absorption of artificial bone and lower the reaction of soft tissue. Diminishing the contact between artificial bone and soft tissue may decrease the reaction of soft tissue to artificial bone. The biological isolation of absorbable hemostatic gauze and the tissue repair may decrease the reaction of soft tissue to artificial bone. Figures and Tables | References | Related Articles | Metrics

Select

Ceramic-on-ceramic total hip arthroplasty Yang Xing, Wang Zheng-fei, Xue Feng, Sheng Xiao-wen, Chen Bin-qian, Qian Yu-feng, Yu Xu-dong 2013, 17 (13):  2289-2296.  doi: 10.3969/j.issn.2095-4344.2013.13.002 Abstract ( 1796 )   PDF (561KB) ( 655 )   Save BACKGROUND: At present, the ceramic manufacturing process has been improved constantly, and the ceramic-on-ceramic friction interface prosthesis has become the focus in the field of joint surgery and has achieved good clinical effects. However, with the wide application of ceramic-on-ceramic friction interface prosthesis, the prosthesis fragmentation and high-profile fricative appear. OBJECTIVE: To discuss the preliminarily clinical effects of ceramic-on-ceramic total hip arthroplasty. METHODS: Fifty patients less than 55 years old treated with ceramic-on-ceramic total hip arthroplasty between February 2006 and June 2010 in the First People’s Hospital of Changshu were enrolled for follow-up visit. There were 19 male patients (20 hips) and 31 female patients (33 hips). The average age of the patients was 45 years. All the patients were followed-up for an average of 20 months (ranged 12-42 months). The clinical effects were evaluated with Harris score preoperatively and postoperatively. Radiographic follow-up included the outreach angle and anteversion angle. The prosthesis loosening was evaluated with Kawamura and Engh standard. Osteslytic lesions were defined according to the Engh standard, and heterotopic ossification was defined according the system of Brooker. RESULTS AND CONCLUSION: The average Harris score improved from (48.10±26.33) points preoperatively to (91.10±19.78) points postoperatively. No patient presented joint abnormal sound, prosthesis loosening, periprosthetic infection, observed wear, osteolysis or heterotopic ossification. One patient had renovation due to acetabular ceramic liner fragmentation. It showed that ceramic-on-ceramic total hip arthroplasty offers a promising choice for young patients with better bone quality, and the long-term effect needs to be further observed. Figures and Tables | References | Related Articles | Metrics

Select

Artificial hip joint replacement for the treatment of severe hip diseases Li Guang-wei 2013, 17 (13):  2297-2304.  doi: 10.3969/j.issn.2095-4344.2013.13.003 Abstract ( 590 )   PDF (532KB) ( 624 )   Save BACKGROUND: Applying artificial hip joint replacement for the treatment of end-stage hip disease is difficult and involves multi-aspects, including the surgical approach, intraoperative osteotomy, prosthesis implantation and selection of type, There are a lot of controversies due to different scholarly opinions. OBJECTIVE: To explore the methods and clinical effects of the artificial hip joint replacement in the treatment of end-stage hip disease. METHODS: Retrospective analysis of 52 patients (57 hips) receiving artificial hip joint replacement was performed based on a long-term follow-up. The follow-up time was 14-86 months, 27 months in average. The preoperative and postoperative (last follow-up) visual analogue scale score and Harris hip score were recorded, analyzed and compared, and the results were statistically analyzed. RESULTS AND CONCLUSION: The visual analogue scale score in 52 patients was decreased from preoperative (7.0±1.2) points to postoperative (2.0±0.7) points. Harris score was increased from preoperative (35.9±5.4) points to the last follow-up (89.7±3.1) points. The difference was statistically significant when compared with that before operation (P < 0.05). All the 52 patients after surgery could walk with crutches or walker ambulation, and all of them could be able to walk independently and take self-care after 3 months. X-ray assessment showed no loosening of the prosthesis, and achieved satisfactory results. Careful preoperative preparation and scientific and rigorous operation can prevent the hip prosthesis loosening, infection and pain after operation. Rehabilitation exercise after surgery is an important measure to reduce the postoperative pain and recover the function to the maximum extent. Figures and Tables | References | Related Articles | Metrics

Select

Hidden blood loss after total hip arthroplasty Liu Zhi-gang, Zhang Shang-shang, Chen Ru-jian, Li Zhong, Zhang Peng, Bi Meng-na, Chen Jing-yong, Lu Li-sha 2013, 17 (13):  2305-2312.  doi: 10.3969/j.issn.2095-4344.2013.13.004 Abstract ( 707 )   PDF (513KB) ( 675 )   Save BACKGROUND: Hidden blood loss commonly occurs after total hip arthroplasty, and has great impact on function recovery after replacement. OBJECTIVE: To investigate relative factors for hidden blood loss after total hip arthroplasty. METHODS: A retrospective study of the clinical data of 850 consecutive patients who underwent total hip arthroplasty was carried on. The hidden blood loss was calculated according to Ward designed mathematical methods through calculating circulating blood volume of red blood cells using hematocrit and Cross formula linear equation. The effects of patient gender, age, body mass index, type of disease, deep vein thrombosis, postoperative anticoagulation method and type of prosthesis on the postoperative hidden blood loss were analyzed. RESULTS AND CONCLUSION: The amount of hidden blood loss after total hip arthroplasty was higher than that of obvious blood loss. Body mass index, type of disease and type of prosthesis could influence the amount of hidden blood loss after total hip arthroplasty, while the influences of patient gender, age, anticoagulation method and lower extremity deep vein thrombosis on hidden blood loss after total hip arthroplasty were not significant. Figures and Tables | References | Related Articles | Metrics

Select

Changes in anatomical parameters of the hip following femoral head necrosis and hip replacement: A 10-year follow-up survery Song Ya-wei, Zhang Xi-yuan, Rong Ke 2013, 17 (13):  2313-2319.  doi: 10.3969/j.issn.2095-4344.2013.13.005 Abstract ( 635 )   PDF (519KB) ( 620 )   Save BACKGROUND: At present, research on the anatomy parameters of the proximal femur is only confined to ordinary Chinese people, and the studies on some special groups are less. OBJECTIVE: To perform a 10-year follow-up in one athlete treated with artificial hip replacement due to right femoral head necrosis, and to compare the hip parameters between healthy side and affected side and between healthy side and ordinary Chinese people. METHODS: Pelvis X-ray plain films were taken from 2001 to 2011. The subject supine on photography table while shooting with double lower limbs in neutral position and closed to the X-ray films, the photographic distance was 100 cm, with the small rotor level as the center. Internal rotation of the femur was required to make the femoral neck in the coronal plane, then parallel to the longitudinal axis of the femoral neck for radiography. The various hip anatomy parameters were measured on the X-ray film, and then the data were imported into the SPSS 16.0 software for variance analysis, correlation analysis and principal component analysis of the contribution rate. RESULTS AND CONCLUSION: Long-term training led to a serious increase in hip load, and the stress on femoral head was far beyond the ordinary people. The eccentricity on the healthy side was smaller which leading to the periarticular soft tissue contraction asthenia. Attention should be paid to maintaining and restoring the deformed parts. The traction after hip replacement recovered the center edge angle somewhat. As a result of long-term curtch walking, the compression on the healthy side was less than that of the ordinary people. A natural form of gravity-assisted traction was shown in the lower limbs. We should pay attention to the recovery of relative acetabular position on the healthy side. As a result of femoral head necrosis, femoral head collapse was observed in the overload area, joint cavity and pelvic height was decreased obviously. After operation, the femoral head and relative acetabular position on the healthy side were restored somewhat, but relative ipsilateral position difference was more obvious. Figures and Tables | References | Related Articles | Metrics

Select

Improved osteotomy in total knee arthroplasty Li Shou-min, Xu Wei, Kong Rong, Shang Xi-fu, Xia Rui 2013, 17 (13):  2320-2326.  doi: 10.3969/j.issn.2095-4344.2013.13.006 Abstract ( 604 )   PDF (461KB) ( 591 )   Save BACKGROUND: Recently, total knee arthroplasty has been widely applied in clinic, and the replacement techniques and prosthetic design concept have been greatly improved. But osteotomy order has not been reported. OBJECTIVE: To discuss the clinical effect of the improved osteotomy in total knee athroplasty. METHODS: The total knee arthroplasty was performed in 60 patients (60 knees), including 52 cases of osteoarthritis, six cases of rheumatoid arthritis and two cases of traumatic arthritis, and posterior stabilized knee joints were used for total knee arthroplasty, such as the PFC-Sigma PS prosthesis or LINK Gemini PS prosthesis. The femoral osteotomy was performed firstly under extreme knee bending, including oblique osteotomy anterior and posterior to the distal femur (some types contained intercondylar osteotomy). Patella un-conventional replacement was performed followed by the tibial plateau osteotomy. The operation time, postoperative drainage volume, range of motion of knee joint as well as Hospital for Special Surgery knee scores before replacement and 6 and 12 weeks after replacement were recorded and statistically analyzed. RESULTS AND CONCLUSION: All the 60 patients were followed-up for 3-14 months. The average operation time was (51.3±12.5) minutes; the postoperative drainage volume was (302±39) mL. The range of motion of knee joint and Hospital for Special Surgery knee scores 6 and 12 weeks after replacement were improved compared with those before replacement (P < 0.01). At 1 month after replacement, two cases had low-grade infection which was improved after anti-infection therapy without prosthesis rejection. Femoral osteotomy before total knee arthroplasty can obtain the great space for tibial operation, which is beneficial to removal of the meniscus, and further loosens the surrounding soft tissue safely. This method has the advantages of simple operation, shortening the operation time, reducing the intraoperative blood loss, and better repairing effect. Figures and Tables | References | Related Articles | Metrics

Select

Treatment for patellofemoral maltracking in total knee arthroplasty Pan Yong-qian, Li Jian, Yang Bo, Zhang Ping, Wang Le, Zhong Zhi-hong 2013, 17 (13):  2327-2332.  doi: 10.3969/j.issn.2095-4344.2013.13.007 Abstract ( 945 )   PDF (432KB) ( 584 )   Save BACKGROUND: The complication of patellofemoral joint is the main cause of anterior knee pain after total knee arthroplasty. OBJECTIVE: To explore the strategies and treatment methods of patellofemoral maltracking in total knee arthroplasty. METHODS: Thirty-one patients (32 knee joints) had patellofemoral maltracking in total knee arthroplast. All the patients were female, aged 53-85 years old, averaged in 68.5 years old. The course of the disease was 8-25 years (22.3 years on average). Among all the cases, 28 knees of 27 cases were diagnosed as having osteoarthritis, four knees of four cases were rheumatoid arthritis. The valgus angle was 12°-32° (20°on average) and the Q angle was 13°-23° (16° on average). Correct osteotomy and prosthesis position adjustment, balancing soft tissue of lateral and medial side of the patella or Goldthwait-Roux methods were used for correcting patellofemoral maltracking in total knee arthroplasty. RESULTS AND CONCLUSION: All the patients were followed-up for 12-120 months postoperatively. Average range of motion of the knee joint was (98.2±10.3)°. The Knee Society Score was increased from preoperative 35 points to postoperative 81 points; and the function score of Knee Society Score was increased from preoperative 34 points to postoperative 83 points. After replacement, all incisions were well-healed by first intension, and complications such as necrosis of the skin and wound infection did not occur. Knutsson X-ray on axial position of the patella for 45° inflexion of the knee was found no tilt, subluxation or dislocation of the patella. For correcting patellofemoral maltracking in total knee arthroplasty, adopting stabilized prosthesis, using osteotomy and adjusting the prosthesis position correctly, balancing soft tissue of lateral and medial side of the patella or Goldthwait-Roux can achieve quite satisfactory results. Figures and Tables | References | Related Articles | Metrics

Select

Accuracy of pedicle screw placement based on three-dimensional lumbar reconstruction Yang Bo, Fang Shi-bing, Yin Biao, Song Lei, Wang Le, Wan Sheng-yu, Xie Jing-kai 2013, 17 (13):  2333-2338.  doi: 10.3969/j.issn.2095-4344.2013.13.008 Abstract ( 599 )   PDF (471KB) ( 617 )   Save BACKGROUND: The three-dimensional reconstruction techniques have been widely used in preoperative planning of pedicle screw placement, but the direct accuracy analysis of the forecast parameters has not yet been reported. OBJECTIVE: To analyze the accuracy of three-dimensional reconstruction based on computerized tomography in the application of lumbar pedicle screw placement. METHODS: By the using of the Mimics software, we selected 136 lumbar pedicles to perform the preoperative three-dimensional reconstruction, which were randomly selected from 30 patients treated with pedicle screw fixation. By the simulation modules of Mimics, the length, diameter, transverse section angle and sagital section angle were preoperatively predicted. Then, the data were statistically compared with the actual data of the patients postoperatively. RESULTS AND CONCLUSION: Through the three-dimensional lumbar reconstruction preoperatively by Mimics software, the best channel of pedicle screw placement was designed and the placement of the screw was simulated. The length, diameter, transverse section angle and sagital section angle of preoperative predicted pedicle screw were pre-measured. There was no significant difference of the data when compared with the actual data obtained from the C-arm and intra-fixation navigation system after placement (P > 0.05). The postoperative actual location and length of pedicle screws were excellent from CT scans. Through the preoperative three-dimensional lumbar reconstruction by Mimics software, the parameters of simulating pedicle screw placement can precisely guide and improve the safety of pedicle screws placement. Figures and Tables | References | Related Articles | Metrics

Select

Pedicle screw placement via paraspinal approach versus conventional approach for the treatment of thoracolumbar vertebral fracture Dai Hu-ming, Fang Shi-yuan, Xia Rui, Wang Xu-jin, Sun Jian-wan, Xu Lei 2013, 17 (13):  2339-2345.  doi: 10.3969/j.issn.2095-4344.2013.13.009 Abstract ( 670 )   PDF (508KB) ( 693 )   Save BACKGROUND: Pedicle screw and rod fixation system is a common method for the treatment of thoracolumbar vertebral fracture. Conventional approach is the midline approach which needs to cut paraspinal muscle widely, and parts of patients suffer from back pain after surgery. OBJECTIVE: To observe the clinical outcome and paraspinal muscle injury after the treatment of thoracolumbar fractures via paraspinal approach and conventional approach. METHODS: A total of 45 patients with thoracolumbar fractures were selected from Department of Orthopedics, Affiliated Provincial Hospital of Anhui Medical University during June 2010 to June 2012. According to Denis fracture classification, there were 11 compression fractures and 34 burst fractures with intact posterior column, and the spinal canal occupied for less than 1/3. American Spinal Injury Association grade was E-class with no neurological symptoms. Randomly, 21 patients adopted paraspinal approach and the other 24 patients underwent the conventional approach. The perioperative parameters and intervertebral indicators were compared between two groups. The visual analogue scale score and Japanese Orthopaedic Association score were analyzed postoperatively, and the postoperative and 1, 3, and 5 days preoperative serum level of creatine kinase were compared, also multifidus muscle electromyography assessment was adopted during follow-up. RESULTS AND CONCLUSION: There was no significant difference in the Cobb’s angle restoration between two groups, but the operation time, blood loss, volume of drainage, serum level of creatine kinase and postoperative visual analogue scale score in the paraspinal approach group were significantly lower than those in the conventional approach group (P < 0.05). The Japanese Orthopaedic Association score at 6 months postoperatively in the paraspinal approach group was lower than that in the conventional approach group, but the difference was not statistically significant (P > 0.05). The multifidus muscle electromyography assessment after 6 months showed that the fibrillation potentials in the paraspinal approach group were less than that in the conventional approach group, and the difference was statistically significant (P < 0.05). Paraspinal approach has satisfactory curative effect with the advantages of less trauma and bleeding as well as shorter operation time. Figures and Tables | References | Related Articles | Metrics

Select

Stability of pedicle screw in patients with osteoporosis: Follow-up visit Yin Qu-dong, Tian Xiao-wu, Zheng Zu-gen 2013, 17 (13):  2346-2351.  doi: 10.3969/j.issn.2095-4344.2013.13.010 Abstract ( 320 )   PDF (339KB) ( 709 )   Save BACKGROUND: Screw loosening and loss of correction are main complications in patients with osteoporosis receiving pedicle screw implantation. Therefore, osteoporosis is considered as a relative contraindication for pedicle screws. OBJECTIVE: To study the clinical results of methods for improving stability of pedicle screw in patients with osteoporosis. METHODS: Thirty-four patients with osteoporosis were treated with pedicle screw internal fixation, and the methods of improving stability of pedicle screw were applied during the operation. There were 14 cases of fractures (fracture group) and 20 cases of osteopathy. Spinal posterolateral or intervertebral body graft fusion was performed in the 20 cases of osteopathy and five cases of fractures (fusion group). According to Jikei grading scale for osteoporosis, eight cases were in early stage, 11 cases Ⅰ stage, eight cases Ⅱ stage and seven cases Ⅲ stage. For 19 cases inearly stage and Ⅰ stage osteoporosis, longer and large size of pedicle screws were used, combined with rod system with ankylosing connection between screws and connecting rods using two cross-link devices, placement of pedicle screw with large angles in the horizontal and the sagittal planes were applied to improve the relative stability of screw. For 15 cases of Ⅱ stage and Ⅲ stage osteoporosis, bone cement was used to fill the screw path to improve the absolute stability of screw. RESULTS AND CONCLUSION: There was no breakage of screw during the follow-up with the mean period of 14 months (ranged 9-26 months), only two cases in fracture group with Jikei Ⅰ stage osteoporosis had screw loosening at 5 to 6 months after fixation, as well as partial loss of correction of reduction, but no other adverse effects. The loss of correction of reduction in the fracture group was 5% in average, and the fusion rate was 100% in the fusion group. Different methods of improving the stability of pedicle screw applied in patients with osteoporosis according to different situations may reduce the occurrence of complications, such as screw loosening and loss of correction. Figures and Tables | References | Related Articles | Metrics

Select

Rubber band stretching and stress relaxation tests during the treatment of fractures with traction splint Qin Hong, Liang Ai-jun, Qian Wen-liang, Huang Xi-bin, Song Ya-wei 2013, 17 (13):  2352-2357.  doi: 10.3969/j.issn.2095-4344.2013.13.011 Abstract ( 532 )   PDF (478KB) ( 521 )   Save BACKGROUND: Simple plaster external fixation for the treatment of distal radius fracture is difficult to obtain the good reduction and fixation, and in recent years, traction splint has better treatment effect. OBJECTIVE: To comparatively analyze the effect of rubber band stretching and stress relaxation on the treatment of distal radius fracture with traction splint through biomechanical methods. METHODS: Totally 236 cases of distal radius comminuted fractures were divided into treatment group and control group according to the treatment method. The patients in the treatment group were treated with traction splints and the patients in the control group were treated with manipulative therapy and splints external fixation. The X-ray films were taken regularly to observe the healing of the fracture, and the wrist function was assessed with Dienst assessment standards. Instron Electronic Universal Material Testing Machine 3367 was used to detect the rubber band stretching and stress relaxation of the traction rubber band in order to test the rubber band maximum stress. RESULTS AND CONCLUSION: According to the intent-to-treat analysis, all the patients were involved in the final analysis. All the patients were followed-up for more than 5 months, and longest for 13 months. Dienst functional assessment showed in the treatment group, excellent in 68 cases, good in 42 cases and the excellent and good rate was 93.2%; the excellent and good rate of the control group was 52.6%, the excellent and good rate of the treatment group was significantly higher than that of the control group. Traction splint for the treatment of distal radius fracture has the advantages of simple operation and reliable clinical efficacy. Rubber band stretching and stress relaxation results showed that the maximum stress of the rubber band was 46.97 N and it was maintained at 20.60 N, thereby achieving the traction effect in the reduction treatment of distal radius comminuted fractures. Figures and Tables | References | Related Articles | Metrics

Select

Repairing ankle lateral collateral ligament chronic injury using different methods: A stability assessment Jiao Chen, Hu Yue-lin, Guo Qin-wei, Wang Cheng, Mei Yu, Xie Xing, Yang Yu-ping, Chen Lin-xin, Jiang Dong 2013, 17 (13):  2358-2367.  doi: 10.3969/j.issn.2095-4344.2013.13.012 Abstract ( 1355 )   PDF (637KB) ( 985 )   Save BACKGROUND: There are many repair and reconstruction methods to restore the stability of lateral ankle joint. OBJECTIVE: To compare the mechanical changes of modified Karlsson procedure and modified Broström procedure for the treatment of lateral chronic ankle instability. METHODS: Seventy-three patients with lateral chronic ankle instability were enrolled, among whom, 43 consecutive patients were treated with modified Broström procedure and followed-up for average (50.8±26.5) months, and 30 consecutive patients underwent modified Karlsson procedure and followed-up for (49.5±11.1) months. Chondral lesions, American Orthopaedic Foot and Ankle Society score, Mazur score, Tegner score, satisfaction score and re-injury situation were recorded before and after treatment. Objective examinations including drawer test and inversion stress test were also done for assessment. RESULTS AND CONCLUSION: 38.4% patients had chondral lesions, and 40.5% lesions occurred in the anteromedial facet of the talocrural joint (talus zone I and tibia region I). Mazur score and Tegner score were significantly improved postoperatively in modified Broström group and modified Karlsson group. There were no significant differences on Mazur score and Tegner score between two groups. The improved American Orthopaedic Foot and Ankle Society score in the modified Karlsson group was significantly higher than that in the modified Broström group. The drawer test and inversion stress test were negative in two groups, except positive in one patient in modified Broström group. The treatment time in the modified Karlsson group was significantly shorter than that in the modified Broström group, and there was no significant difference in satisfaction score between two groups. There were two cases of re-injury in modified Broström group while one case in modified Karlsson group. Modified Karlsson procedure has the treatment effect similar to modified Broström procedure, but it is easier to operate. Figures and Tables | References | Related Articles | Metrics

Select

Normal human gaits based on image edge detection Meng Qing-yun, Tan Shi-li, Yu Hong-liu, Shen Li-xing 2013, 17 (13):  2368-2374.  doi: 10.3969/j.issn.2095-4344.2013.13.013 Abstract ( 715 )   PDF (507KB) ( 760 )   Save BACKGROUND: The parameters of kinematics and dynamics are usually used to describe the law of gaits. Up to now, in the fields of sports medicine, rehabilitation engineering and bionics, gait analysis can provide important basis for ascertaining the scenario of diagnosis disease, the scenario of treatment and recovery. OBJECTIVE: To acquire the lower extremity motion gaits video on the treadmill by the image measuring device system based on the human motion in order to analyze the regular pattern of human gaits. METHODS: The identification points were set on the right and left hip joints, knee joints and foot plate by the image-gathering system in order to acquire the lower extremity motion gait while the subject walked on a treadmill. After processing and analyzing the data based on the theory of image edge detection, angle between the right and left thighs and vertical direction, angle between leg and vertical direction, angle between foot plate and vertical direction and the changes of the angles of identification points of knee joints and ankle joints were obtained. RESULTS AND CONCLUSION: The human lower extremity motion gait obtained according to the theory of image edge detection has relatively low cost and small error, and the accuracy was similar to the imported equipment. Finally, a database of human gait was built based on the measurement results, and it provided a basis for the further establishment of assessing standard for human gait, better analysis of abnormal gait and rehabilitation treatments． Figures and Tables | References | Related Articles | Metrics

Select

Body surface localization using laser auxiliary X-ray in orthopaedic implant internal fixation Wang Ming-xin, Xiong Min, Liu De-chang 2013, 17 (13):  2375-2382.  doi: 10.3969/j.issn.2095-4344.2013.13.014 Abstract ( 421 )   PDF (586KB) ( 579 )   Save BACKGROUND: C-arm X-ray machine is often used in orthopedic surgery to perform the body surface localization. But the repeatedly perspective during the fixation surgery will increase the damage to the human body and prolong operation time. OBJECTIVE: To explore a kind of simple practical technology of body surface localization by laser auxiliary X-ray used in the orthopedic surgery. METHODS: The radar-shaped red laser was projected in the body surface by self-made simple device to assistant the C-arm machine to perform body surface localization. Sprague Dawley rats and New Zealand white rabbits were used to design animal experiment, three kinds of orthopedic surgeries were simulated. Traditional C- arm machine and the technology of body surface localization by laser auxiliary X-ray was used separately to get position of foreign body in soft tissue, place the distal cross-bolting of fracture intramedullary nail, and place the pedicle screw in spinal surgery. There were 30 cases in every test. The influence of two methods to the operation was analyzed, and the influence of depth and living body to the technology of body surface localization by laser auxiliary X-ray was analyzed. RESULTS AND CONCLUSION: Compared with the traditional C-arm machine, the technology of body surface localization by laser auxiliary X-ray could obtain the body surface localization more faster (P < 0.05). But the depth and living body may influence the accuracy of technology of body surface localization by laser auxiliary X-ray (P < 0.05). It suggested that the technology of body surface localization by laser auxiliary X-ray has the advantages of convenient, fast and dynamic which could be greatly convenient for orthopaedic surgery. But various kinds of influential factors should be reduced or eliminated in order to better the advantages of the technology in the operation process. Figures and Tables | References | Related Articles | Metrics

Select

Establishment and application of virtual reality technique in hip fracture operation Huang Ruo-kun, Xie Ming, Yu Jia, Ren Yi-jun, Kan Wu-sheng, Huang Wen-jie 2013, 17 (13):  2383-2389.  doi: 10.3969/j.issn.2095-4344.2013.13.015 Abstract ( 426 )   PDF (733KB) ( 587 )   Save BACKGROUND: The hip fractures are difficult to treat because of its complexity. Clinicians select appropriate treatment options and surgical approaches according to imaging studies, which are difficult to accurately determine the spatial three-dimensional relationship. OBJECTIVE: To study the feasible and clinical value of computer-assisted preoperative design for hip fractures based on 64-slice spiral CT scanning data. METHODS: CT data in .dicom format from the patients with hip fractures were imported into Mimics. In segmentation process, the three-dimensional model of fracture was built to perform simulated reduction. The reduced model in .stl format was transferred into Imageware 12.0 to determine an appropriate dynamic hip screw in a suitable place and fixed with screw. And then using rapid prototyping, the entity and navigation template were formed. RESULTS AND CONCLUSION: The three-dimensional reconstructed visualization model could reflect the features of fractures, and the direction and degree of fracture displacement. And the fracture models could be rotated in any direction and space for observation which could simulate the internal fixation surgery. Preoperative computer-assisted virtual reality surgery can help to make a reasonable individualized surgical option, which has good clinical value. Figures and Tables | References | Related Articles | Metrics

Select

Dabigatran and rivaroxaban versus enoxaparin for anticoagulant therapy after total knee or hip arthroplasty Ruan Jia-li, Lü Tao, Miao Jing-jing, Chen Ming-yi, Han Zhong-yu, Tian Jing 2013, 17 (13):  2390-2398.  doi: 10.3969/j.issn.2095-4344.2013.13.016 Abstract ( 642 )   PDF (987KB) ( 835 )   Save BACKGROUND: The enoxaparin is commonly used in clinic to prevent venous thrombosis after total hip or total knee replacement, but it is not 100% effective and safe. OBJECTIVE: To systematically evaluate the efficacy and safety of dabigatran and rivaroxaban versus enoxaparin in preventing venous thrombosis after total knee or hip arthroplasty in the clinical randomized controlled trials. METHODS: A computer-based online search of PubMed database, ScienceDirect database, Cochrane Library, CBM database and CNKI database was performed for the randomized controlled trials on efficacy and safety of dabigatran and rivaroxaban versus enoxaparin for anticoagulant therapy after total knee or hip arthroplasty. The methodological quality of included studies was evaluated, and the statistical software was RevMan5.1.0. RESULTS AND CONCLUSION: A total of 14 randomized controlled trials including 17 212 patients were included. Meta-analysis showed that the incidences of total vein thrombosis, large vein thrombosis and symptomatic vein thrombosis in the rivaroxaban group were lower than those in the enoxaparin group; the incidence of deep vein thrombosis in the rivaroxaban group and dabigatran group was lower than that in the enoxaparin group; there was significant difference of incidence of deep vein thrombosis between rivaroxaban group, dabigatran group and dabigatran group. It indicates that the effect of new oral anticoagulants for the prevention of deep vein thrombosis after total hip or total knee arthroplasty is superior to enoxaparin, and rivaroxaban is better than dabigatran. Figures and Tables | References | Related Articles | Metrics

Select

Effectiveness of fibrin sealants in reducing blood drainage after total knee arthroplasty Yang Li-yu, Wang Xing-li, Zhou Long, Xue Feng, Ba Gen, Fu Qin 2013, 17 (13):  2399-2406.  doi: 10.3969/j.issn.2095-4344.2013.13.017 Abstract ( 526 )   PDF (582KB) ( 538 )   Save BACKGROUND: There is no systematic evaluation about effectiveness and safety of fibrin sealants in reducing blood drainage after total knee arthroplasty. OBJECTIVE: To systematically evaluate the effectiveness and safety of fibrin sealants in reducing blood drainage after total knee arthroplasty. METHODS: A computer-based search was performed in PubMed database, Cochrane Library, EMBASE database, OVID database, China Journal Full-text database, Chinese Biomedicine database and Chinese Scientific Journals Full-text database for randomized controlled trials from 1975 to October 2012 and manual search was performed in the relevant orthopedic journals. The Chinese key words were “total knee arthroplasty, knee joint replacement, fibrin sealants, tissue glue”. The quality of the extracted data was evaluated by Jadad methodological assessment, and Revman 5.1 software was used for the statistical analysis. The blood drainge, rate of transfusion, the average hospital stay, range of motion of knee joint and the rate of deep vein thrombosis after total knee arthroplasty were observed. RESULTS AND CONCLUSION: A total of 310 cases in five clinical prospective randomized controlled trials were included. Totally 168 patients were enrolled in the fibrin sealants group and 142 in the control group. Meta-analysis results showed that fibrin sealants could reduce the amount of blood drainage significantly in fibrin sealant group [weighted mean difference (MD)=-386.88, 95% confidence interval (CI): -583.66-, -190.10, P < 0.01]; moreover, the rate of transfusion in fibrin sealants group was significantly lower than that in the control group [relative risk (RR)=0.53, 95%CI: 0.42, 0.83, P < 0.01]. Fibrin sealants could reduce the average hospital stay in fibrin sealant group (MD=-3.56, 95%CI: -4.97-2.16, P < 0.01), meanwhile, it could improve the range of motion of knee joint in fibrin sealant group (MD=16.48, 95%CI: 5.94-27.02, P < 0.01). There was no significant difference of deep vein thrombosis between two groups (RR=1.18, 95%CI: 0.18-7.84, P=0.86). The results indicated that fibrin sealants could significantly reduce the blood drainage and rate of transfusion after total knee arthroplasty and had a good hemostatic effect, but there was still no evidence that the fibrin sealants could increase the incidence of deep vein thrombosis. Figures and Tables | References | Related Articles | Metrics

Select

Elastic stable intramedullary nailing versus plate fixation for midshaft clavicular fractures: A Meta-analysis Chen Hao, Zhang Jin-hong, He Zeng-liang 2013, 17 (13):  2407-2414.  doi: 10.3969/j.issn.2095-4344.2013.13.018 Abstract ( 604 )   PDF (445KB) ( 518 )   Save BACKGROUND: This is no consensus on the choice of elastic stable intramedullary nailing or plate fixation for the treatment of midshaft clavicular fractures. Current research is limited to a small sample studies, and it is difficult to carry out a large-sample multicenter analysis. OBJECTIVE: To evaluate the efficacy and safety of elastic stable intramedullary nailing and plate fixation for the treatment of midshaft clavicular fractures with Meta-analysis. METHODS: The PubMed database, EMbase database, Cochrane Library, CBM database, CNKI database, VIP database and Wangfang database were searched with computer to collect the controlled trials of elastic stable intramedullary nailing versus plate fixation for midshaft clavicular fractures, and related Chinese journals were manually searched. The searching time ranged from the date of database establishment to March 2012. The trails were selected, the data were extracted and the quality was evaluated by two investigators independently. RESULTS AND CONCLUSION: One randomized controlled trial and four retrospective controlled trials involving 388 patients were included in our Meta-analysis. The results showed the postoperative functional recovery Constant score of the elastic stable intramedullary nailing group was higher than that of the plate fixation group (P < 0.01). The average bone union time, operation time, incision length, intraoperative blood loss and the hospital stay of the elastic stable intramedullary nailing group were less than those of the plate fixation group (P < 0.01). There were no significant differences in incidence rate of complications, nonunion, implant failure, wound infection and malunion between two groups. Based on the current evidence, elastic stable intramedullary nailing for the treatment of midshaft clavicular fractures is superior to the plate fixation in the efficacy. There is no significant difference of incidence rate of complications between elastic stable intramedullary nailing and plate fixation. The results still need to be confirmed by high-quality randomized controlled trials. Figures and Tables | References | Related Articles | Metrics

Select

Open versus minimally invasive transforaminal lumbar interbody fusion for single segment degenerative lumbar disease: A Meta-analysis Wang Yin, Chen Gen-yuan, Hu Long, Xiao Wen-yao, Wang Jian-min 2013, 17 (13):  2415-2422.  doi: 10.3969/j.issn.2095-4344.2013.13.019 Abstract ( 702 )   PDF (538KB) ( 563 )   Save BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion can be performed through a tiny incision using a expandable channel. Compared with open transforaminal lumbar interbody fusion, minimally invasive transforaminal lumbar interbody fusion has smaller surgical field, more elaborate operation and less injury to the surrounding tissue which is conductive to accelerate overall recovery. OBJECTIVE: To evaluate the surgical outcome and clinicaI value between minimally invasive and open transforaminal lumbar interbody fusion in treatment of single segment degenerative lumbar disease． METHODS: The Cochrane library, PubMed database, Embase database, SCI database, CNKI database, Wanfang database and Chinese Biomedical database were searched for controlled trials, prospective cohort study and retrospective cohort study on the comparison between minimally invasive and open transforaminal lumbar interbody fusion in treatment of degenerative lumbar disease. Furthermore, we also manually searched the relevant references and four Chinese orthopedic journals. Methodology quality of the trials was critically assessed and the relative data were extracted. Cochrane Collaboration provided Revman 5.1 software was used for Meta-analysis. RESULTS AND CONCLUSION: Seven studies involving 856 cases were included. All the studies observed the surgical time, and the results of Meta-analysis showed that there was no statistically significant difference in the surgical time between minimally invasive and open transforaminal lumbar interbody fusion (P=0.11); six studies observed the intraoperative blood loss, and the results showed that the intraoperative blood loss of minimally invasive transforaminal lumbar interbody fusion was significantly less than that of the open transforaminal lumbar interbody fusion (P < 0.000 01); two studies observed the weight bearing time, and the results showed that the weight bearing time after minimally invasive transforaminal lumbar interbody fusion was shorter than that after open transforaminal lumbar interbody fusion (P < 0.000 01); six studies observed the intraoperative and postoperative complications, and the results showed that there were no significant differences between minimally invasive and open transforaminal lumbar interbody fusion (P=0.75); three studies observed the fusion rate, and the results showed there was no significant difference between minimally invasive and open transforaminal lumbar interbody fusion (P=1.00). The results showed that minimally invasive transforaminal lumbar interbody fusion was the ideal method for the treatment of single segment degenerative lumbar disease. Figures and Tables | References | Related Articles | Metrics

Select

Spine-pelvis sagittal balance in the treatment of spinal diseases Chen Tao, Li Guan-bao, Liang Ke-you, Jia Shi-qing 2013, 17 (13):  2423-2430.  doi: 10.3969/j.issn.2095-4344.2013.13.020 Abstract ( 937 )   PDF (676KB) ( 650 )   Save BACKGROUND: Related clinical studies have shown that there are different levels of characteristic changes in spine-pelvis sagittal balance parameters in patients with spine-related degenerative diseases. OBJECTIVE: To investigate the effect of spine-pelvis sagittal balance parameters on the treatment of spinal diseases. METHODS: The measurement parameters and measurement methods of spine-pelvis sagittal balance, as well as the quantization and important parameters of spine-pelvis sagittal balance in the diagnosis and treatment of adult spinal diseases were analyzed. The relationship between parameters and the quality of life of the patients was analyzed. The effect on spinal diseases after correction and the role of spine-pelvis sagittal balance in the treatment of spinal disorders were evaluated. RESULTS AND CONCLUSION: Spinal sagittal morphology was closely related to the pelvic parameters, and the pelvic parameters can also be used for the spinal sagittal curves typing. There is a significant statistical correlation between pelvis sagittal parameters and spinal sagittal parameters. The spine-pelvis sagittal balance parameters are the important indicators for the evaluation of spinal diseases and treatment and prognosis, and studies addressing pelvis and spine morphological parameters should be included when evaluating the changes of spine-pelvis sagittal balance. Figures and Tables | References | Related Articles | Metrics

Select

Three-dimensional image reconstruction for elbow fractures Lu Hao-ning, Pan Shi-nong 2013, 17 (13):  2431-2438.  doi: 10.3969/j.issn.2095-4344.2013.13.021 Abstract ( 986 )   PDF (819KB) ( 560 )   Save BACKGROUND: The structure and function of elbow joint is complex, which has an important role in adjusting the upper limb activities. OBJECTIVE: To evaluate the diagnostic effect of different imaging methods on elbow fracture. METHODS: The diagnostic effects of X-ray image, CT image and MRI image on internal and external humeral condyle fracture, humeral supracondylar and intercondylar fractures, radial head fractures and ulna coronoid fractures, as well as the injury of surrounding ligaments, tendons and other soft tissues were evaluated, especially the imaging evaluation of the commonly seen “terrible triad” of elbow trauma was performed. RESULTS AND CONCLUSION: X-ray could clearly display the fracture line of elbow fracture and the displacement of fracture site, and it could be able to show the position of posterior triangle of elbow joint. CT scanning has better detection effect on fracture than X-ray image. It cannot only display the displaced fracture, micro-displaced fracture and tiny intra-articular fracture fragments, but also display the position, area, number, size, displacement and crushing circumstances of fracture. MRI is mainly used to evaluate surrounding tissue injury of the elbow joint. Figures and Tables | References | Related Articles | Metrics

Select

Biomechanical changes and clinical effect of internal fixator placement for the treatment of distal femoral fractures Guan Ji-kui, Guan Yu, Zhao Li, Wang Hui, Kong Li, Li Jing, Liu Jian-guo 2013, 17 (13):  2439-2446.  doi: 10.3969/j.issn.2095-4344.2013.13.022 Abstract ( 405 )   PDF (664KB) ( 620 )   Save BACKGROUND: Placement of internal fixators is one of the preferred methods for the treatment of distal femoral fractures. OBJECTIVE: To evaluate the biomechanical changes of different internal fixators after distal femoral fracture due to the complexity of the anatomical structure of distal femoral fractures, in order to guide the clinical application. METHODS: Compressive stiffness and bending strength of less invasive stabilization system steel plate, dynamic condylar screw and retrograde interlocking intramedullary nail internal fixation for the treatment of distal femoral fractures were detected, and the biomechanical changes of the three internal fixations were compared. Patients with distal femoral fractures who were treated with less invasive stabilization system steel plate, dynamic condylar screw and retrograde interlocking intramedullary nail internal fixations were followed-up to identify the clinical effect of three internal fixators and the clinical effects were compared. RESULTS AND CONCLUSION: Biomechanical testing showed that during the treatment of distal femoral fractures with internal fixators, dynamic condylar screw had higher stress shielding, while the retrograde interlocking intramedullary nail had lower stiffness. Less invasive stabilization system steel plate had a certain degree of deformability which can conduct the stress through bone, and it also had strong rigidity, which can provide better stability for the internal fixation of fracture. The follow-up of the patients with distal femoral fractures showed that less invasive stabilization system steel plate had shorter fracture healing time, lower incidence of complications and higher excellent and good rate of knee joint, which is considered as the best method for the treatment of distal femoral fractures. Figures and Tables | References | Related Articles | Metrics

Select

Which factors will affect the medium-term results of total hip arthroplasty? Chen Ming, Kan Wu-sheng, Fang Zhen-hua, Zheng Qiong, Xu Min-chao 2013, 17 (13):  2447-2454.  doi: 10.3969/j.issn.2095-4344.2013.13.023 Abstract ( 704 )   PDF (772KB) ( 575 )   Save BACKGROUND: Life quality of patients after total hip arthroplasty will affected by various factors, and the factors that can affect the treatment effect after replacement should be analyzed in order to take the specific measures to intervene. OBJECTIVE: To investigate the relative factors that affect the treatment effect of initial total hip arthroplasty. METHODS: The clinical data of 352 patients treated with initial total hip arthroplasty were retrospectively analyzed, and the factors that affect the scoring were determined according to the Harris score. The relationship between various factors and the treatment of total hip arthroplasty was evaluated and analyzed through chi-square test and Spearman classification. Comparative analysis was performed to compare the results of relative articles and researches. RESULTS AND CONCLUSION: Age, body mass index, hip rotation center, femoral eccentricity and post-operative rehabilitation training of the patients with initial total hip arthroplasty could affect the medium-term results after total hip arthroplasty. While the influence of preoperative diagnosis, surgical approach, patient gender and type of prosthesis on the treatment effect of total hip arthroplasty was not obvious. Adequate attention to these factors, correct prevention and scientific treatment of a variety of factors that may affect the recovery of joint function, all these effort are the prerequisites for the surgeons to improve satisfaction of the patients. Figures and Tables | References | Related Articles | Metrics

Select

Anti-rotation intramedullary nail and dynamic hip screw internal fixation for treatment of femoral intertrochanteric fractures Gao Yan-ming, Zhang Lu 2013, 17 (13):  2455-2462.  doi: 10.3969/j.issn.2095-4344.2013.13.024 Abstract ( 425 )   PDF (753KB) ( 520 )   Save BACKGROUND: The anti-rotation intramedullary nail and dynamic hip screw has been widely used in the fixation treatment of intertrochanteric fracture. OBJECTIVE: To evaluate and compare the effect of anti-rotation intramedullary nail and dynamic hip screw internal fixation for the treatment of femoral intertrochanteric fractures. METHODS: The clinical patients with femoral intertrochanteric fractures were followed-up, and the clinical effect of effect of anti-rotation intramedullary nail and dynamic hip screw internal fixation for the treatment of femoral intertrochanteric fractures was comprehensively analyzed through evaluating the fracture healing, incidence of complications and joint function score. RESULTS AND CONCLUSION: Both anti-rotation intramedullary nail and dynamic hip screw internal fixation could obtain the good effect on the treatment of femoral intertrochanteric fractures, but anti-rotation intramedullary nail internal fixation for the treatment of femoral intertrochanteric fractures had the advantages of less bleeding, lower incidence of complications, shorter fracture healing time and higher excellent and good rate of hip function, which is one of the preferred methods for the treatment of femoral intertrochanteric fractures. Figures and Tables | References | Related Articles | Metrics

Select

Screw and rod system fixation combined with debridement treats tuberculosis of the thoracic, lumbar and sacral spine in the elderly Deng Qiang, Guo Hai-long, Sheng Wei-bin, Li Shi-hao, Sheng Jun, Mai Er-dan, Pu La-ti, Zhang Jian 2013, 17 (13):  2463-2470.  doi: 10.3969/j.issn.2095-4344.2013.13.025 Abstract ( 552 )   PDF (591KB) ( 651 )   Save BACKGROUND: Screw and rod system is a priority choice fixation material for the reconstruction and spine stabilization of elderly spinal tuberculosis patients. There are controversies on the debridment, internal fixation, interbody fusion and the selection of anterior approach operation for the treatment of tuberculosis of thoracic, lumbar and sacral spine in elderly patients. OBJECTIVE: To observe the effect of screw and rod system fixation combined with debridement in treating tuberculosis of thoracic, lumbar and sacral spine in elderly patients, and to compare the difference of treatment effect of anterior and posterior surgery. METHODS: Forty-seven elderly patients with tuberculosis of thoracic, lumbar and sacral spine were selected, and divided into two groups according to the surgery program. There were 27 patients in posterior operation group, and the patients in the posterior group were treated with debridment, bone graft fusion and screw and rod system internal fixation. There were 20 patients in anterior operation group, and the patients were treated with debridment, bone graft fusion and posterior screw and rod system internal fixation. Frankel neurological grade was used to evaluate spinal cord injury and recovery situations before and after treatment. The clinical efficacy was evaluated with X-ray films before and after treatment, and the changes of erythrocyte sedimentation rate and Cobb angle were observed before and after treatment. RESULTS AND CONCLUSION: All the 47 patients were followed-up for 10-36 months, and all the patients were cured. No severe complications occurred during and after operation. Spinal fusion occurred in all the patients at 10-18 months after operation. Frankel neurological grades were improved significantly. There were no significant differences of the improvement of Frankel neurological grades, Cobb angle and erythrocyte sedimentation rate between two groups (P > 0.05). Both of anterior and posterior screw and rod system fixation combined with debridement for the treatment of tuberculosis of thoracic, lumbar and sacral spine in elderly patients can obtain the satisfactory effect, reconstruct the spinal stability and restore normal spine sequence. Reasonable surgical approach should be chosen based on the type of spinal tuberculosis, the extent of the damage and surgery caused spine stability changes. Figures and Tables | References | Related Articles | Metrics