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25 June 2013, Volume 17 Issue 26 Previous Issue    Next Issue

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Acetabular trabecular direction between different species Sun Jian-wei, Yan Bing-shan, Yin Wang-ping, Zhang Chun-cai 2013, 17 (26):  4751-4940.  doi: 10.3969/j.issn.2095-4344.2013.26.001 Abstract ( 788 )   PDF (1712KB) ( 445 )   Save BACKGROUND: Some studies have shown that the morphological structure of bone is closely related with the stress environment. But the human walking upright movement may affect the direction of the acetabular trabecular bone. OBJECTIVE: To observe the differences of acetabular bone direction between different species. METHODS: Hip bones of human and rhesus monkey selected from Department of Anatomy, Second Military Medical University and the Shandong University School of Life Science were scanned by X-ray under the same conditions of shooting. The images were imported into Imagine pro plus 6.0 and transferred by fast fourier transform, then obtained the spectrum value of 0°-180° to calculate the number of trabeculae in a certain direction.    RESULTS AND CONCLUSION: The human had highest spectrum value in 0° and 90° which were in accordance with Ilioischial bundle and sacropubic bundle. Rhesus monkeys distributed dispersedly and there was no obvious peak. The human trabecular in acetabular region mainly distributed along 90°-180° which were in accordance with Ilioischial bundle and sacropubic bundle, this indicated that there was relationship between Ilioischial bundle and human walking pattern. Figures and Tables | References | Related Articles | Metrics

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Characteristics of total hip arthroplasty in patients with end stage renal disease Zhuang Ze, Li Zhi-yong, Chen Yu-xian, Ren Jian-hua, He Rong-han, Zhao Jia-yao, Wang Kun 2013, 17 (26):  4759-4766.  doi: 10.3969/j.issn.2095-4344.2013.26.002 Abstract ( 694 )   PDF (887KB) ( 716 )   Save BACKGROUND: Due to the long-term bone metabolism, endocrine disorders and the application of hormones, the end stage renal disease is prone to femoral neck fractures, femoral head avascular necrosis and other diseases. The patients with end stage renal disease have the characteristics that different to general hip joint replacement when having total hip arthroplasty.   OBJECTIVE: To observe the characteristics of biological or cementless total hip arthroplasty for the treatment of end stage renal disease combined with hip diseases. METHODS: The clinical data of 15 end stage renal disease patients with hip disease (four males and 11 females) who received total hip arthroplasty or artificial femoral head replacement in the Third Affiliated Hospital of Sun Yat-sen University from June 2006 to March 2012 were retrospectively reviewed. There were eight cases of femoral neck fracture (one case of bilateral femoral neck fracture), five cases of femoral head avascular necrosis, two cases of osteoarthritis, totally 16 hips. The joint replacement included total hip arthroplasty in nine hips (cementless type five hips, cemented type four hips) and hemiarthroplasty in seven hips (cementless type two hips, cemented type five hips). The follow-up X-ray film was taken to observe whether the translucent zone could be seen around the prosthesis, as well as the dynamic changes, and the Harris hip score and SF-36 score were used to evaluate the recovery of joint function and improvement of life quality. RESULTS AND CONCLUSION: Patients were followed-up for 0.5-4 years after replacement, the followed-up time showed skewed distribution, and the median time was 30 months. Harris hip score was increased from preoperative (53.0±5.8) to the last follow-up (86.0±3.8). SF-36 score was increased from preoperative (65.0±2.4) to the last follow-up (83.0±4.9). There were five cases of complications before discharge, two cases of hypotension shock when undergoing dialysis after replacement, two cases of pulmonary infection, one case of delayed wound union, and all the patients recovered after treatment. No prosthesis loosening, dislocation or prosthesis infection was observed during follow-up after replacement. The early to medium-term follow-up results show that total hip arthroplasty can relieve pain and improve hip function and life quality during the treatment of end stage renal disease patients with hip diseases. Some patients do not have good postoperative follow-up results due to the progress of kidney disease. Figures and Tables | References | Related Articles | Metrics

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Biotype and bone cement-type artificial femoral head replacement for the treatment of femoral neck fracture in elderly patients Shi Jian-guo, Qiu Nan-hai 2013, 17 (26):  4767-4774.  doi: 10.3969/j.issn.2095-4344.2013.26.003 Abstract ( 751 )   PDF (750KB) ( 490 )   Save BACKGROUND: With the maturity and development of artificial joint materials, processes and technology, artificial femoral head replacement has been widely used for the treatment of femoral neck fracture, especially the elderly patients with displaced femoral neck fracture.  OBJECTIVE: To observe the clinical efficacy of biotypes and cementless artificial femoral head replacement for the treatment of elderly femoral neck fracture combined with heart disease.   METHODS: Thirty-five elderly femoral neck fracture patients with heart disease treated in the Department of Orthopedic Center, Tianjin Nursing Home from January 2004 to December 2009 were selected, including 16 cases of coronary heart disease combined with angina pectoris, eight cases of myocardial infarction coronary heart disease, eight cases of asymptomatic coronary heart disease and three cases of ischemic cardiomyopathy and coronary heart disease. And 18 cases were treated with biotypes artificial femoral head replacement, 17 cases were treated with cementless artificial femoral head replacement. RESULTS AND CONCLUSION: One of the 35 patients was dead in the surgery, other 34 cases were followed-up for 8 to 36 months. Three cases of complications occurred in surgery were belongs to cementless group, and one patient died during surgery, two cases had to drop in blood pressure and suffered from difficulty breathing in surgery, whose life characteristics returned to normal after efforts to save. In the follow-up process, part of the prosthesis implanted in the two cases of patients with severe osteoporosis appears sinking in the biotype group, the excellent rate of biotype group was 89%(16/18), and the cementless group was 94%(16/17). It suggests that biotype artificial femoral head replacement is suitable for the patients with severe heart disease, while the cementless artificial femoral head replacement is suitable for osteoporosis patients. Figures and Tables | References | Related Articles | Metrics

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Anatomical measurements of proximal tibia of anterior and posterior cruciate ligament-retaining knee prosthesis He Pei-heng, Xu Dong-liang, Zuo Jian-wei, Li Shuai-hua, Wa Qing-de 2013, 17 (26):  4775-4781.  doi: 10.3969/j.issn.2095-4344.2013.26.004 Abstract ( 621 )   PDF (643KB) ( 456 )   Save BACKGROUND: There are many problems with the present anterior and posterior cruciate ligament-retaining knee prosthesis. Morphological measurements to improve and design bi-cruciate ligament-retaining knee prosthesis, particular in proximal tibia, were less seen in the literature. OBJECTIVE: To analyze the morphology of proximal tibia with three-dimensional digital models of knee joint, in order to provide reference for improving and designing bi-cruciate ligament-retaining knee prosthesis. METHODS: Forty volunteers were selected, and they were scanned with CT and MRI. The acquired image data were imported into computer for image segmentation and three-dimensional reconstruction by using MIMICS 10.01 software. Then three-dimensional digital models of the knee joint were imported into Geomagic Studio 11 software. By the knee joint models, the anatomical parameters of anterior and posterior cruciate ligaments on proximal tibia were measured. Also the anatomical parameters of the proximal tibial osteotomy surface were measured after simulation osteotomy. RESULTS AND CONCLUSION: The whole width of anterior cruciate ligament and posterior cruciate ligament was (14.94±2.56) mm, and the comparison between genders showed that transverse osteotomy width should be increased in male to avoid anterior and posterior cruciate ligament injury. The length of the top of the tibial spine, the base of the tibial spine and the height of the tibial spine were (8.02±1.03) mm, (15.19±1.71) mm and (9.13±0.88) mm, respectively. And the trapezoidal frame was located in the 48%-82% of the anteroposterior diameter. The mediolateral diameter of medial tibial osteotomy surface was smaller than that of lateral tibial osteotomy surface, however, the anteroposterior diameter of medial tibial osteotomy surface was larger than that of lateral tibial osteotomy surface, these results may imply that bi-cruciate ligament-retaining knee prosthesis need an asymmetric prostheses design. Figures and Tables | References | Related Articles | Metrics

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Diagnostic markers in synovial fluid during prosthetic loosening after total knee arthroplasty Zhao Xu-hong, Wu Ji, Li Song-lin, Chu Dong 2013, 17 (26):  4782-4788.  doi: 10.3969/j.issn.2095-4344.2013.26.005 Abstract ( 440 )   PDF (702KB) ( 530 )   Save BACKGROUND: Aseptic loosening of the prosthesis is a common complication after total knee arthroplasty. Whether the loosening of the prosthesis has relationship with the levels of tenascin-C, interleukin-6 and tumor necrosis factor is not clear. OBJECTIVE: To observe the expressions of interleukin-6, tumor necrosis factor α and tenascin-C of the patients with aseptic prosthesis loosening after total knee arthroplasty. METHODS: Forty-five patients treated with total knee arthroplasty and revision surgery were selected as the experimental group, and 25 patients treated with initial total knee arthroplasty were selected as the control group. In the experimental group, the patients with history of inflammatory arthritis, systemic secondary arthritis infection, autoimmune disease and combined hepatitis, malignant tumors, hormones or  immunosuppressants administration were eliminated. Synovial fluid samples of the prostheses in each group were obtained, and the expression of tenascin-C shear variants in synovial fluid was tested with Western-blot. The levels of interleukin-6, tumor necrosis factor α and tenascin-C were analyzed with enzyme-linked immunosorbent assay.   RESULTS AND CONCLUSION: Western blot results showed the presence of large tenascin-C variants in the synovial fluid of prostheses with loosening. The interleukin-6 and tenascin-C levels in the synovial fluid of prosthesis loosening were approximately three times higher than those in the control group, and tumor necrosis factor α level in the synovial fluid of prosthesis loosening was approximately 2.5 times higher than that in the control group. Levels of tenascin-C including large variant subunits are elevated in synovial fluid of prosthesis loosening, indicating that tenascin-C is a useful novel biochemical marker of prosthesis loosening. Figures and Tables | References | Related Articles | Metrics

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Bone cement distribution patterns of osteoporotic vertebral fractures with intravertebral clefts after vertebroplasty Li Liang, Yu Xue-zhong, Sui Hai-tao, Ren Yue-bing, Liu Guang-quan 2013, 17 (26):  4789-4796.  doi: 10.3969/j.issn.2095-4344.2013.26.006 Abstract ( 531 )   PDF (707KB) ( 566 )   Save BACKGROUND: There is no domestic research on the effectiveness of bone cement distribution patterns of osteoporotic vertebral fractures with intravertebral clefts after treated by using percutaneous kyphoplasty. OBJECTIVE: To evaluate the clinical effectiveness of bone cement distribution patterns of osteoporotic vertebral fractures with intravertebral clefts after treated by using percutaneous kyphoplasty. METHODS: Between February 2008 and November 2011, the clinical data of 61 patients of osteoporotic vertebral fractures with intravertebral clefts undergoing percutaneous kyphoplasty were retrospectively reviewed. The vertebral height restoration and kyphosis correction were measured, and the injection volume of bone cement, bone cement leakage distribution and adjacent vertebral fractures were recorded. The Visual Analogue Scale score was used to evaluate the degree of low back pain, and the Oswestry disability index was used to evaluate the limitation degree of activity function. RESULTS AND CONCLUSION: According to the vertebral bone cement distribution in the X-ray film or CT image, the study was divided into bulky group (n=29) and sponge-like group (n=32). The bone cement injection volume was (5.20±0.62) mL in the bulky group and (4.80±0.66) mL in the sponge-like group, and there was significant difference between groups (P < 0.05). All patients were followed-up for 16 months. The Visual Analogue Scale score and Oswestry disability index were decreased significantly at 3 days after operation and final follow-up when compared with those before treatment (P < 0.05), and the pain relief in the sponge-like group was better than that in the bulky group (P < 0.05). The frontal vertebral height, midline vertebral height and kyphosis correction in two groups were significantly recoved (P < 0.05), and the restoration rate of imaging index in the bulky group was better that that in the sponge-like group (P < 0.05). The incidence of secondary adjacent vertebral fracture in bulky group was 14%, and 6% in the sponge-like group, and there was significant difference between two groups (P < 0.05). The incidence of bone cement leakage was 17% in bulky group and 25% in the sponge-like group, and there was significant difference between groups (P < 0.05). The results indicate that the sponge-like bone cement distribution pattern can relieve the pain effectively and stably than bulky distribution pattern, and it can improve the life quality of the patients, but with a high incidence of bone cement leakage. The bulky distribution pattern can recover the vertebral height better than sponge-like distribution pattern with a high incidence of secondary adjacent vertebral fracture. Figures and Tables | References | Related Articles | Metrics

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Above two-level segment interbody fusion with double-way connection intervertebral fusion device Fu Yu, Fu Yun-gen,Luo Jia-quan, Cao Sheng-sheng, Li Jun-ning, Xu Wen-hua 2013, 17 (26):  4797-4803.  doi: 10.3969/j.issn.2095-4344.2013.26.007 Abstract ( 543 )   PDF (617KB) ( 515 )   Save BACKGROUND: Anterior cervical spine plate fixation is believed to be the standard method for the treatment of cervical anterior segmental discectomy and fusion, however, anterior cervical plate implants has a lot of risk related to metal implants complications. OBJECTIVE: To analyze and compare the effectiveness of the application of double-way connection intervertebral fusion device and Cage intervertebral fusion device+anterior cervical plate fixation for anterior above two-level cervical interbody fusion. METHODS: Fifty-four patients with above two-level cervical intervertebral disc herination were treated with anterior cervical decompression and fusion. These patients were treated with anterior cervical interbody fusion using double-way connection intervertebral fusion device (n=30) and Cage intervertebral fusion device and anterior plate fixation system (n=24). The clinical results were evaluated with Japanese Orthopedic Association scale scores, and the cervical curvature, intervertebral height and cervical fusion state were tested with X-ray film at 3 and 6 months after interbody fusion.   RESULTS AND CONCLUSION: All patients were followed-up for 6 months. The patients in two groups got osseous fusion, and the average fusion time was 5.5 months. Average Japanese Orthopedic Association scale score of double-way connection intervertebral fusion device group was increased from (7.4±0.4) preoperatively to (14.3±0.5) at 3 months and (14.5±0.8) at 6 months postoperatively; and the average Japanese Orthopedic Association scale score of Cage intervertebral fusion device group was increased from (7.6±0.7) preoperatively to (13.9±0.4) at 3 months and (14.0±0.6) at 6 months postoperatively, and the differences were significant. The spinal curvature and intervertebral height were significantly improved after treatment. This procedure can effectively restore cervical lordosis, obviate the complications related to graft harvest and screw-plate fixation, and lead to satisfactory outcomes. Figures and Tables | References | Related Articles | Metrics

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Intramedullary internal fixation for the treatment of fibrous dysplasia of proximal femur combined with coxa varus deformity Yu Xiao-kui, Zhu Bing, Sun Tian-sheng, Qin Fa-bin, Ma Qing-song 2013, 17 (26):  4804-4811.  doi: 10.3969/j.issn.2095-4344.2013.26.008 Abstract ( 714 )   PDF (788KB) ( 847 )   Save BACKGROUND: The surgical treatment for fibrous dysplasia of the proximal femur combined with coxa varus deformity must be carried out in order to restore the mechanical axis of the femur as far as possible. Though, there are various osteotomy programs, wedging valgus osteotomy has predominated. There are more complications after extramedullary fixation, such as screws and screw-plate systems, and the long-term stable therapeutic effect cannot be reached. Studies have shown that the wedging valgus osteotomy at the proximal femur and interlocking intramedullary nail fixation can obtain better medium- and long-term therapeutic effect. OBJECTIVE: To investigate the intramedullary internal fixation method for the treatment of fibrous dysplasia of proximal femur combined with coxa varus deformity, and to investigate the biocompatibility. METHODS: A total of 23 patients with fibrous dysplasia of proximal femur combined with coxa varus and limb reduction deformities were adopted and treated. The mean femoral neck-shaft angle was 79° in average (range 56°-110°). The relative femoral length was 4.0 cm shorter on average (range 1.9-8.9 cm) than that of the opposite side. All patients were treated with wedging valgus osteotomy in the proximal femur, curettage, autogenous rib bone-grafting and interlocking intramedullary nail internal fixation. RESULTS AND CONCLUSION: Postoperatively, 19 patients were followed-up for an average period of 1 year (range 6 months to 2 years). All internal fixations were stable. The mechanical axis of femur was just corrected, all patients got bone healing. Postoperative neck-shaft angle was corrected to 112°on average (range 90°-125°) and the average relative length of femur was increased by 2.0 cm on average (range 1.5-2.5 cm), and there was no significant effect on hip function. After surgery, three patients could walk normally without claudication, seven patients could walk with crutches, five patients ambulated with a unilateral cane and four patients were slightly limbing without support. Pain disappeared in 12 patients, pain was significantly improved in six patients, and pain aggravated and new pain appeared in one patient. No infection, refracture or progression of deformity occurred in the patients. The surgical treatment method of wedging valgus osteotomy in the proximal femur, curettaging, autogenous rib bone-grafting and interlocking intramedullary nail internal fixation have good effect for fibrous dysplasia of proximal femur combined with coxa varus and limb reduction deformity. This method can not only reduce the mass of bone-grafting and fully correct deformity, but also can prevent recurrence of the deformity. And meanwhile, the middle-term follow-up observation confirms that the osteotomy surface get bone healing, and hip function is significantly improved with good biocompatibility. Figures and Tables | References | Related Articles | Metrics

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Arthroscopic assisted percutaneous bone grafting and screw fixation for the treatment of lateral tibial plateau fractures: A 4-year follow-up Zeng Run-ming, Wu Sheng-rong, Lin Shao-bin 2013, 17 (26):  4812-4818.  doi: 10.3969/j.issn.2095-4344.2013.26.009 Abstract ( 495 )   PDF (640KB) ( 513 )   Save BACKGROUND: Studies have shown the knee secondary osteoarthritis may occur after the treatment of tibial plateau fractures with open reduction and internal fixation, but the researches on the middle- and long-term effect of arthroscopic assisted tibial plateau fracture fixation are still rare. OBJECTIVE: To evaluate the outcomes of lateral tibial plateau fractures after treated with arthroscopic assisted percutaneous bone grafting and screw fixation for 1 and 4 years through clinical and radiological assessment. METHODS: Between March 2007 and March 2009, with the information of the patients with lateral tibial plateau fractures undergoing arthroscopic assisted percutaneous bone grafting and screw fixation were enrolled. The data of the type of fractures in the Schatzker classification, the accompanying lesions of the cartilage defect on the lateral tibial plateau, the cartilage damage on the femoral condyle, intra-articular soft tissue lesions and insufficient reduction of the fracture, as well as postoperative subsidence in the lateral tibial plateau were collected. The Lysholm score, Ahlback osteoarthritis classification, Rasmussen function score and radiological score were assessed at 1 and 4 years after treated with percutaneous bone grafting and screw fixation. RESULTS AND CONCLUSION: Twenty-three patients finished the follow-up. At 1 and 4 years after percutaneous bone grafting and screw fixation, the mean Lysholm score was 90 and 87 points respectively (P=0.23), and the mean Rasmussen function score was 26 and 24 points respectively (P=0.30). At 4 years after surgery, 11 cases (47.8%) presented osteoarthritis and the Rasmussen radiological score was decreased from early postoperative 17.4 points to 4-year postoperatively 13.6 points (P=0.01). No correlation could be observed between the various types of fractures and their prognosis. The elder cases, cartilage damage and/or defect, intra-articular soft tissue lesions and postoperative subsidence in the lateral tibial plateau were correlated with function and radiological middle outcomes after surgery. However, the cartilage defects on tibial plateau had minor effect on knee osteoarthritis when compared with cartilage damage on the femoral condyle. Early radiological outcomes do not completely consistent with that of the 4 years after surgery, but the medium-term clinical and functional follow-up outcomes are still satisfied. Age, cartilage damage or defect, intra-articular soft tissue lesions and postoperative subsidence in lateral tibial plateau appears as prognostic factors for osteoarthritis after treatment. The prognostic effect of cartilage defects on tibial plateau for osteoarthritis is lower than that of cartilage damage on the femoral condyle which may be attributed to integrated function of lateral meniscus. Figures and Tables | References | Related Articles | Metrics

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Elastic intramedullary nail for the treatment of femoral shaft fracture in children with failed plate fixation Wang Hua-ming, Chen Zhi-long, Li Wei-ping, Pei Sheng-tai, Chen Shi-hai 2013, 17 (26):  4819-4825.  doi: 10.3969/j.issn.2095-4344.2013.26.010 Abstract ( 532 )   PDF (647KB) ( 401 )   Save BACKGROUND: Elastic intramedullary nail fixed technology supported by three principle of elastic fixation fracture is suitable for children’s short transverse and oblique shape limbs long tubular bone fracture. This paper will investigate the advantages of elastic intramedullary nail in the treatment of femoral shaft fracture with failed plate fixation in children. OBJECTIVE: To observe the clinical effect and prognosis of elastic intramedullary nail technology in the treatment of femoral shaft fracture with failed plate fixation in children. METHODS: Retrospective analysis was performed in 21 cases of femoral shaft fracture patients with plate fracture and failure after fixation in the Department of Pediatric Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine from March 2008 to August 2012. During the surgery, the plates were removed from the primary incision; after cleaned the fracture end, the medial and lateral retrograde percutaneous penetration of elastic nail was performed to fix the fracture on 1.0-2.0 cm from the femoral distal patellar. At 3-6 months after surgery, the healing of the fracture was evaluated based on the imaging data, and then the screw was removed. The efficacy was analyzed in accordance with the Flynn fracture healing criteria in 2001. RESULTS AND CONCLUSION: All the 21 patients were followed-up for 10 months in average. According to the Flynn fracture healing criteria, there were 19 cases of excellent, two cases of good, no poor, and the excellent and good rate was 100%. After followed-up for 10 months, two cases had overgrowth of affected limbs with the unequal length <1.0 cm, and disappeared in 1 year; three cases had limited activity of 30°-50°, and after 1 year functional exercise, two cases had limited activity of <15°, and one case had limited activity of >30°, there was no elastic nail breakage or nonunion. Compared with open reduction technology, elastic intramedullary nail for fracture fixation has fast recovery and healing and has fewer complications, so it is the effective method for the treatment of femoral shaft fracture fixation in children. Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis of different fixation methods in the treatment of posteromedial tibial plateau fracture Yang Hai-feng, Huang Jun-wu, Zhang Chun-lin 2013, 17 (26):  4826-4832.  doi: 10.3969/j.issn.2095-4344.2013.26.011 Abstract ( 383 )   PDF (613KB) ( 432 )   Save BACKGROUND: The treatment of posteromedial tibial plateau fracture is difficult which is prone to have re-displacement, nonunion, fixation failure and joint function movement disorder caused by inappropriate choice of fixation method.   OBJECTIVE: To analyze the biomechanical performance of three different fixation methods for posteromedial tibial plateau fracture. METHODS: Twenty-seven fresh tibia specimens were made into models of posteromedial tibial plateau fracture. The models were divided into normal group, dual plate fixation group, T-shaped plate fixation group and lag screw fixation group. The stress, load-displacement, stress intensity, stiffness and rotation performance of the three experimental groups were tested. RESULTS AND CONCLUSION: The load-displacement in the dual plate fixation group was significantly lower than that in the T-shaped plate fixation group and lag screw fixation group, while the axial stiffness, horizontal shear stiffness and torque torsion angle in the dual plate fixation group were larger than those in the T-shaped plate fixation group and lag screw fixation group. The results indicate that biomechanical stability of dual plate fixation for the treatment of posteromedial tibial plateau fracture is better than the other two methods. Figures and Tables | References | Related Articles | Metrics

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Biomechanical measurement system for measuring frictional properties of synovial joint after cartilage injury Mu Yi-ping, Otto Muller, Nicolas Wullker 2013, 17 (26):  4833-4840.  doi: 10.3969/j.issn.2095-4344.2013.26.012 Abstract ( 508 )   PDF (786KB) ( 491 )   Save BACKGROUND: Osteoarthritis will change the frictional factor and performance of synovial joints. There is no perfect system to objectively measure and evaluate the fractional properties of synovial joints. OBJECTIVE: To observe the changes of fractional properties of synovial joints under different pressure conditions with biomechanical measurement system. METHODS: A sheep’s wrist joint was fixed in the biomechanical measurement system to measure the friction properties. Each sample was tested in four different axial loading conditions: 100 N, 200 N, 400 N and 800 N axial forces that vertical to the joint articular surface, in order to measure the torque and the coefficient by whirligig the joint for 5°. After measurement, 16 mm2 cartilage defects were made in each specimen. Then the torque and the coefficient were measured under 100 N, 200 N, 400 N and 800 N axial forces. RESULTS AND CONCLUSION: The torque of sheep wrist joint was 0.021 7, 0.031 7, 0.063 0 and 0.145 0 N•m respectively, and the coefficient of fraction was 0.006 7, 0.007 3, 0.012 0 and 0.014 5 μ when it was loaded by four different axial forces without cartilage defect. The torque of sheep wrist joint was 0.027 0, 0.041 7, 0.080 6 and 0.172 4 N•m respectively, and the coefficient of fraction was 0.008 6, 0.009 7, 0.013 7 and 0.016 4 μ when it was loaded by four different axial forces with cartilage defect. The torque and the coefficient of fraction were gradually increased with the increasing of loading forces (P < 0.05), and the articular cartilage defects may lead to the increasing of joint torque and the coefficient of fraction (P < 0.05). The joint torque was positively correlated with coefficient of fraction. Figures and Tables | References | Related Articles | Metrics

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CT measurement of acetabulum geometric parameter Hu Rong-hui, He Bin, Liu Li, Yan Rui, Liu Jia-kai, Huang Xiao-bo, Zhang Jian, Ding Wei 2013, 17 (26):  4841-4848.  doi: 10.3969/j.issn.2095-4344.2013.26.013 Abstract ( 1460 )   PDF (740KB) ( 614 )   Save BACKGROUND: Although, the previous studies on acetabular morphological characteristics have yielded some results, quantitative description of the acetabular surface morphology has not yet been unified because of the special nature of acetabular structure and location, and this is bound to affect the accuracy of the diagnosis and treatment of hip disease. OBJECTIVE: To investigate the CT measuring methods to acetabulum geometric parameters. METHODS: Seventy cases performed CT scan were selected, including 50 normal adults (a total of 100 hips on both sides) and 20 cases with unilateral congenital hip dislocation. The hip CT images of the subjects were treated with coronal reconstruction and three-dimensional reconstruction, in order to compare the coronal and three-dimensional measurement value of acetabulum upper chamber, and to compare acetabulum upper camber between the normal side and the abnormal side in the congenital hip dislocation group. The acetabulum posterior abduction angle, anterior acetabulum index and posterior acetabular index were measured in the images in accordance with scan bed and the body coronal plane. RESULTS AND CONCLUSION: The acetabulum upper camber measured in coronal plane and three-dimensional image was (39.99±6.1)° and (40.13±5.80)° respectively, and there was no significant difference (P > 0.05). The acetabulum upper camber measured value of the unilateral congenital hip dislocation patients in normal side and abnormal side on coronal plane was (48.95±3.80)° and (63.56±6.35)°, and there were significant differences (P < 0.01). There were significant differences in acetabulum posterior abduction angle, anterior acetabulum index and posterior acetabular index measured in both sides on the images in accordance with scan bed and the body coronal plane (P < 0.01), and there were no significant differences in accordance with coronal plane (P > 0.05). The measurement is more reliable on the images in accordance with the body coronal plane when measuring acetabulum posterior abduction angle, anterior acetabulum index and posterior acetabular index. It can reflect the acetabular real condition and provide quantitative indicators for the diagnosis and treatment of hip disease. Figures and Tables | References | Related Articles | Metrics

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Spinal canal volume change and clinical significance of cervical minimally invasive lamionplasty with specimen simulation Zhang Chun-lin, Zeng Zhao-feng, Tang Heng-tao, Yan Xu, Wang Chuang-jian 2013, 17 (26):  4849-4856.  doi: 10.3969/j.issn.2095-4344.2013.26.014 Abstract ( 517 )   PDF (754KB) ( 580 )   Save BACKGROUND: Single-door and double-door of cervical laminopalsry are now the main methods for the treatment of multiple segments cervical spondylotic myelopathy, but they all have the same question that with the spinous process ligament complex damaged, even completely resected and affect the curative effect OBJECTIVE: To observe the canal volume expansion and to analyze the effect of decompression and curative effect after cervical minimally invasive laminoplasty. METHODS: Twelve dry specimens of the fifth cervical vertebra were selected to simulate cervical minimally invasive lamionplasty. In the concession 1, 2 and 3 mm groups, the bilateral vertebral plate long strip slotted, spinous and vertebral plate retruded by 1 mm, 2 mm and 3 mm respectively, and the specimens before concession were regarded as the control group. The specimens were thin-slice scanned with spiral CT, the volume of bony cervical canal was measured with the tools in CT workstation respectively. Forty-six cervical spondylotic myelopathy patients received cervical minimally invasive laminoplasty from September 2010 to September 2011 in the Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University. According to Japanese Orthopaedic Association scoring system, neurologic function was evaluated before and after surgery through self-control. RESULTS AND CONCLUSION: The average cervical bony spinal canal volume of the control group was       (1 592±331) mm3, the average cervical bony spinal canal volumes of concession 1 mm, 2 mm and 3 mm groups were (1 727±357) mm3, (1 861±386) mm3 and (2 001±416) mm3 respectively; the improvement rates of canal capacity of concession 1 mm, 2 mm and 3 mm groups were (8.53±1.05)%, (16.93±1.78)% and (25.75±2.97)% respectively, and there was significant difference between groups (P < 0.05). The Japanese Orthopaedic Association score of the 36 patients was (7.97±1.73) points before treatment, and (13.14±1.74) in the final follow-up, there was significant difference (P < 0.05); the Japanese Orthopaedic Association score improvement rate was (58.55±13.71)%, the excellent and good rate was 83.3% (9 excellent, 21 good and 6 fair). Specimen simulation can better reflect the spinal canal volume after cervical minimally invasive lamionplasty, and provide a reliable basis for guiding effective decompression. Figures and Tables | References | Related Articles | Metrics

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Liuwei Dihuang Wan serum influences the expression of type Ⅰ and type Ⅱ collagen in intervertebral discs Xu Wu-ji, Li Yue, Yuan Chao 2013, 17 (26):  4857-4864.  doi: 10.3969/j.issn.2095-4344.2013.26.015 Abstract ( 363 )   PDF (957KB) ( 509 )   Save BACKGROUND: Collagen fiber is the main subject to maintain the structural integrity and its physiological function, the type and content of the collagen in intervertebral disc will influence the physical and pathological condition of entire intervertebral disc. Type Ⅰ and type Ⅱcollagen are the main components of intervertebral disc collagen fiber. OBJECTIVE: To observe the effect of Liuwei Dihuang Wan-containing serum on expression of type Ⅰ and type Ⅱ collagen and genes of the intervertebral discs in tumor necrosis factor-α injured rabbit. METHODS: Forty-five L2-L5 intervertebral discs harvested from 15 rabbits were randomly divided into five groups: control 1st day, control 14th day, tumor necrosis factor-α group, Liuwei Dihuang Wan-containing serum group and tumor necrosis factor-α+ Liuwei Dihuang Wan-containing serum group. The culture medium in the Liuwei Dihuang Wan-containing serum group and tumor necrosis factor-α+ Liuwei Dihuang Wan-containing serum group contained 5 μg/L tumor necrosis factor-α and 10% Liuwei Dihuang Wan-containing serum. The nucleus pulposus and annulus fibrosus were collected after cultured for 14 days. RESULTS AND CONCLUSION: Reverse transcription-PCR and Western Blot showed that with the culture time prolonging, the expressions of type Ⅰ collagen and genes in nucleus pulposus and type Ⅱ collage and genes in the annulus fibrosus were significantly decreased; Tumor necrosis factor-α could aggravate the change, while Liuwei Dihuang Wan-containing serum could delay the changes. The results indicate that Liuwei Dihuang Wan can protect the extracellular matrix of intervertebral discs through stabilizing the expressions of type Ⅰ and type Ⅱ collagen and genes. Figures and Tables | References | Related Articles | Metrics

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Measurement of fibular rotation angle: Intraoperative judgment of the success rate of inferior tibiofibular syndesmosis reduction Ruan Zhi-yong, Huang Jin-liang, Luo Cong-feng 2013, 17 (26):  4865-4871.  doi: 10.3969/j.issn.2095-4344.2013.26.016 Abstract ( 908 )   PDF (757KB) ( 510 )   Save BACKGROUND: The CT image is better than X-ray plain film in diagnosing inferior tibiofibular syndesmosis, but the research on CT diagnostic criteria for the diagnose of inferior tibiofibular syndesmosis rotation mismatch is rare. At present, there lacks of systematic research on inferior tibiofibular joint three-dimensional mismatch at home and abroad, especially for the measurement of rotational relationship. OBJECTIVE: To measure the tibiofibular rotation angle of tibiofibular syndesmosis in normal people with CT imaging. METHODS: Twenty-one male and 21 female volunteers were collected for test, and the CT scan was performed to scan the ankle joint. Axial CT measurements included the anterior tibiofibular interval, posterior tibiofibular interval, fibula rotation angle, tibiofibular articular surface tangent angle and tibia Philippians articular surface tangent angle. Two researchers accomplished the measurement at three different occasions independently, and evaluated each CT data. RESULTS AND CONCOUSION: A total of 42 ankles enrolled in the study of data analysis. The tibial surface shape of the tibiofibular syndesmosis was described as deep curved, shallow arc, shallow sloping and flat-shaped. The deep curved symmetrical sydesmosis was the most common type. The shape of fibula was divided into triangular, circular, elliptical, and the most common shape was triangle. Each measurement data was in 95% confidence interval: the anterior tibiofibular interval was 2.10-2.25 mm, the posterior tibiofibular interval was 4.14-4.29 mm, fibula rotation angle was 103.97°-106.30°, tibiofibular articular surface tangent angle was 21.88°-26.64°, tibia Philippians articular surface tangent angle was 33.03°-36.63°. The fibula rotation angle had the smallest variation coefficient with relative small fluctuations and was more representative. The fibular rotational angle was the most stable parameter when comparing with the rest parameters. These data in the study provided the data base with regarding to the precise reduction of the tibiofibular syndesmosis. Figures and Tables | References | Related Articles | Metrics

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Hip surface replacement and total hip arthroplasty: Meta-analysis on the efficacy Zhang Pi-jun, Hong Gu-qi, Wang Gang 2013, 17 (26):  4872-4879.  doi: 10.3969/j.issn.2095-4344.2013.26.017 Abstract ( 439 )   PDF (576KB) ( 376 )   Save BACKGROUND: Hip surface replacement has been widely used in recent years, but there is great controversy on which works better, hip surface replacement or traditional total hip arthroplasty. OBJECTIVE: To investigate and compare the advantages and disadvantages of hip surface replacement and total hip arthroplasty trough compressive analyzing the published literatures. METHODS: The randomized controlled trials on the hip surface replacement and total hip arthroplasty from January 1900 to July 2012 were retrieved. The quality of the included randomized controlled trials was evaluated strictly. The RevMan5.1.6 was used for Meta-analysis RESULTS AND CONCLUSION: Ten randomized controlled trials were included. Results of Meta-analysis showed that there were no significant differences in operation time, intraoperative blood loss, 1 year postoperative Harris score, 1 year postoperative University of California at LosAngeles hip function score and serum levels of cobalt and chromium ion at 2 years after replacement between hip surface replacement and total hip arthroplasty. The average acetabulum anteversion angle in the hip surface replacement group was greater than that in the total hip arthroplasty group. The results indicate that there was no significant difference in the short-term follow-up between hip surface replacement and total hip arthroplasty, but the long-term effect needs to be evaluated with higher quality and larger sample clinical randomized controlled trials. Figures and Tables | References | Related Articles | Metrics

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The treatment of active hip and knee tuberculosis: One-stage arthroplasty feasible or not? Pang Bo-tao, Cao Li 2013, 17 (26):  4880-4887.  doi: 10.3969/j.issn.2095-4344.2013.26.018 Abstract ( 376 )   PDF (704KB) ( 1030 )   Save BACKGROUND: Efficacy of one-stage arthroplasty for patients with active hip and knee tuberculosis is significant, but whether the presence of prosthesis will increase the uberculosis recurrence risk is still the focus of debate. OBJECTIVE: To review the basic and clinical research progress of one-stage arthroplasty for patients with active hip and knee tuberculosis. METHODS: A computer-based online search of CNKI database, VIP database, Wanfang database and PubMed database between January 1985 and October 2012 was performed by the first author to search related articles with the key words of “hip tuberculosis, knee tuberculosis, mycobacterium tuberculosis, prosthesis, arthroplasty, replacement” in English or Chinese. A total of 258 literatures were primarily selected. According to the inclusion and exclusion criteria, finally 55 articles were included for review. RESULTS AND CONCLUSION: One-stage arthroplasty is an effective method for the patients with active hip and knee tuberculosis. The presence of prosthesis will not affect the anti-tuberculosis drugs to kill mycobacterium tuberculosis; meanwhile, the large amount of molecular biology researches also provides a solid theoretical foundation for clinical treatment. With the deepening of research and surgeon experience accumulating, one-stage arthroplasty for the patients with active hip and knee tuberculosis will increasingly common. Figures and Tables | References | Related Articles | Metrics

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Research progresses of artificial cervical disc structure, material and in vitro biomechanics Pu Ting, Yuan Fang, Liao Zhen-hua, Liu Wei-qiang 2013, 17 (26):  4888-4895.  doi: 10.3969/j.issn.2095-4344.2013.26.019 Abstract ( 838 )   PDF (745KB) ( 4172 )   Save BACKGROUND: Artificial cervical disc replacement has been widely used in clinical cervical surgery. Further research of biomechanics of the artificial cervical disc used in the surgery is needed. OBJECTIVE: To review the structure, material types and in vitro biomechanical study of the existed artificial cervical disc, and to prospect the development in the future.    METHODS: The PubMed databases and CNKI database were searched with key words of “artificial cervical disc, prosthesis, structure, material, biomechanical study” in English and Chinese respectively. The articles related to artificial cervical disc structure, material, and in vitro biomechanics were included. The researches in the recent 5 years were collected, and the repetitive studies were excluded. A total of 36 articles were discussed for interview. RESULTS AND CONCLUSION: The existed cervical artificial disc products mainly use the structure of the metal-polymer, and most are the semi-restrictive and non-restrictive structure, dimension series are more perfect and all of them are the imported products. The analysis and the summary of the existed products show that the cervical artificial disc has major development space in three aspects of structure design, oriented population design and material improvement, and the improvement of the material can be considered from the aspects of ndplate material, nucleus pulposus material and surface coating material. Figures and Tables | References | Related Articles | Metrics

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Digital measurement of atlas and axis pedicles with different ages Wu Chun-li, Zhang Pei 2013, 17 (26):  4896-4903.  doi: 10.3969/j.issn.2095-4344.2013.26.020 Abstract ( 374 )   PDF (855KB) ( 400 )   Save BACKGROUND: The CT reconstruction technique can provide the digital model of the internal structure of atlas and axis and it can also use the related software to perform surgery design and measurement of relevant parameters in the model. At the same time, it can provide reliable data for pedicle screw placement security and effectively.  OBJECTIVE: To summary the progress of digital measurement of atlas and axis pedicle, in order to  provide a theoretical basis for the treatment of atlas and axis disorders with pedicle screw technology. METHODS: A computer-based online search was performed in PubMed database, VIP database and Wanfang database from 1994 to 2012 for the literatures about the application of CT reconstruction in the measurement of atlas and axis pedicle. The Chinese key words were “atlas pedicle, axis pedicle, computer-aided design, digitization, adult, children” and the English key words were “atlas pedicle, axis pedicle, digitization, computer-aided design, children”. A total of 110 literatures were obtained after the initial search, and finally 40 literatures were included for the final review.  RESULTS AND CONCLUSION: CT reconstruction technique could obtain a clear image of the cervical spine, and the pedicle screw entrance channel was established with the modern digital technology, then the positioning point, direction and length of screw entrance were determined according to the position of the channel. The method was considered to be more direct, specific and more accurate, and can provide guidance for individual placement of screw in clinic. The domestic and international researches on the adult atlas and axis pedicle have obtained many important scientific data, and the researches on children atlas and axis pedicle are rare. With the development of medical technology and the accurate digital measurement of children atlas and axis pedicle, children atlas and axis pedicle fixation technique will be more secure and accurate. Figures and Tables | References | Related Articles | Metrics

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Intramedullary fixation for the treatment of femoral intertrochanteric fracture: Pros and cons evaluation Guo Xiao-liang1, Wei Xiao-chun2, Wang Xiao-hu2 2013, 17 (26):  4904-4911.  doi: 10.3969/j.issn.2095-4344.2013.26.021 Abstract ( 562 )   PDF (662KB) ( 493 )   Save BACKGROUND: With the increasing of the incidence of femoral intertrochanteric fracture, the treatment method is developed. There are many methods for the treatment of femoral intertrochanteric fracture, and intramedullary fixation has more advantages when compared with extramedullary fixation in biomechanics.  OBJECTIVE: To review the development and current state of intramedullary fixation for the treatment of femoral intertrochanteric fracture, to analyze the pros and cons of each method and to prospect the future of intramedullary fixation for the treatment of femoral intertrochanteric fracture.  METHODS: The PubMed database, CNKI database and CAJ database were retrieved by computer with key words of “intertrochanteric fracture, intramedullary nail, Gamma nail, proximal femoral nail, locking intramedullary nail” in English and Chinese for the related articles published from 2001 to 2012. The literatures about or related with intramedullary fixation for the treatment of femoral intertrochanteric fracture were included. A total of 115 articles were screened out, the repetitive researches were excluded, and finally 54 articles were included for review.  RESULTS AND CONCLUSION: For the unstable intertrochanteric femoral fracture, intramedullary fixation has superiority in the biomechanics, because it more closes to the center of gravity and its force arm is shorter. Intramedullary nail can against the conductive stress along with calcar femorale well and can prevent the femoral shaft ingression. Gamma nail, proximal femoral nail, proximal femoral nail anti-rotation, expandable proximal femoral intramedullary nail, minimally invasive short reconstructive intramedullary nail and locking intramedullary nail can achieve the satisfactory reduction and nail rigid internal fixation in clinic. The artificial hip replacement can be used for the treatment of the patients with unstable, elderly and combined with the medical disease and severe osteoporosis fractures. With the rediscover of biomechanics, changes and updates of the internal fixation and the development of operation, the method and effect for the treatment of femoral intertrochanteric fracture will be improved. Figures and Tables | References | Related Articles | Metrics

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Bone cement injection for the treatment of thoracolumbar osteoporotic fractures: Common problems in the mature technology Han Wei-dong, Huang Ai-jun, Chen Li-ping 2013, 17 (26):  4912-4918.  doi: 10.3969/j.issn.2095-4344.2013.26.022 Abstract ( 959 )   PDF (760KB) ( 457 )   Save BACKGROUND: Bone cement injection is one of the commonly used methods for the treatment of thoracolumbar osteoporotic fractures. OBJECTIVE: To evaluate biomechanical properties and fixed effects of bone cement injection for the treatment of thoracolumbar osteoporotic fractures. METHODS: The specimens of thoracolumbar osteoporotic fractures were selected, and used to measure the mechanical properties of bone mineral density, maximum pressure load, displacement and stiffness. The bone model was established, and after bone cement injection, the maximum pressure load, displacement and stiffness were measured again. The mechanical properties before and after bone cement injection were compared, and compared with those in the treatment of thoracolumbar osteoporotic fractures with pedicle screw fixation. The patients received bone cement injection for the treatment of thoracolumbar osteoporotic fractures were followed-up, and the treatment effect of bone cement injection was determined through evaluating the pain relief degree, thoracolumbar vertebral height restoration, amount of bone cement injection and bone cement extravasation. RESULTS AND CONCLUSION: The biomechanical experiment determined that the maximum load was 2 285 N after thoracolumbar osteoporotic fractures treated with bone cement injection, which increased almost by 16.9% than 1 954 N before fracture; the stiffness was 427 N after thoracolumbar osteoporotic fractures treated with bone cement injection, which increased almost by 22.1% than 349 N before fracture, and showed good biological properties. The thoracolumbar osteoporotic fractures patients treated with bone cement injection and closed reduction combined with bone cement injection were followed-up, and found that both these two methods could relieve the pain of the patients. But closed reduction combined with bone cement injection for the treatment of thoracolumbar osteoporotic fractures was better than bone cement injection in the amount of bone cement injection, local kyphosis angle and vertebral height restoration. The results indicate that closed reduction combined with bone cement injection is a safe and effective method for the treatment of thoracolumbar osteoporotic fractures. Figures and Tables | References | Related Articles | Metrics

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Comparison of therapeutic effects of implant internal fixation for the treatment of Sanders Ⅱ calcaneal fractures after poking and open reduction Xiong Hao1, Liu Wei1, Lin Wei-wen1, Xia Xiong-chao, Li Bei, Ou Cai-qiong, Lai Mao-song, Huang Rui-liang, Aihemaitijiang•Yusufu 2013, 17 (26):  4919-4925.  doi: 10.3969/j.issn.2095-4344.2013.26.023 Abstract ( 599 )   PDF (985KB) ( 635 )   Save BACKGROUND: Although, implant fixation is effective for many patients with calcaneal fractures, there is no consensus on the classification and treatment of calcaneal fractures as well as the choice of implants internal fixation. OBJECTIVE: To compare the effect of poking reduction and open reduction internal fixation for the treatment of Sanders Ⅱ calcaneal fractures. METHODS: The clinical data of the 56 patients with Sanders Ⅱ calcaneal fractures who treated in the Second Department of Orthopedics, Foshan Gaoming District People's Hospital from May 2010 to October 2012 were retrospectively analyzed. The age of the patients was 15-61 years. There were 27 cases treated with poking reduction fixation, and 29 cases were treated with open reduction internal fixation. RESULTS AND CONCLUSION: All the patients were followed-up for 12-24 months, average 16.5 months. The postoperative X-ray film showed talar articular surface of calcaneus was recovered to normal basically. In the poking reduction fixation group, the Bohler angle was recovered from preoperative (17.88±2.06)° to postoperative (30.60±2.89)°; in the open reduction internal fixation group, the Bohler angle was recovered from preoperative (17.55±2.46)° to postoperative (31.69±2.29)°, and there was no significant difference in Bohler angle between two groups (P > 0.05). Evaluation of the postoperative function according to the Maryland foot score showed that in the poking reduction fixation group, there were 14 cases of excellent, six cases of good, five cases of average and two cases of poor, the excellent and good rate was 74.0%; in the open reduction internal fixation group, there were 11 cases of excellent, 13 cases of good, four cases of average and one case of poor, the excellent and good rate was 82.7%. There was no significant difference in the excellent and good rate between two groups (P > 0.05). Both poking reduction fixation and open reduction internal fixation are effective for the treatment of calcaneal fractures. Figures and Tables | References | Related Articles | Metrics

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Design of digitized anterior approach screw fixation program: Clinical application in the treatment of type Ⅱ odontoid fractures Chen Xuan-huang, Zhang Guo-dong, Wu Chang-fu, Lin Hai-bin 2013, 17 (26):  4926-4933.  doi: 10.3969/j.issn.2095-4344.2013.26.024 Abstract ( 354 )   PDF (2887KB) ( 477 )   Save BACKGROUND: The treatment of type Ⅱ odontoid fractures has the difficulties of difficult, high risk and the choice between cervical spine stability and cervical activity. OBJECTIVE: To investigate the method and clinical application of computer in the three-dimensional construction of type Ⅱ odontoid fractures, reduction and design of digitized fixation. METHODS: One cervical specimen was used to prepare the type Ⅱ odontoid fractures model for high-speed thin CT scan. The model was reconstructed and reseted in the Mimics. The Solidworks was used to design the screw and performed virtual simulation on the three-dimensional model of fracture reduction in order to guide the clinical application. RESULTS AND CONCLUSION: Three-dimensional reconstruction and reduction were performed on the fracture model, and the virtual screw fixation was completed according to the three-dimensional measurement data thus guiding the clinical surgery successfully. The results show that digitized screw fixation that used in the treatment of type Ⅱ odontoid fractures can be designed on the computer with Mimics and Solidworks, which has good reference value to the clinical surgery. Figures and Tables | References | Related Articles | Metrics

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Atlantoaxial lesions treated with internal fixation: Advantages of transoral approach Sun Ming-qi, Bao Guo-yu, Liu Bin 2013, 17 (26):  4934-4940.  doi: 10.3969/j.issn.2095-4344.2013.26.025 Abstract ( 419 )   PDF (821KB) ( 367 )   Save BACKGROUND: Transoral approach is the traditional method for the treatment of atlantoaxial lesions, and is the hotspot and difficulty of the researches on spine surgery.    OBJECTIVE: To provide intuitive operation path for transoral approach reach to the craniocervical junction area, and to provide anatomical data for safe operation. METHODS: Cadaver specimen received layer by layer surgical anatomy through transoral approach, and then the anatomical level, organization structure, and the relationship with the adjacent were observed. The main anatomical structures and the distances between structures were measured with the maker point of incisor; the distance between vertebral artery and center line and the atlantoaxial morphological structure were measured. RESULTS AND CONCLUSION: Transoral anterior approach could directly expose the range from the middle-lower segment of the slope to the upper edge of C3 vertebral body, showed that the distance between bilateral vertebral arteries and center line was as follows: distance between left C1 vertebral artery and the center line was (20.72-29.70) mm, distance between right C1 vertebral artery and the center line was (20.36-28.98) mm, distance between left C2 vertebral artery and the center line was (13.10-23.00) mm, distance between right C2 vertebral artery and the center line was (13.85-24.02) mm. The distances from anterior tubercle, anterior odontoid process, posterior odontoid process, spinal dural, spinal cord, anterior C2 vertebral body and anterior C3 vertebral body to the incisor were (69.24-88.16) mm, (74.95-96.27) mm, (84.77-107.39) mm, (87.65-111.45) mm, (91.38-116.11) mm, (76.21- 92.77) mm and (78.53-105.13) respectively. The length of atlas was (19.8±2.3) mm, the height of odontoid process was (15.9±1.9) mm, the maximum transverse diameter was (10.5±0.6) mm, and the maximum sagittal diameter was (11.5±1.9) mm; the atlantoaxial maximum transverse diameter was (15.1±1.6) mm, the atlantoaxial maximum sagittal diameter was (17.7±1.3) mm, the distance from the outer edge of upper articular surface to the center line was (26.1±1.7) mm, and the distance between transverse foramen entrance and the upper articular surface was (8.1±1.3) mm. The anatomical structures of craniocervical junction are complex, and transoral approach has advantages in the treatment of craniocervical junction lesions within anatomical security range. Figures and Tables | References | Related Articles | Metrics