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22 January 2011, Volume 15 Issue 4 Previous Issue    Next Issue

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Total knee arthroplasty for osteoarthritis patients: A multi-central randomized controlled trial Wang Guo-wei, Sun Shui, Lin Yong-jie, Chen Ji-ying, Zhou Yong-gang, Shi En-dong 2011, 15 (4):  571-574.  doi: 10.3969/j.issn.1673-8225.2011.04.001 Abstract ( 274 )   PDF (873KB) ( 481 )   Save BACKGROUND: Total knee arthroplasty (TKA) can be performed for osteoarthritis patients, aged more than 60 years, with joint pain, dysfunction and joint deformity. OBJECTIVE: To compare differences in early joint functional recovery between three kinds of TKA surgery, i.e. TKA, minimally invasive surgery (MIS)-TKA and MIS-quadriceps sparing (QS)-TKA.  METHODS: 120 osteoarthritis patients were selected from Beijing 301 Hospital, Shandong Provincial Hospital, and Shandong Jiaotong Hospital, including 42 undergoing traditional TKA, 42 MIS-TKA and 36 MIS-QS TKA. Each knee was rated according to the Hospital of Special Surgery (HSS) scoring system at 2, 6, and 12 weeks post-operatively. Range of motion was detected. RESULTS AND CONCLUSION: The operation time was longer in MIS-TKA and MIS-QS TKA groups compared with TKA group (P < 0.01), but the bleeding amount was less (P < 0.01). There was no obvious difference between MIS-TKA and MIS-QS TKA groups (P > 0.05). Range of motion and HSS scores of MIS-TKA and MIS-QS TKA groups were superior over traditional TKA at postoperative 2 weeks (P < 0.01), but there was no prominent difference of ROM between MIS-TKA and MIS-QS TKA groups (P > 0.05). The HSS scores were significantly greater in MIS-QS TKA compared with MIS-TKA (P < 0.01). At 6 and 12 weeks, there were no significant differences in HSS scores or range of motion among three groups (P > 0.05). Compared with traditional TKA, MIS-TKA and MIS-QS TKA showed less bleeding amount, less injury to the quadriceps, and this could contribute to the earlier recovery of the patients. Related Articles | Metrics

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Toll-like receptors 4 and 9 expression in leukocytes following joint arthroplasty Zhang Zi-ji, Kang Yan, Sheng Pu-yi, Zhai Qi-yi, Zhang Hao, Zhang Yang-chun, Hou Chang-he, Li Zi-qing, Liao Wei-ming 2011, 15 (4):  575-579.  doi: 10.3969/j.issn.1673-8225.2011.04.002 Abstract ( 244 )   PDF (1242KB) ( 357 )   Save BACKGROUND: Little researches focus on the expression of Toll-like receptors (TLRs) and its mechanism in arthroplasty patients. Evidence shows TLRs are expressed on the surface of biofilms in loosening hip prosthesis. OBJECTIVE: To investigate the differences in TLRs 4 and 9 expression in leukocytes of patients with and without prosthesis. METHODS: Fasting blood plasma samples were harvested 24 hours post admission and 3 days post-operation from patients undergoing arthroplasty (n=11) or arthroscopy (n=10). Cell-associated TLR 4 and 9 was measured by flow cytometry, white blood cells, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were tested. RESULTS AND CONCLUSIONS: WBC, ESR, CRP were at normal level in both groups. TLR4 and 9 were mostly expressed in monocytes of peripheral blood, with low expression levels in lymphocytes and neutrophils. The expression levels of TLR 4 and TLR 9 were of no significance between post-operation and pre-operation in both groups (P > 0.05), whereas a significant change of TLR9 expression gap was found in arthroplasty patients before and after the procedure (P < 0.05). TLR 4 expression remained unchanged (P > 0.05). Results showed that in the absence of clinical infection, stress and tissue damage during arthroplasty and arthroscopy did not affect TLR4 and TLR9. TLR9 seems to be downgraded by implantation of joint prosthesis. Related Articles | Metrics

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Total hip replacement revision with a fluted, tapered, modular stem  Luo Yuan, Sun Jun-ying, Li Yong-wang, Yang Mao-wei 2011, 15 (4):  580-584.  doi: 10.3969/j.issn.1673-8225.2011.04.003 Abstract ( 321 )   PDF (792KB) ( 535 )   Save BACKGROUND: Modular femoral stem revision prosthesis is theoretically considered to overcome disadvantages of cemented femoral stem or biological fixed non-modular femoral stem. Some studies report favorable effect of modular femoral stem. OBJECTIVE: To summarize the experience on the revision total hip replacement with a fluted, tapered, modular stem. METHODS: From May 2000 to August 2005, 19 patients (21 hips) undergoing total femoral revision were selected from First Affiliated Hospital of Soochow University. All were diagnosed as aseptic loosening of stems coupled with bone loss prior to revision. Pre-revision femoral defects were classified according to the system of Paprosky, including 4 (19%) of type Ⅱ femoral bone loss, 14 (67%) of type Ⅲ a femoral bone loss, and 3 (14%) of type Ⅲ b femoral bone loss. The revision was performed using the fluted, tapered, modular stem. The revision effect was observed. RESULTS AND CONCLUSION: All stems achieved primary stability. No infection or dislocation was found. The Harris Hip Score at the latest follow-up maintained at 92.2±3.5. X-ray showed general bone ingrowth and bone stability in 20 hips (95%), and fiberous stability in 1 hip (5%). All of the cases showed bone restoration in the proximal defect zone after bone graft without increased radiolucent lines. Anterioposterior and lateral X-ray showed that femoral stem intramedullary filling rate was 80% and 70% in 18 hips (86%), < 80% and 70% in 3 hips (14%). All stems were in neutral position and the average subsidence was 2.4 mm. There were no re-revisions of the femoral stem for any reason. Revision with fluted, tapered, modular stem can achieve satisfied results. But we must pay more attention to the following factors: 1)Hand reaming was important to reduce fracture rate; 2)appropriate cannel filling and adjustment of proximal component can prevent subsidence and dislocation; 3)proximal cavity reconstruction around the Morse taper junction. Related Articles | Metrics

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Proximal femoral nail anti-rotation versus artificial femoral head replacement for femoral intertrochanteric fracture in the elderly Meng Xiang-qi, Ding Ning, Yu Ji-wen, Yuan Feng, Feng Hu 2011, 15 (4):  585-588.  doi: 10.3969/j.issn.1673-8225.2011.04.004 Abstract ( 318 )   PDF (568KB) ( 586 )   Save BACKGROUND: It remains controversial on treatments for elderly femoral intertrochanteric fracture in elderly. OBJECTIVE: To compare the curative effects between proximal femoral nail anti-rotation (PFNA) and artificial femoral head replacement in treatment of femoral intertrochanteric fracture in the elderly. METHODS: From October 2007 to June 2009, 79 cases of femoral intertrochanteric fracture in elderly patients were treated by PFNA (n=34 cases, aged 65-81 years) and femoral head replacement (n=45, aged 67-94 years). The difference of length of stay, operation time, intraoperative bleeding, postoperative complications and the function changes of hip joint was analyzed. RESULTS AND CONCLUSION: All patients were followed up for 6 to 24 months, with an average of 17.5±4.9 months. There were no statistical differences between two groups in terms of hospital stay, postoperative complications and function change of hip (Harris scores; P > 0.05). PFNA exhibited advantages in operation time (P< 0.001), intraoperative bleeding (P < 0.000 1) compared with artificial femoral head replacement, but bedridden time was longer than artificial femoral head replacement group (P< 0.0001). Both the PFNA method and the artificial femoral head replacement have good clinic curative effects in treatment of femoral intertrochanteric fracture in elderly patients. PFNA has advantages of short operation time and less bleeding but long bedridden time. The surgery should be selected according to the actual situations of patients. Related Articles | Metrics

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A dynamic biomechanical analysis of the intervertebral disk following thoracolumbar spine compression fracture treated with hyperextending based on finite element method Liu Ying-jun, Li Xiao-lin 2011, 15 (4):  589-592.  doi: 10.3969/j.issn.1673-8225.2011.04.005 Abstract ( 315 )   PDF (1831KB) ( 400 )   Save BACKGROUND: Hyperextending treatment for thoracolumbar spine compression fracture has the advantages of good effect, low cost, light damage, and rapid effect. However, clinical application lacks of specification, the mechanism of practices is relative inadequate. OBJECTIVE: To explore the dynamic biomechanical characteristics of intervertebral disk with the treatment of thoracolumbar spine compression fracture by hyperextending based on finite element method. METHODS: The finite element model of compression fracture of T12 based on the 210-layer consecutive CT DICOM format images from one patient of compression fracture of T12 was constructed. The hyperextending was stimulated after effective verification of model. All surfaces of the lower of T12 was restrained, a vertical traction at the top of T11 was imposed, and a  3 cm-displacement towards the vertebral by three steps at the top of spinous process of T11, T12, and L1. The forces of the upper and lower intervertebral discs of compressed vertebrae were read by operational procedure. RESULTS AND CONCLUSION: A realistic appearance and full biomechanical properties 3D finite element model of thoracolumbar spine compression fracture was established. The intervertebral disks were obviously stretched after hyperextending. The stress of intervertebral disk is different, when the hyperextending fulcrum is different. It is indicated that the treatment effect of thoracolumbar spine compression fracture by hyperextending is exact. The intervertebral disk plays an important role in bone fracture reposition. The mechanism of traditional practices with finite element method has many advantages, such as reliable experimental results, intuitive results, resource conservation and accurate practices. Related Articles | Metrics

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Accuracy of thoracic pedicle screw placement based on computer-aided reconstruction technique Wei Dong-xing, Zhang Zhen, Wang Jiu-hui 2011, 15 (4):  593-596.  doi: 10.3969/j.issn.1673-8225.2011.04.006 Abstract ( 392 )   PDF (780KB) ( 359 )   Save BACKGROUND: The achievement ratio of thoracic pedicle screw placement is not ideal, because of the complex environment surround vertebrae. With the sophisticated image equipment development, preoperative orthopedics examination becomes clearer and accurate. OBJECTIVE: To compare the success rate and accuracy of thoracic pedicle screw placement achieved by screw insertion assisted by spiral CT image three dimensional reconstruction technique and the conventional free hand placement technique. METHODS: A total of 56 patients with thoracic vertebrae injury were included. According to patients’ will to select placement means before internal fixation, three-dimensional reconstruction-aided group and conventional free hand technique group of 28 cases, respectively. All patients in three-dimensional reconstruction-aided group were treated with thoracic vertebrae scanning by high-resolution spiral CT, the data entered into computer database. According to software-generated three-dimensional images, surgical path and pedicle screw parameters were stimulated. Patients in conventional free hand technique group underwent ordinary X-ray and CT detection, reconstruction and stimulation function in three-dimensional reconstruction-aided group were not applied. The success rate of pedicle screws in all cases was recorded. The accuracy of pedicle screws was evaluated again by spiral CT scanning after internal fixation.  RESULTS AND CONCLUSION: Compared with conventional free hand technique group, the success rate of thoracic screw placement in three-dimensional reconstruction-aided group was significantly increased (P < 0.05), the pedicle perforation rate was significantly reduced (P < 0.05). It is indicated that thoracic pedicle screw internal fixation with spiral CT three-dimensional reconstruction-aided technology can significantly improve the success rate and accuracy of thoracic screw placement. Related Articles | Metrics

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Comparison of two anterior decompression bone fusion treatments plus titanium plate implantation for two-level cervical spondylotic myelopathy Liu Yong, Chen Liang, Gu Yong, Xu Yun, Yang Hui-lin, Tang Tian-si 2011, 15 (4):  597-601.  doi: 10.3969/j.issn.1673-8225.2011.04.007 Abstract ( 283 )   PDF (3713KB) ( 533 )   Save BACKGROUND: Anterior surgical approaches for cervical spondylotic myelopathy (CSM) include Cloward method, anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion. OBJECTIVE: To compare the clinical effects and biocompatibility of two different anterior approaches in combination with titanium plate implantation for two-level CSM. METHODS: A total of 54 cases of two-level CSM were randomly divided into two groups: 27 cases were treated with anterior cervical discectomy and fusion (ACDF), and 27 with anterior cervical corpectomy and fusion (ACCF). Complications, the function recovery rate of spinal cord, the height and Cobb’s angle of the fused segment between two groups. RESULTS AND CONCLUSION: Four patients in ACDF group and four in ACCF group were excluded for analysis because of follow-up lost or follow-up less than 2 years. The follow-up period of 23 patients in ACDF group was 26-48 months and of 23 patients in ACCF group was 24-53 months. There were no significant differences in hospital stay, the height of the fused segment, complications, or the function recovery rate of spinal cord between the two groups (P > 0.05). Operation time and bleeding amount were significantly greater in ACCF group compared with ACDF group (P < 0.05). Postoperative Cobb’s angle of the fused segment was significantly better in the ACDF group (P < 0.05), and incidence of complications was low in bone donor region (P < 0.05). Results show that surgical managements of two-level CSM using ACCF or ACDF obtained favorable clinical outcomes. However, ACDF was superior over ACCF in terms of operation time and bleeding amount, Cobb’s angle of the fused segment, vertebral bone reservation, elimination of donor site complications. Related Articles | Metrics

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Comparison of pedicle screw fixation and simple vertebral canal decompression in the treatment of lumbar degenerative spondylolisthesis   Liu Bao-hua, Wang Pei, Xia Qun, Feng Shi-qing, Zheng Yong-fa, Li Bing 2011, 15 (4):  602-606.  doi: 10.3969/j.issn.1673-8225.2011.04.008 Abstract ( 306 )   PDF (1509KB) ( 456 )   Save BACKGROUND: With the development of spinal internal fixation and spinal fusion technology, spinal fusion has become undisputed “gold standard” of lumbar degenerative spondylolisthesis. Meanwhile, the problem of adjacent segment degeneration attracts more and more attention. OBJECTIVE：To observe the clinical effect, the stability of surgical segment, and their influences on adjacent segments of pedicle screw fixation and fusion in treatment of degenerative spondylolisthesis, and to compare with simple vertebral canal compression. METHODS: A total of 38 patients with lumbar degenerative spondylolisthesis received treatment at the Department of Orthopaedics, General Hospital of Tianjin Medical University were selected, and 3 patients were lost in follow-up. Of the remaining 35 cases, 21 cases underwent pedicle screw fixation posterolateral fusion and 14 cases underwent simple vertebral canal decompression. Simple vertebral canal compression group treated with the rongeur bite yellow ligament and lamina to relieve nerve root compression, forward vertebral slippage of adjacent vertebral body with posterior inferior formation relative prominence was chiseled with osteotome. According to Wein-stein method pedicle screw into the needle localization, then screw into the pedicle screw and undergo vertebral plate decompression on the basis of compression condition in pedicle screw fixation and fusion group. The clinical effect underwent comprehensive evaluation of oswestry dysfunction index; horizontal displacement and angular displacement were observed at hyperextension and flexion time. Degenerative condition of adjacent segment was evaluated by UCLA system. RESULTS AND CONCLUSION: A total of 35 patients were followed up for 1 year. The excellent rate in pedicle screw fixation and fusion group was significantly higher than that in simple vertebral canal compression group (P < 0.05). Pedicle screw fixation and fusion has little effect on the stability of lumbar. There was no significant change in adjacent segment before degenerative insertion and 1 year after insertion. Simple vertebral canal compression had a significant effect on the stability of lumbar, and there was no significant change in adjacent segment degeneration before treatment and 1 year after treatment. It is indicated that pedicle screw fixation and fusion has satisfying effects in treatment of degenerative spondylolisthesis, and has less influence on stability of lumbar, which has little effect on adjacent segments of intervertebral discs after insertion in early stage. Related Articles | Metrics

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Anatomical dynamic hip locking plate versus dynamic hip screw for intertrochanteric femoral fracture   Wang Liang, Zhao Hai-bo, Yu Dan, Hu Ming, Zhang Huai-ping 2011, 15 (4):  607-610.  doi: 10.3969/j.issn.1673-8225.2011.04.009 Abstract ( 306 )   PDF (1270KB) ( 434 )   Save BACKGROUND: Dynamic hip screw (DHS) has been widely used to treat intertrochanteric femoral fracture (IFF). Anatomical dynamic hip locking plate (ADHLP) is a novel hip internal fixation device. OBJECTIVE: To compare and assess the treatment of IFF by ADHLP and DHS in operative time, blood loss and clinical effect. METHODS: A total of 50 patients with IFF were selected from Department of Orthopedics, Jilin Central Hospital, who had been treated by two internal fixation operations (DHS and ADHLP). The data of two groups were collected for statistical analysis on the following aspects: operative time, blood loss, clinical healing time of fracture, postoperative complications and Harris Hip scores. RESULTS AND CONCLUSION: The operating time of ADHLP was shorter than DHS (P < 0.05), and the intraoperative bleeding was less than DHS group (P  < 0.05). There was no significant difference in bone healing time between the two groups (P > 0.05). The excellent and good rate in Harris score was 92% (22/24) in ADHLP group, greater than in DHS group (88%, 23/26; P  < 0.05). Compared to DHS, ADHLP is a reliable internal fixation method with shorter operating time and less bleeding, less bone loss, and can be used as an effective method for IFF. Related Articles | Metrics

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Clinical effects of implant anchorage versus J-hook headgear: A Meta-analysis Chen Yan, Wang Si, Cao Yang, Chen Song 2011, 15 (4):  611-614.  doi: 10.3969/j.issn.1673-8225.2011.04.010 Abstract ( 322 )   PDF (593KB) ( 507 )   Save BACKGROUND: Implant anchorage and J-hook are commonly used in orthodontic treatment, both of which can enhance the anchorage, but the effects of them may be different.  OBJECTIVE: To compare the differences of implant anchorage and J-hook headgear between clinical therapeutic efficacy and root adsorption. METHODS: PubMed database (1950-01/2010-08), Embase (1966-01/2010-08), Cochrane library (the second phase, 2010), VIP database (1989-2010-08), CBM database (1978-01-2010-08), CNKI database (1979-01-2010-08) was retrieved by computer. Literatures addressing implant anchorage and J-hook headgear effect published in 10 years by domestic and foreign scholars were collected with manual research and supplemented with the article retrospective approach. Cephalometric measurements were quantitatively analyzed by Meta analysis. Revman 5.0 was used for data management. Chi-square test was used to undergo homogeneity test of included studies. Fixed effect model and random effect model were adopted to calculate weighted mean difference (MD) and 95% confidence interval (95% CI). RESULTS AND CONCLUSION: A total of 4 literatures were included, 87 cases of objects. Meta analysis demonstrated that there were significant differences among overbite decrement, overjet decrement, and the vertical distance of upper central incisor cutting to palatal plane (PP) decrement in index changes. Individual results showed that compared to J-hook headgear, the reduction of root adsorption was caused by implant anchorage; there were significant differences in results. In terms of anchorage control, implant anchorage is a good alternative to J-hook headgear. However, it still needs more high quality RCT of large sample to further verify the differences between implant anchorage and J-hook headgear. Related Articles | Metrics

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Meta-analysis of association between Asporin polymorphism and osteoarthritis Jiang Xiao-hong, Xiao Zeng-ming, Jiang Jun-jun, Li Shi-de 2011, 15 (4):  615-619.  doi: 10.3969/j.issn.1673-8225.2011.04.011 Abstract ( 363 )   PDF (540KB) ( 376 )   Save BACKGROUND: Epidemiologic studies have shown that osteoarthritis has genetic predisposition. Osteoarthritis-related predisposing genes have been discovered. There are studies focusing on osteoarthritis and Asporin polymorphism in Greece, UK, Spain, China and Korea. However, the results vary. OBJECTIVE: To assess the association between Asporin polymorphism and osteoarthritis using Meta analysis. METHODS: Related articles were searched from PubMed, EMBASE, Cochrane library in English and from Wanfang, VIP, CBM in Chinese published by from January 2000 to July 2010, with key words “osteoarthritis, Asporin” in English and “osteoarthritis，Asporin, gene” in Chinese. A total of 48 relevant articles were collected which met the criteria and Hardy-Weinberg(H-w) genetic laws. The correlated index was extracted for analysis in RevMan 5.0. RESULTS AND CONCLUSION: Finally, 6 were included, involving 1 560 patients with knee osteoarthritis and 2 672 controls; 1 800 patients with hip osteoarthritis and 1 416 controls. Of knee osteoarthritis patients, D14/others genotype exhibited OR value=1.23, 95% CI (0.94-1.61), P > 0.05; and D13/others: OR=0.90, 95%CI (0.76-1.06), P > 0.05. Subgroup analysis showed that the P of D14/others and D13/ others > 0.05 in Asian group, while in European group the P of 14/others > 0.05; the OR values of D13/others were 0.83, 95%CI (0.72-0.95), P < 0.05. Of hip osteoarthritis patients, D14/others and D13/others exhibited   P values > 0.05. Results suggest no association between Asporin and knee or hip osteoarthritis, but the recessive protective effects were observed for the D13 allele in knee European populations. Related Articles | Metrics

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A biomechanical test evaluates the stability of posterior longitudinal ligament following thoracolumbar anterior decompression   Chen Xiang-dong, Zhang Feng, Dong Shi-kui, Wang Yi-jin 2011, 15 (4):  620-624.  doi: 10.3969/j.issn.1673-8225.2011.04.012 Abstract ( 334 )   PDF (656KB) ( 350 )   Save BACKGROUND: Up to now, it is scarcely reported that the biomechanical stability of the thoracolumbar posterior longitudinal ligament (PLL) in anterior decompression. OBJECTIVE: This biomechanical study was undertaken to determine the role of thoracolumbar PLL following anterior decompression and interbody iliac bone graft fixed with Kaneda instrumentation. METHODS: A total of seven fresh calf thoracolumbar spines (T11-L3) following the trial procedure were noted as normal group (the PLL was intact without decompression and internal fixation), intact PLL group (the PLL was intact with decompression, bone graft and internal fixation), resected PLL group (the PLL was cut with decompression, bone graft and internal fixation). The biomechanical property was determined with experimental stress methods. L1 vertebra excision, anterior decompression and interbody iliac bone graft + Kaneda internal fixation were performed. Nondestructive biomechanical tests were performed with WE-10A testing machines. The data of strain, stress, axis compression stiffness, rotational rigidity were recorded and calculated, then analyzed by F test. RESULTS AND CONCLUSION: Following thoracolumbar anterior decompression and bone graft + Kaneda internal fixation, when the PLL was cut, the stability of the specimen tended to decrease at rotation, axial compression, flexion, extension and lateral bending. The decrease at flexion was the most remarkable with significant differences (P < 0.05). During the thoracolumbar anterior decompression and internal fixation, the resection of the PLL may lead to the instability of spine cord at flexion, which is bad for bone graft fusion. So the normal PLL should be protected. Related Articles | Metrics

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Torsional stability of innovative versus traditional split crimpable hooks  Liu Ke-jin, Ji Li, Li Chi-bin, Huang Dai-ying, Zhong Xiao-long 2011, 15 (4):  625-628.  doi: 10.3969/j.issn.1673-8225.2011.04.013 Abstract ( 287 )   PDF (872KB) ( 477 )   Save BACKGROUND: Traction is a method generally used in orthodontic treatment by which the movement of teeth can be manipulated. However, the split crimpable hooks currently used appear to unwished slide sometimes, due to insufficient resistance, which cannot achieve the en-mass movement of teeth. OBJECTIVE: To develop a new type of archwire hook assembly (uncrimpable split hook with pin) and to compare the torsional stability with traditional split hook. METHODS: The new archwire hooks composed of split box-form body, hook and pin were designed and manufactured. A total of 30 innovative archwire hooks and 30 traditional AO split hooks were respectively attached to a 0.019 × 0.025-inch stainless steel archwire. The archwire/hook attachment assembly was fitted into a dual contact jig and securely mounted to the base of a universal testing machine. The force that required to dislodge the hooks on the archwire was measured. The resistance of dislodgement of two hooks was compared. RESULTS AND CONCLUSION: The mean forces required to dislodge the hooks measured in newtons (N) were as follows: new archwire hooks (22.37±9.06) N, traditional split crimpable hooks (4.96±0.70) N. The new archwire hooks provide more resistance to torsional dislodgement from a rectangular stabilizing archwire than traditional split crimpable hooks. Related Articles | Metrics

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Biomechanical changes in bone anchor fixation of tibial anterior tendon in orthopedic surgery of congenital clubfoot  Chen Bo, Du Yuan-li, Li Yu-peng, Wang Hua, Wu Bin, Ru Neng, Le Jin-bo 2011, 15 (4):  629-632.  doi: 10.3969/j.issn.1673-8225.2011.04.014 Abstract ( 394 )   PDF (28548KB) ( 367 )   Save BACKGROUND: In orthopedic surgery for congenital clubfoot, the tibial anterior tendon is commonly reattached to the cuneiform bone with wire, which should be pulled out by second surgery and might induce infection. Bone anchor has been attempted to fix tibial anterior tendon. OBJECTIVE: To explore the biomechanical properties of bone anchor to fix tibial anterior tendon in orthopedic surgery of congenital clubfoot. METHODS: The anterior tibial tendon and the cuneiform bone were dissected from the amputated children's leg, which were fixed with a Mitek GII bone anchor or No. 2 Ethibond suture. All samples were subjected to biomechanical vertical pull testing until failure. RESULTS AND CONCLUSION: In the bone anchor fixation failure mode: all 10 bone anchors were pulled out without suture broken or anchor damaged. The average maximum pullout load was 137 N. In The suture fixation failure mode: 10 No. 2 Ethibond sutures all broke, and the average maximum pullout load was 92 N. Biomechanical properties of bone anchor are better than suture, which achieve the strength to fix the anterior tibial tendon in orthopedic surgery of congenital clubfoot. Related Articles | Metrics

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Endobutton CL versus Rigidfix fixation systems for fixation of autologous quadrupled hamstring tendon in anterior cruciate ligament reconstruction Tu Jun, Xu Bin, Xu Hong-gang, Wang Rui 2011, 15 (4):  633-638.  doi: 10.3969/j.issn.1673-8225.2011.04.015 Abstract ( 290 )   PDF (6481KB) ( 671 )   Save BACKGROUND: Endobutton CL and Rigidfix system are widely used in anterior cruciate ligament (ACL) reconstruction. OBJECTIVE: To retrospectively evaluate and compare clinical results between Endobutton CL and Rigidfix fixation systems after ACL reconstruction with autologous quadrupled hamstring tendons. METHODS: Thirty patients that were treated with arthroscopic ACL reconstruction respectively using hamstring autograft with EndoButton CL system and Rigidfix fixation systems from April 2007 to June 2009 were selected. Patients were evaluated by the anterior drawer test, Lachman test, Pivot shift test, and Lysholm score. ACL reconstruction was performed by one doctor, followed by rehabilitative exercise. The patients were followed up and the follow-up indexes were recorded and compared with preoperative indexes to evaluate improvement of two groups. RESULTS AND CONCLUSION: The follow-up period of EndoButton CL group was 6 to 26 months, and Lysholm scores were increased from preoperative (56.6±5.9) to postoperative (91.4±4.0), which showed significant differences in t-test (P < 0.05). The follow-up period of Rigidfix group was 6 to 24 months, and Lysholm scores were increased from preoperative (59.2±6.4) to postoperative (93.1±4.7), which showed significant differences in t-test (P < 0.05). There were no significant differences in postoperative Lysholm scores between two groups (P> 0.05). Results demonstrated that Rigidfix and Endobutton fixation device have specific advantages in ACL reconstruction. Related Articles | Metrics

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Plantar pressure characteristics in some young males with toe-out foot from Shijiazhuang city Wei Meng-tian, Zhao Jian-bo, Li Li 2011, 15 (4):  639-652.  doi: 10.3969/j.issn.1673-8225.2011.04.016 Abstract ( 380 )   PDF (595KB) ( 502 )   Save BACKGROUND: Toe-out feet destroys the distribution of normal power in knee joint, then increases the biological stress on one side and reduces on the other. OBJECTIVE: To further understand the characteristics of plantar pressure in toe-out foot. METHODS: Footscan plantar pressure test system (Belgium) was used to detect pole pressure of young males aged 20-25 years, selected from Shijiazhuang. A total of 39 had normal foot as normal group, and 39 toe-out foot as abnormal group. RESULTS AND CONCLUSION: The peak torque of foot in Meta3 on left side in abnormal group was higher than normal group  (P < 0.01), while the peak torque in Meta5 and arch was lower than normal group (P< 0.05). There were significant differences in impulse in Meta1 and Meta5 of normal group (P < 0.05); while in abnormal group, highly significant differences were observed in Meta2 and Meta4 (P < 0.01, P < 0.05). Between two groups, disparity presented in toe 3 of the left foot (P < 0.05) and in heel medial, heel lateral regions (P < 0.01), respectively. In the right foot, there were highly significant differences in heel medial (P < 0.01). Toe-out foot result in the slant power rather than straight direction, so the strength in walking direction is small. During walking, stress sequence is not along the arcus pedis longitudinalis, so the foot arch cannot reduce the shock power but increase the impulse and risk of injury. People with toe-out foot should pay attention to the relation of function time and foot pole pressure, which can increase the contact time with the ground to reduce impact value and avoid sports injury. Related Articles | Metrics

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Construction of a cardiac multi-chamber model in three-dimensional location and navigation system of ablation catheter Qiao Hai-feng, Su Zhi-jian 2011, 15 (4):  643-647.  doi: 10.3969/j.issn.1673-8225.2011.04.017 Abstract ( 406 )   PDF (898KB) ( 495 )   Save BACKGROUND: Now, the development of endocardium three-dimensional (3D) mapping system is a hot spot in medical engineering in domestic and foreign countries. The system applied to clinic has been introduced, but its price is extremely expensive. In domestic, the system is still in the phase of research. Therefore, the domestication of endocardium 3D mapping system has heavy responsibilities. OBJECTIVE: To analyze the modeling data acquisition in 3D location and navigation system of ablation catheter, and to reconstruct endocardium 3D geometry model. METHODS: The acquisition of endocardium 3D modeling data is directly related to the quality of reconstructed model. We visualized data acquisition process in the form of discrete points, which could achieve the comprehensive and efficient modeling point data. Through doing convex hull operation on acquired point cloud data, we got the surface extreme points of data set and constructed the polyhedron model by using of boundary representation. Finally, the generated polyhedron was served as basic voxel to complete the modeling process by discrete modeling. endocardium 3D geometry model was successfully reconstructed by using of visualization class library VTK. RESULTS AND CONCLUSION: Simulation experiments showed that the methods we proposed could get the comprehensive and efficient modeling point data, and reconstruct endocardium 3D geometry model. It is indicated that reconstructed endocardium three-dimensional geometry model can provide technical support for 3D location and navigation system of ablation catheter. Related Articles | Metrics

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A reduction method for mass point cloud data in the three-dimensional denture construction Wang Fu-fu, Su Zhi-jian, Zhang Chang-lu, Qiao Hai-feng 2011, 15 (4):  648-652.  doi: 10.3969/j.issn.1673-8225.2011.04.018 Abstract ( 305 )   PDF (1286KB) ( 416 )   Save BACKGROUND: The construction of the three-dimensional denture model is always the core of the dental computer-aided design/computer-aided manufacture (CAD/CAM) systems; however, the precision and the efficiency of the three-dimensional model closely connected with the data reduction of the large amounts of original point data. The existing point cloud reduction technology cannot completely meet the special requirements of dental treatment. OBJECTIVE: To efficiently reduce the original point cloud data for the dentures in order to achieve the best effect using the fewest points. METHODS: The large amounts of original discrete point data were topologically reconstructed by the three-dimensional grid method and formed grids. The plane and quadric were fitted in each grid, and determined by chordal deviation method; grid points need to be retained. Then points in the larger curvature with their curvature and normal vector were retained by the octree subdivision method. RESULTS AND CONCLUSION: The results showed that this algorithm is simple and efficient; the reduction algorithm method of point cloud is suitable for the scattered and disordered point cloud data were measured in reverse engineering. This method can directly and effectively reduce a large amount of intensive data, and can retain more details in the region of the larger curvature and contains more detailed features. It is indicated that the point cloud data for the dental prosthesis obtained by 3DSS-STD-Ⅱstructured light 3D scanner have the best effect of reduction at λ=0.7, ε=0.000 3 mm. Related Articles | Metrics

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Three-dimensional visualization of human cutaneous microvasculature  Guo Zhi-yong, Ding Hong-mei, Yin Zhi-xun, Dong Wei-qiang, Bai Bo, Peng Tian-hong 2011, 15 (4):  653-656.  doi: 10.3969/j.issn.1673-8225.2011.04.019 Abstract ( 363 )   PDF (6461KB) ( 435 )   Save BACKGROUND: Angiotomy methods such as dissection, ink injection and angiographs techniques have been used to identify vessel location. However, these techniques rarely provide a steric architecture of the cutaneous angiosome. OBJECTIVE: To establish three-dimensional (3D) architecture of the cutaneous angiosome for assessing and designing perforator flaps. METHODS: Two fresh cadavers were injected with carboxymethyl cellulose/lead oxide and subjected to CT scanning before and after the injection to obtain data of the cutaneous and subcutaneous tissue derived from one injected cadaver. Three-dimensional reconstruction and perforator flaps design were performed using Mimics13.1 software. RESULTS AND CONCLUSION: Three-dimensional digital models of the bone, blood vessels, skin were obtained. The flap with total perforator of external femoral circumflex artery and the flap with main perforator of posterior humeral circumflex artery were developed. The 3D microvascular architecture model can clearly display the spatial location, distribution range and anastomose relationship of the cutaneous perforators, the caliber, length, position of particular source artery in the exact spatial location. As a result, it visualized the general area and expandable direction of a respective flap. This technique facilitates perforator flaps design and blood supply evaluation. Related Articles | Metrics

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A new multiple dimensional approach for analyzing correlated brain activities Cui Yuan, Zhang Jun-peng 2011, 15 (4):  657-659.  doi: 10.3969/j.issn.1673-8225.2011.04.020 Abstract ( 309 )   PDF (696KB) ( 407 )   Save BACKGROUND: High correlation between electroencephalogram (EEG) sources can cause rank deficit of the correlation matrix of EEG scalp recordings. Classical spatio-temporal EEG source localization cannot localize such sources. OBJECTIVE: To develop a novel method to image correlated EEG sources. METHODS: An algorithm, termed multivariate correlation coefficient matrix decompositions (MVMD), was proposed. Correlation index, obtained by decomposing cc matrix, was a measure of the degree of correlations between the specified channels and the system. The numerical experiment proved that this kind of matrix decomposition was correct and reasonable. RESULTS AND CONCLUSION: MVMD transforms the relations between each pair of variables into those between each pair and the system generating all the variables. Such transform is useful in visualizing the relations between variables. It has promising prospect in cognitive neuroscience and other fields associated with multiple variable analysis. Related Articles | Metrics

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MRI motion artifact cancel based on an improved phase correction algorithm Deng Yu, Huang Hua 2011, 15 (4):  660-662.  doi: 10.3969/j.issn.1673-8225.2011.04.021 Abstract ( 235 )   PDF (1036KB) ( 439 )   Save BACKGROUND: At present, magnetic resonance imaging (MRI) has been extensively clinically used due to high spatial resolution and contrast of soft tissue. However, the imaging time is very long, and it is vulnerable to the impact of patient’s body movement, resulting in motion artifact. OBJECTIVE: To eliminate MRI motion artifact and improve image quality. METHODS: MRI motion artifact was canceled with phase correction algorithm and level set algorithm. Image quality was enhanced after cancelling artifact with fuzzy enhancement algorithm. RESULTS AND CONCLUSION: Results proved that the images obtained by improved phase correction algorithm are better than those by original phase correction algorithm. Related Articles | Metrics

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Application of digital radiography and image processing technique in the determination of bone mineral density   Zhang Wei, Wang Yan, Ma Xiao-hui, Guo Zhi-ping, Li Shi-ling, Song Yan 2011, 15 (4):  663-666.  doi: 10.3969/j.issn.1673-8225.2011.04.022 Abstract ( 240 )   PDF (11503KB) ( 371 )   Save BACKGROUND: With the appearance of direct digital X-ray camera system digital radiography(DR), computer-related knowledge is applied to increase post-processing procedures, which provides a new method for the determination of clinical bone mineral density. OBJECTIVE: To explore a new method measuring bone mineral density by measuring pixel density of femoral neck, ward's triangle and greater trochanter of femur with digital DR’s powerful post-processing function on standard pelvic plain film. METHODS: According to age, 105 pelvic direct digital X-ray plain films were randomly divided into experimental group (≤ 60 years old) and control group (> 60 years old). Three spots on femoral neck density, one spot on ward triangle, and three spots on femur large nodule were measured according to standard formulation of the pelvic plain films. T test was used to examine femoral neck, femoral greater trochanter and femoral neck ward triangle mean pixel density between two groups female patients, respectively. The density distribution of femoral neck, femoral greater trochanter and femoral neck ward triangle between two groups were observed. RESULTS AND CONCLUSION: In control group, pixel density of the femoral neck (945.59±174.70), greater trochanter pixel density (712.67 ± 196.89), ward triangle pixel density (873.70±195.17); in experimental group, neck pixel density (779.03 ±125.79), greater trochanter pixel density (526.22±127.93), ward triangle pixel density (668.30±131.19). There were significant differences between two groups (P < 0.05). It is indicated that pelvis pixel density by DR technology can be used as one of the methods of measuring bone mineral density, and the operation is simple, having potential for application, avoiding second medical examination. Related Articles | Metrics

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Spiral CT three-dimensional reconstruction of location and shape of impacted teeth and correlation with peripheral tissues  Zhang Tao, Wang Tie-mei, Lin Zi-tong, Zou Chang-ning, Lu Wei 2011, 15 (4):  667-670.  doi: 10.3969/j.issn.1673-8225.2011.04.023 Abstract ( 350 )   PDF (642KB) ( 446 )   Save BACKGROUND: Impacted teeth lead to permanent teeth aberrance, occlusal disharmony and affects beauty or masticatory functions. A clear imaging evaluation plays an important part of correct diagnosis.  OBJECTIVE: Application of three-dimensional (3D) reconstruction technology of spiral CT to impacted teeth in bone for preoperative evaluation. METHODS: A total of 23 patients were examined with plain radiograph and spiral CT before performing an operation for extraction. After CT scanning, shaded surface display (SSD) and multiplanar reformation (MPR) was used to get 3D CT images of the impacted teeth. The plain radiographs and the 3D CT images were used for preoperative evaluation respectively. All the teeth were finally extracted and evaluated during the operation. The diagnostic accuracy of the plain radiographs and the CT images for location and root malformation evaluation was calculated and compared. RESULTS AND CONCLUSION: The 3D CT images clearly presented the impacted teeth: the location, the shape and the relationship with the adjacent teeth. The accuracy of plain radiographs and the 3D CT images for location evaluation was 37.0% and 100% and was 44.4% and 88.8% for root malformation. The 3D reconstruction technology of spiral CT is useful to get more information about the impacted teeth to have individual, proper and effective treatment. Related Articles | Metrics

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Comparison of different dose contrast media in three-dimensional CT reconstruction of healthy canine pulmonary artery Li Guo-ce, Wang Zhi-ming, Lei Zhen, Qian Ying, Xu Na, Zhang Jun, Zheng Shi-lei 2011, 15 (4):  671-674.  doi: 10.3969/j.issn.1673-8225.2011.04.024 Abstract ( 457 )   PDF (970KB) ( 494 )   Save BACKGROUND: CT angiograph needs that the contrast media injects into vein, and the greater the dose of contrast media, the greater the hazard to patients. OBJECTIVE: To validate the feasibility of low dose contrast media in spiral CT pulmonary artery angiograph.  METHODS: A total of 12 healthy canis familiaris with reference to iohexol dose of human in clinic, according to “equivalent dose conversion of animals and between animals and humans in pharmacological experiments”, which got the corresponding three dose groups: iohexol 2.40 mL/kg group, iohexol 2.02 mL/kg group, iohexol 1.62 mL/kg group. Twelve canis familiaris were treated with 3 kinds of doses for once; scan interval of each experiment was at least 48 hours, a total of 36 CT scans. Pulmonary artery branch conditions, pulmonary vein edge clarity, and filling degree of pulmonary vein of 3 proposals were scored by original image, volume recurrence image, and maximum intensity projection image, and the concentration of contrast media in pulmonary artery was measured RESULTS AND CONCLUSION: Three kinds of proposals can clearly show 4 branches of canines’ pulmonary artery, the edge of vascular is clear. There was no significant difference in each group (P > 0.05). The degree of pulmonary vein imaging was lowered, and had a good density comparison with pulmonary artery; there was no significant difference in each group (P > 0.05). The concentration of contrast media in pulmonary artery maintained at a high level, there was no significant difference (P> 0.05). It is indicated that it is feasible to use low dose contrast media in multislice spiral CT pulmonary artery angiograph of canines, the image quality can meet the clinical diagnostic requirements to provide the experimental basis of pulmonary artery angiograph with low dose contrast media for clinical application. Related Articles | Metrics

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Influence of different slice thickness on display rate of pulmonary arterial and incidence rate of artifacts by 128-slice spiral CT  Liu Ning, Niu Yu-jun, Cao A-dan, Li Guo-ce 2011, 15 (4):  675-678.  doi: 10.3969/j.issn.1673-8225.2011.04.025 Abstract ( 340 )   PDF (1161KB) ( 400 )   Save BACKGROUND: The display rate of pulmonary artery and the incidence of artifact by CT pulmonary angiography (CTPA) play an important role in the evaluation of diagnostic accuracy. OBJECTIVE: To evaluate the effect of different thickness on the 128-slice spiral CT display rate of pulmonary artery and the incidence rate of artifact. METHODS: Patients with suspected acute pulmonary embolism were examined by CTPA, and images were divided into 4 groups according to different thickness: 0.6, 1.0, 3.0 and 5.0 mm. Display clarity of pulmonary embolism arteries of the images of 4 groups was compared to evaluate the continuous level of pulmonary artery branches and the incidence rate of artifact. RESULTS AND CONCLUSION: The main pulmonary artery and lobe pulmonary artery of two lungs showed no significant difference among the 4 groups; segmental and sub-segmental pulmonary artery showed 0.6 mm and 1.0 mm slice thickness were better than 3.0 mm and 5.0 mm thickness groups (P < 0.001); for the 6th pulmonary artery, 4 groups showed significant differences (P < 0.001), and the display rate of 0.6 mm was the best. The ability that 1.0 mm slice thickness images showed sub-segmental pulmonary artery branch level and above was similar to the 0.6 mm, and better than 3.0 mm and 5.0 mm groups; 3.0 mm and 5.0 mm slice thickness groups showed continuous pulmonary artery  all branches lower than 0.6 mm and 1.0 mm slice thickness groups. Partial volume artifacts of 39 cases with negative were 2 cases from 0.6 mm group, 5 from 1.0 mm group, 11 from 3.0 mm group, 17 from 5.0 mm group, showing significant differences among 4 groups (P < 0.001). In CTPA examination, slice thickness at 3.0 mm or less can observe sub-segmental pulmonary artery more accurately, while 0.6 mm slice thickness can reduce the incidence of partial volume artifacts and improve images quality of CTPA. Related Articles | Metrics

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Two- and three-dimensional imaging techniques of CT colonography in evaluating colon diseases Zhang Shu-qian, Ye Yu-fang, Li Dong-hui, Zhou Ru-ming, Wang Lian-qing, Liu Rong-hui, Sun Ji-lin 2011, 15 (4):  679-682.  doi: 10.3969/j.issn.1673-8225.2011.04.026 Abstract ( 414 )   PDF (1363KB) ( 420 )   Save BACKGROUND: CT examination of gastrointestinal tract becomes possible with the widely using of multi-slice spiral CT. OBJECTIVE: To evaluate the validity of two- and three-dimensional post processing techniques of CT colonography. METHODS: CT colonography data by multi-slice spiral CT of 38 patients with suspicious colon disease were analyzed. Two-dimensional techniques concluded the original axial images and coronal and sagittal images obtained by multi-planar reformation (MPR). Three-dimensional techniques concluded CT virtual colonoscopy, shaded surface display, raysum and virtual pathology (luman unfolded). The location, size and appearance around colon were evaluated by two imaging physicians and compared with surgical findings and electronic colonoscope. RESULTS AND CONCLUSION: A total of 17 polyps, 20 masses, and 5 cases of colonic inflammation were detected except one case of familial adenoma polypsis. The detection ratio of there diseases was: 82%, 100%, and 100% for MPR; 100%, 100%, and 80% for CT virtual colonoscopy; 41%, 90%, and 40% for shaded surface display; 47%, 90%, and 40% for raysum. The detection ratio for virtual pathology (luman unfolded) was 100%. Two-dimensional images are the foundation of multi-slice CT and can evaluate the position, size and density of colon disease objectively, and exhibits advantages in showing information outside the affected colon segments. The sensitivity of CT virtual colonoscopy is higher than other techniques. Virtual pathology can avoid the blind area of colon lumen. Shaded surface display and raysum have advantage on display the overall view of colon. Related Articles | Metrics

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HLSVD versus AMARES for magnetic resonance spectroscopy data quantification Bao Chen, Qi Jing, Weng De-he, Sun Yu, Wan Sui-ren 2011, 15 (4):  683-686.  doi: 10.3969/j.issn.1673-8225.2011.04.027 Abstract ( 371 )   PDF (919KB) ( 469 )   Save BACKGROUND: Magnetic resonance spectroscopy (MRS) has become important auxiliary diagnosis tool in clinical diagnosis. At present, 1H MRS in human brain has been frequently used, which has important clinical value in diagnosis of brain tumor. OBJECTIVE: To quantify the human brain 1HMRS data based on HLSVD and AMARES methods separately, by comparing the two methods through a certain amount of data to find the method which is more suitable for the clinical auxiliary diagnosis. METHODS: We used the two methods separately in the JMRUI analysis software, and then the physical parameters such as frequency, amplitude and phrase, were obtained, which were results of the quantification in terms of these parameters, so we could deal with the interpretation of the signal. RESULTS AND CONCLUSION: HLSVD quantifies data according waveform features, while AMARES produced deviation in images. Therefore, HLSVD is more suitable than AMARES for the clinical diagnosis, both in accuracy and timeliness. Related Articles | Metrics

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Hyperdense line by sacroiliac joints on pelvic plain film and gluteal muscle contracture Chang Feng, Yuan Feng, Ding Ning, Qi Xiang-ru, Wang Yang, Sun Wei 2011, 15 (4):  687-689.  doi: 10.3969/j.issn.1673-8225.2011.04.028 Abstract ( 274 )   PDF (12020KB) ( 426 )   Save BACKGROUND: Hyperdense line has been found at sacroiliac joints on pelvic plain film of patients with non-gluteal muscle contracture (GMC), who are finally confirmed as GMC by physical examination and pathology. OBJECTIVE: To explore the relationship between the hyperdense line by sacroiliac joints and GMC and to investigate the effect of the hyperdense line in diagnosis and treatment for GMC. METHODS: The pelvic plain films of 50 cases of GMC, including 45 involving gluteus maximus muscle and 5 involving gluteus medius muscle, were analyzed. Those of 100 individuals with non-GMC served as control. RESULTS AND CONCLUSION: The hyperdense line by sacroiliac joints was found on the pelvic plain film in 42 cases of GMC group and 3 in control group. The incidence rate of hyperdense line was significantly greater in GMC group compared with control group (P < 0.01); 4 cases presented pelvic tilt in gluteal mediums main contracture group, but only 1 had the hyperdense line, while 40 cases in gluteus maximus main contracture group presented the hyperdense line (P < 0.01), indicating a correlation between hyperdense line and gluteus maximus main contracture. Results show that the hyperdense line by sacroiliac joints on pelvic plain film can be used as a sign to diagnose GMC. Related Articles | Metrics

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Effect of low-intensity pulsed ultrasound on bone fracture healing Ye Dong, Tao Jun 2011, 15 (4):  690-694.  doi: 10.3969/j.issn.1673-8225.2011.04.029 Abstract ( 322 )   PDF (693KB) ( 654 )   Save BACKGROUND: Low-intensity pulsed ultrasound attracts much attention due to its low-cost, non-invasive, non-infection, convenient treatment, and no adverse reactions to promote bone fracture healing. OBJECTIVE: To review the effect of low-intensity pulsed ultrasound on bone fracture healing by mechanism, animal experiments, and clinical application so as to provide new ideas and theoretical evidences for promoting bone fracture healing. METHODS: The relevant articles in Pubmed database (http://www.ncbi.nlm.gov/Pubmed) (1989/2009), Vip database (www.cqvip.com) (1981/2009) and Wanfang database (www.wanfangdata.com.cn) (1981/2009) were retrieved. The index words were “LIPUS, fracture” in both English and Chinese. Inclusion criteria: articles which were closely related to the low-intensity pulsed ultrasound or ultrasound treatment of bone fracture healing and recently published or in authoritative magazines at the same field. The duplicated articles were excluded. The retrieval articles included reviews, animal experiments, and clinical experiments. Totally 60 literatures were primarily selected, 35 documents of which were involved for analysis according to inclusion criteria.  RESULTS AND CONCLUSION: Low-intensity pulsed ultrasound characterized by low cost, safety, environmental protection, non-invasive, non-infection, simple operation, wide application and less complications for treating bone fracture healing. Clinical experiments and clinical application have confirmed that low-intensity pulsed ultrasound was an effective method to promote bone fracture healing, characterizing by low frequency and low intensity. Bone fracture healing treated with low-intensity pulsed ultrasound involved in not only physics, but also medical and other disciplines. With the research progress of ultrasound, organic complexity, and ethics, the mechanism, parameters of low-intensity pulsed ultrasound and the combination of all parameters need to be further studied. Related Articles | Metrics

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Potential spinal cord injury induced by mild persistent stretch of internal fixation Huang Ping, Zou Guo-yao, Zou Zhi-yuan 2011, 15 (4):  695-698.  doi: 10.3969/j.issn.1673-8225.2011.04.030 Abstract ( 294 )   PDF (4750KB) ( 346 )   Save BACKGROUND: Reports demonstrated that a transient stretch can cause different degree of spinal cord injury. The effect of persistent stretch on myeloid tissues remains unclear.  OBJECTIVE: To observe the effect of mild persistent stretch on expression of superoxide dismutase (SOD) and malonaldehyde (MDA) of rabbits.  METHODS: Totally 36 healthy, white, rabbits were randomly divided into 3 groups: rabbits in the sham-operated group only install internal fixation; those in the experimental group were stretched 25% of transverse diameter of L1/L2 articular surface and fixed by internal fixation; those in the control group were housed at the same conditions. At 3, 7 and 14 days after intervention, function of spinal cord was assessed, levels of MDA and SOD in spinal cord tissues were determined.  RESULTS AND CONCLUSION: A total of 36 rabbits were included in the final analysis. The motor functions of rabbits were slightly decreased in the experimental and sham-surgery groups after operation, which began recovery at 7 days and return to normal levels at 14 days after operation. There was no significance between two groups in decline of motion function at the same time period. From 8 days after operation, the motion function of animals had no significant difference compared with before operation. The SOD activity decreased but MDA contents increased in spinal cord tissues. The neuronal interspaces increased at 3 days, Nissl's body reduce, and some neuronatrophy, no other pathological changes could be found in the experimental group. No abnormality could be seen in the other groups. Related Articles | Metrics

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Advanced ceramics synthesized intervertebral discs Xin Feng, Zhang Bo, Li Ji-yun 2011, 15 (4):  701-704.  doi: 10.3969/j.issn.1673-8225.2011.04.032 Abstract ( 316 )   PDF (686KB) ( 438 )   Save BACKGROUND: Intervertebral disc replacement has obtained favorable effects in clinical application. However, prosthesis design, wearing debris, osteoporosis, revision strategy, and case selection can influence outcomes. OBJECTIVE: To review problems in intervertebral disc replacement, requirements for future intervertebral disc replacement and future development trends of ceramics companies. METHODS: With key words “total disc replacement, vertebra, ceramics” in English, PubMed and international science citation databases were searched for articles published between 1990 and 2008. Articles related to intervertebral disc replacement and ceramic joint were included. Repetitive studies were excluded. A total of 27 articles were discussed. RESULTS AND CONCLUSION: Wearing degree of intervertebral disc replacement is lighter than hip and knee arthroplasty. However, people worry that wearing debris and any secondary inflammatory reaction occur adjacent to nerve structures. It remains controversial on metal ion release in intervertebral disc replacement. Metal alloy can induce artifacts in MRI scanning. To date, no in vitro experimental data are available on implant febrility or displacement in MRI examination. Composite material Biolox® delta is advanced ceramic material, with good biocompatibility, wearing and fracture resistance. It can ensure high quality of radiology and MRI images during follow-up of patients undergoing intervertebral disc replacement. Related Articles | Metrics

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Torque parameters of human knee joint Zhao Hong-yao, Xu Xiu-lin 2011, 15 (4):  705-708.  doi: 10.3969/j.issn.1673-8225.2011.04.033 Abstract ( 925 )   PDF (598KB) ( 1060 )   Save BACKGROUND: Parameters of knee joint are not directly measured due to complex body motion. Therefore, the parameters are obtained by simulation or reverse dynamics. OBJECTIVE: To conclude and compare the method of determining torque parameters, and to find a reasonable, responsible, practical method.  METHODS: A computer-based online search of CNKI, Wanfang, and Science Direct databases, articles related to measurements of torque parameters were searched with key words “knee joint, torque, isokinetic dynamometer, lagrangian modeling, neural network modeling” in Chinese and English. Correlated and newly-published articles were included. RESULTS AND CONCLUSION: A total of 123 articles were collected, and 75 were firstly selected following exclusion of repetitive articles. Finally, 35 articles were included according to title and abstract. Results show that isokinetic dynamometer has been extensively used, but reliability is low, and the price of dynamometer is expensive. Lagrangian modeling and neural network modeling can be modified to obtain reliability and practicality. Related Articles | Metrics

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Early diagnosis of artificial joint aseptic loosening Wei Hui, Tian Jing 2011, 15 (4):  709-713.  doi: 10.3969/j.issn.1673-8225.2011.04.034 Abstract ( 439 )   PDF (682KB) ( 488 )   Save BACKGROUND: The most significant factor that affects the life span of joint prosthesis is the artificial joint aseptic loosening. OBJECTIVE: To explore the early diagnosis of artificial joint aseptic loosening methods in order to facilitate active early treatment. METHODS: A computer-based online search of PubMed database, CNKI database, VIP database and Wanfang database between May 1997 and October 2010 was performed to search related articles with the key words of “aseptic loosening, artificial joint, prosthesis, osteolysis, early diagnosis” in English or Chinese. Literatures related to aseptic loosening of prosthesis were selected; in the same field, the articles published lately in authoritative journals were preferred. A total of 182 literatures were primarily selected, and 39 documents of which addressing the analysis and treatment of aseptic loosening of prosthesis were involved for summary according to inclusion criteria. RESULTS AND CONCLUSION: Aseptic loosening of prosthesis and osteolysis has a close relationship with abnormality of bone metabolism and inflammatory reaction. Therefore, related cytokines of inflammatory reaction induced by bone metabolic markers and wear particles can be used for early diagnosis. Isotopic tracer can not only displays the morphology of tissue and organ, but also reflects the function of tissues and organs by showing physiological and biochemical processes of organs or tissues. Pathological changes can be found earlier than imaging for a few weeks or even months. Related Articles | Metrics

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Application of finite element analysis in cervical spondylosis treatment by traction Gao Neng, Wang Wei-jia 2011, 15 (4):  714-716.  doi: 10.3969/j.issn.1673-8225.2011.04.035 Abstract ( 305 )   PDF (474KB) ( 386 )   Save BACKGROUND: With the development of computer simulation technology, the researches on three-dimensional finite element of cervical traction combined with imaging technique become a focus, since it enables external experiments.  OBJECTIVE: To summarize the literatures of cervical traction by the finite element analysis method. METHODS: A computer-based online search of CNKI and PubMed databases was performed for articles related to the applications of finite element method in spinal mechanics and treatment of cervical spondylosis by traction. RESULTS AND CONCLUSION: The finite element analysis method can probably replace the biological mechanical experiments to some degree, and the experimental conditions are controllable and the mechanics condition in vivo can be simulated without harm to the patients. Although the finite element analysis method is suitable to any complex construction theoretically, there remain difficulties and limitations in the spinal biology researches. Especially it exhibits some limitations in cervical vertebra due to small and complex structures. Therefore, related mechanical experiments and researches are required. Related Articles | Metrics

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Biomechanical principle of locking compression plate and the reason for its failure after insertion Liu Xiao-hui, Zhang Guo-chuan 2011, 15 (4):  717-720.  doi: 10.3969/j.issn.1673-8225.2011.04.036 Abstract ( 267 )   PDF (588KB) ( 380 )   Save BACKGROUND: Locking compression plate (LCP) is a new screw-plate system developed by combining the traditional compression plate techniques with the principles of internal fixator. Compared with traditional plates, LCP system has many advantages in the treatment of fracture． OBJECTIVE: To analyze biomechanical principle of LCP and common causes for its failure. METHODS: The articles related to LCP in CNKI database, Pubmed database from January 2004 to October 2010 were retrieved by computer with the key words of “Locking Compression Plate, Fracture, Internal fixation, Failure” in Chinese or in English. The articles related to LCP, and recently published or published in authoritative magazines in the same field were selected. A total of 126 literatures were obtained from the computer screen, and 18 documents of them were involved for summarization according to inclusion criteria. RESULTS AND CONCLUSION: The fixation principle of LCP is not rely on the friction between nickelclad and cortical bone, but on angle stability of nickelclad and locking screw and pullout strength of screw and cortical bone to achieve the fixation of fracture. From the large number of literature reports, most of the reason for failure of internal fixation is not on nickelclad itself, but on iatrogenic fault, such as short nickelclad, gap oversized between nickelclad and facies ossea, deviation of nickelclad and backbone axis, and inappropriate selection of screw type. The LCP system is relative complex, patients need to follow the biomechanical principles and adequate preoperative preparation, in order to avoid the occurrence of complications as much as possible, and to achieve the best therapeutic effect. Related Articles | Metrics

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Reconstruction of acromioclavicular joint dislocation: Selection of metal implants Cai Yu, Wang Kai, Liang Jing-feng 2011, 15 (4):  721-724.  doi: 10.3969/j.issn.1673-8225.2011.04.037 Abstract ( 265 )   PDF (703KB) ( 562 )   Save OBJECTIVE: To introduce the metal implant internal fixation methods and implant selection of acromioclavicular joint dislocation, to evaluate the efficacy of clavicular hook plate in treatment of acromioclavicular joint dislocation. METHODS: Using “clavicular hook plate; acromioclavicular joint dislocation; internal fixation” as the key words, a computer-based online search of PubMed database and VIP database from 1996 to 2010 was performed for articles about metal implants fixation for the dislocation of acromioclavicular joint, focusing on the acromioclavicular joint dislocation treatments and the choice of internal fixation implant, and clinical validation was conducted. Patients who were treated with AO/ASIF clavicular hook plate for acromioclavicular joint dislocation and distal clavicle fractures in accordance with type Ⅲ-Ⅴ of Rockwood classification, were involved. Lazzcano score was applied to determine function. RESULTS: The present method of treating acromioclavicular joint dislocation includes a simple Kirschner wire internal fixation, Kirschner wire and tension band fixation, Bosworth method, coracoclavicular fixation between the wire, titanium wire cable instead of the wire fixation method, modified Weaver method, tendon or artificial ligament for coracoclavicular ligament reconstruction, clavicular hook plate and so on, each has their advantages and disadvantages. Clinical validation showed that, 34 patients after treatment of AO/ASIF clavicular hook plate were visited for 12 months as a follow-up. No plate or screw loosed and broken. At 6-12 months, the implants were taken out, 2 cases exhibited acromioclavicular subluxation, coracoclavicular ligament repair was not performed. Assessment criteria was in accordance with Lazzcano scores, 30 cases were excellent and 4 cases were good. CONCLUSION: The clavicular hook plate for acromioclavicular joint dislocation and distal clavicle fracture is a simple operation, with reliable fixation, less trauma, rapid recovery of shoulder function and other advantages. Related Articles | Metrics

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Absorbable retention pin for the treatment of multiple rib fracture Huang Guo-sheng 2011, 15 (4):  725-728.  doi: 10.3969/j.issn.1673-8225.2011.04.038 Abstract ( 257 )   PDF (655KB) ( 527 )   Save OBJECTIVE: To report the categories and advantages of absorbable materials, the indication and contraindication of absorbable retention pin for the treatment of fracture of multiple ribs. METHODS: “Fracture of rib, absorbable retention pin, internal fixation” in Chinese was utilized as search terms to retrieve PubMed database (2001/2010), VIP database, and articles related to absorbable retention pin and fracture of multiple ribs. The categories and advantages of absorbable materials, and the indication and contraindication of absorbable retention pin for the treatment of fracture of multiple ribs were explored and underwent clinical verification. A total of 120 fractures of multiple ribs cases were treated with absorbable retention pin internal fixation; meanwhile, 80 cases of which underwent expectant treatment as controls. RESULTS: Absorbable retention pin has good histocompatibility, the bending strength was slightly higher than human cortical bone, and there was no toxic side effect. Absorbable retention pin can be completely degraded 3 to 5 years, avoid the second surgery. Clinical verification demonstrated that the continuity of the recovery ribs, the breast bone durante dolors, and length of stay of patients with absorbable retention pin was significantly shorter than that of patients with expectant treatment (P < 0.01). At the same time, the number of cases of atelectasis, number of cases of thoracic deformity, number of cases of pleural effusion, and number of cases of pleural adhesions of patients with absorbable retention pin was less than that of patients with expectant treatment (P < 0.01). CONCLUSION: Absorbable retention pin was applied to undergo retention for chest trauma caused by multiple sections of rib fractures. This method is simple, fewer complications, and reliable curative effect. Related Articles | Metrics

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Digital surgery: Bioelectrical impedance measurement assistance on clinical operation Wang Zhi-yun, Yin Qing-shui 2011, 15 (4):  729-732.  doi: 10.3969/j.issn.1673-8225.2011.04.039 Abstract ( 327 )   PDF (2258KB) ( 379 )   Save BACKGROUND: Modern chirurgery technique claims less trauma and higher precision. Bioelectical impedance measurement technique, which transfers anthropometric tissue information to digital signal, can afford aid to clinical surgery discriminate different tissue and organ. OBJECTIVE: To summarize the clinical application of bioelectical impedance measurement technique for assistance of the chirurgery operation. METHODS: Literatures about application of bioelectical impedance measurement technique for the chirurgery operation were searched from Chinese Journal Full-text database and PubMed database, published from 1999 to 2009. Articles that qualitatively improve accuracy and curative effect evaluation using digital signal collection and analysis were analyzed. RESULTS AND CONCLUSION: The bioelectical impedance measurement technique is an ideal aided means, by the advantages of noninvasive, safe, durative monitoring, and repetitive use. With developing theory and methods of this technique, a large number of clinical trials have been conducted, which would enlarge its application. Related Articles | Metrics

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Effect size selection for Meta analysis of outcome variables in noncomparative studies and pre-post contrasts studies Shen Xu-hui, Wang Zhen 2011, 15 (4):  733-736.  doi: 10.3969/j.issn.1673-8225.2011.04.040 Abstract ( 571 )   PDF (568KB) ( 884 )   Save BACKGROUND: Meta-analysis or system evaluation theory and method of grouping design pattern comparison are mature. However, there are a few articles or methods for univariate relationship, single group outcome variable and their relationship. OBJECTIVE: To introduce several effect statistics, such as pooled incidence rate estimates and pooled arithmetic means estimates used for noncomparative studies, mean gain effect sizes estimates used for pre-post contrasts studies. METHODS: A computer-online search of the full text database of Chinese CNKI, VIP full text database of Chinese Doctoral database, Pubmed database was performed. Relevant meta-analysis or systematic review methodology literature about non-comparative studies and pre-post contrasts studies were included. RESULTS AND CONCLUSION: Univariate described several common statistics, such as mean, median, mode or ratio, while Meta analysis analyzed ratio and mean (arithmetic mean). Pre-post contrasts studies is to explore the measurement of one variable of one group population (single sample) at two time points. This type of study is also called matched-pairs design mean comparison. Two effective size indexes can be selected in this study: non-standardized mean score and standardized mean score. If one measurement method is used for results variables of Meta analysis, non-standardized mean score can be used, otherwise, standardized mean score should be used as effect size. Related Articles | Metrics

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Calculation of standardized mean difference effect size in Meta-analysis Zhang Hong, Wang Zhen 2011, 15 (4):  737-740.  doi: 10.3969/j.issn.1673-8225.2011.04.041 Abstract ( 1292 )   PDF (642KB) ( 936 )   Save BACKGROUND: In most Meta-analysis of two-group comparison study, the outcome variables of original research literature are quite different between different researches, so outcome variables cannot be directly compared, limiting Meta-analysis. OBJECTIVE: To investigate methods for mining the information of original research and enhance the performance of Meta-analysis. METHODS: According to the outcome variables of the original research, 10 common standardized mean difference effect size calculation methods were described. RESULTS AND CONCLUSION: Before conducting Meta-analysis of two-group comparison study, we should consider all kinds of possible situations, especially when there were some distances between the original research literature information and those we have grasped. We have to dig information as much as possible to avoid information loss. Related Articles | Metrics

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Research progress and development direction of visualization and accelerating techniques for medical images Tang Min, Chen Feng, Tao Ling 2011, 15 (4):  741-744.  doi: 10.3969/j.issn.1673-8225.2011.04.042 Abstract ( 407 )   PDF (707KB) ( 644 )   Save BACKGROUND: Algorithms of reconstruction and visualization for medical images are increasing. However, there are few reviews on research progress and development direction. OBJECTIVE: To present a survey of recent publication concerning about visualization and accelerating techniques for medical images. METHODS: PubMed database and Wanfang database were retrieved for publications of visualization and accelerating techniques for medical images published from 2000 to 2009. Repetitive studies were excluded. A total of 56 literatures were primarily obtained, while 23 were selected for summary according to inclusion criteria. RESULTS AND CONCLUSION: Visualization techniques for medical images can perform quantitative and qualitative analysis based on three-dimensional image models to facilitate understanding of complex structures in vivo, which is significant and valuable for medical research and clinical diagnosis. Visualization techniques for medical images are divided into surface rendering and volume rendering. Due to limitations of surface rendering and rapid development of computer techniques, volume rendering has aroused increasing attention. Three-dimensional reconstruction and visualization of medical images, accompanied with virtual reality and GPU technology, is a powerful strategy allowing the evaluation of significant structures. Related Articles | Metrics

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Algorithm for computer-assisted medical image 3D reconstruction Wang Rui-juan, Zhang Ji, Peng Ke 2011, 15 (4):  745-748.  doi: 10.3969/j.issn.1673-8225.2011.04.043 Abstract ( 367 )   PDF (607KB) ( 679 )   Save BACKGROUND: Three-dimensional reconstruction identifies two-dimensional medical images to recover the three-dimensional images of detected tissues and organs. OBJECTIVE: To analyze algorithm choice for medical image 3D reconstruction. METHODS: A computer-based online search of CNKI and Pubmed databases was performed to search related articles with key words “medical image, three-dimensional reconstruction, surface rendering, volume rendering” in Chinese and English. A total of 33 articles regarding algorithm of medical image three-dimensional reconstruction were collected to analyze the implementation principle, complexity, and real-time display of surface rendering technology and volume rendering technology. RESULTS AND CONCLUSION: Medical image three-dimensional reconstruction is classified into surface rendering, volume rendering and combined rendering according to data description methods. Surface rendering exhibits advantages in algorithm efficiency and real time reciprocity compared with volume rendering. Although surface rendering results in detail loss during rendering, it has been extensively applied due to simple operation and small memory occupying. Volume rendering is direct operation on voxel in volume dataset, which can render abundant information of three-dimensional dataset. Therefore, the rendering effect is better than surface rendering. Related Articles | Metrics

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Electroencephalogram-based brain-computer interface system Ren Ya-li 2011, 15 (4):  749-752.  doi: 10.3969/j.issn.1673-8225.2011.04.044 Abstract ( 490 )   PDF (571KB) ( 816 )   Save BACKGROUND: Brain-computer interfaces (BCI) provide a direct communication and control channel for sending messages and instructions from brain to external computers or other electronic devices. Using the non-muscular channel, subjects with severe neuromuscular dysfunction can directly express their thought and manipulate the external devices without using human language and actions. This greatly enhances the ability of these subjects to manage external event and improves their quality of life. OBJECTIVE: To summarize latest research advances and problems in the BCI and discuss the research direction of BCI. METHODS: The literatures on BCI were searched on the PubMed database published from January 1990 to December 2009 with the key words “brain-computer interface, rehabilitation” in English. In addition, the related articles were also searched on CNKI-KNS published between January 1990 and December 2009 with the key words “brain-computer interface, signal processing and electroencephalography” in Chinese. RESULTS AND CONCLUSION: Researches of BCI system is still at a developing stage. There are some disadvantages, such as low rate of communications instability, especially for algorithm improvement and selection of signal processing. Related Articles | Metrics

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CT pulmonary function imaging and its clinical application Han Xiao-yu, Ge Ying, Li Zhi-yong 2011, 15 (4):  753-756.  doi: 10.3969/j.issn.1673-8225.2011.04.045 Abstract ( 294 )   PDF (512KB) ( 665 )   Save BACKGROUND: With the development of CT imaging technology, CT images can clearly display pulmonary structure and measure pulmonary function. It is a new method for evaluation and research of pulmonary function. OBJECTIVE: To summarize the analysis index and clinical application of CT pulmonary function, so as to early discover and accurately monitor respiratory diseases in clinic. METHODS: Articles about imaging indexes and clinical applications of CT pulmonary function were searched from CNKI and PubMed, published between January 1989 and May 2010 with key words “computed tomography, pulmonary function, quantitative CT” in both Chinese and English. We mainly selected these articles in the authoritative journals or recently published. A total of 26 Chinese articles and 287 English articles were collected, and 20 articles were included in the final analysis. RESULTS AND CONCLUSION: CT pulmonary function could reflect the changes of pulmonary function by measurement of lung volume, density and pixel index, so as to reveal the pathological anatomy and pathophysiology of pulmonary tissues. It is a valuable method to early discover and monitor respiratory diseases. CT pulmonary function measurement can be used in quantitative analysis of chronic obstructive pulmonary diseases and emphysema, prediction of pulmonary functional reserve after lung cancer surgery. Related Articles | Metrics

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Acidic fibroblast growth factor combined with partially deproteinized bone in repair of early-stage avascular necrosis of the femoral head in rabbits Zhu Xiao-qi, Guo Hao, Ge Bao-feng 2011, 15 (4):  757-760.  doi: 10.3969/j.issn.1673-8225.2011.04.046 Abstract ( 330 )   PDF (1221KB) ( 383 )   Save BACKGROUND: Previous studies have demonstrated that acidic fibroblast growth factor (aFGF) combined with partially deproteinized bone (PDPB) (aFGF/PDPB) well promotes vascularization in animals with early-stage avascular necrosis of the femoral head (ANFH), but the histological results remain unknown. OBJECTIVE: To observe the histological repairing effects of aFGF/PDPB on early-stage ANFH in rabbits. METHODS: New Zealand rabbits were established models of bilateral ANFH and were randomly divided into a blank group, a simple PDPB group, and an aFGF/PDPB group. PDPB and aFGF/PDPB bone were implanted into the PDPB and aFGF/PDPB group accordingly. The blank group did not receive any implantation. At 2, 4, and 8 weeks after surgery, all animals were sacrificed for histological examination to observe the osteogenesis by hematoxylin-eosin staining. RESULTS AND CONCLUSION: Defects were filled with granulation tissues and fibrous connective tissues, only a little osteoid tissue formed at the borderline in the blank group at the end of the 8th week. In the PDPB group, a little new bone and cavitas medullaris formed. At 8 weeks, lots of graft was absorbed and cavitas medullaris formed with more osteoplasts and myeloid cells in it. The osteogenesis in the aFGF/PDPB group was better than that of PDPB group in each time point. At 4 weeks, the transplanted cavity was filled with osteoid tissues, a lot of osteogenic precursor cells and osteoblasts could be seen. Plenty of micrangium was observed, and osteoid tissues began to rebuild. At 8 weeks, the graft was replaced by bone tissues, and cavitas medullaris were formed with lots of bone marrow cells in it. At the borderline of the bone trabecula, there were lots of osteoplast and little osteoclasts, which may play a role in bone remodeling. There were mature bone cells in bone lacuna. Results indicate that aFGF/PDPB has better repair effect on rabbit model of ANFH than that of simple PDPB. Related Articles | Metrics