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27 August 2013, Volume 17 Issue 35 Previous Issue    Next Issue

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Alcohol affects the femoral head intramedullary adipocytes Chen Yue-ping, Gao Hui, Chen Liang, Dong Pan-feng, Yin Qing-shui 2013, 17 (35):  6221-6227.  doi: 10.3969/j.issn.2095-4344.2013.35.001 Abstract ( 374 )   PDF (2118KB) ( 522 )   Save BACKGROUND: Alcohol has become pathogenic factors of avascular necrosis, and the alcohol induced abnormal lipid metabolism in bone marrow may be the important reason for the onset of avascular necrosis, but the mechanism is not clear yet.  OBJECTIVE: To observe the changes of structure and function of fat cells under the action of alcohol, in order to analyze the pathogenesis of alcoholic femoral head necrosis. METHODS: Primary adipocytes in vitro culture technique was used to obtain rabbit femoral head intramedullary adipose tissue, and then the fat cells were separated, and the phenotype was identified with oil red O staining. The passaged stable intramedullary fat cells were collected. Coverslip was cut into 1 cm × 1 cm in size, and placed in the 24-well culture plate before planting. The cells were randomly divided into alcohol group and control group, 24 holes (each hole for a sample) in each group. The control group was without alcohol, while the alcohol group was added with 0.15 mol/L alcohol. At 4, 6, 8 and 10 days, the culture medium was replaced. Medium was changed and no longer adding alcohol, and then cultured for 10 days. When the culture terminated, the coverslip was removed for oil red O staining. Finally, the morphology and the number of the fat cells were observed under light microscope.  RESUTLS AND CONCLUSION: With time prolonging, the number of fat cells in the alcohol group was significantly more than that in the control group (P < 0.001). The lipid droplets in the two groups were gradually increased and enlarged, but more significant in the alcohol group. The number of intramedullary fat cells in the alcohol group after cultured for 4, 6, 8 and 10 days was respectively (200.90±24.60), (1 102.30±76.73), (1 160.30±28.37) and (1 199.70±44.74)/cm2; the number of intramedullary fat cells in the control group was respectively (99.80±10.82), (0.40±94.71), (1 000.20± 41.85) and (1 059.80±26.79)/cm2, the number of fat cells increased with the time of alcohol influence. Alcohol can promote the intramedullary fat cells to increase and enlarge, and this may be the main reason for femoral head necrosis, as long-term alcoholism can lead to bone marrow fat tissue increasing, intraosseous pressure increasing and perfusion reducing, thus resulting ischemia. Figures and Tables | References | Related Articles | Metrics

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Total knee arthroplasty: Goodness-of-fit analysis of intraoperative knee society score of Peking Union Medical College Jia Hai-ying, Lu Ming, Wang Xiao-ping, Zheng Rui, Zhang Jing, Ma Hua-song 2013, 17 (35):  6228-6233.  doi: 10.3969/j.issn.2095-4344.2013.35.002 Abstract ( 693 )   PDF (646KB) ( 472 )   Save BACKGROUND: Knee society score of Peking Union Medical College has been promoted and used in the 306th Hospital of PLA for 2 years and we have accumulated some clinical data. OBJECTIVE: To analyze the stability and feasibility for suitable clinical medical practice of knee society score of Peking Union Medical College.  METHODS: Fifty-five patients with osteoarthritis of the knee were included, and the patients were divided into three groups: the preoperative group; 3 months postoperative follow-up group; 6 months postoperative follow-up group. The measurement results obtained by the application of the scale were compared to those of the Western Ontario and McMaster Universityies Ostroarthritis Index, visual analog scale, and hospital for special surgery score, and then knee society score goodness-of-fit analysis was performed based on the structural equation model. RESULTS AND CONCLUSION: Knee society score performance assessment of the signs and symptoms of osteoarthritis of the knee patients was positively correlated with the pain severity of visual analog scale score; the overall knee society score of the patients after 6-month follow-up was significantly improved compared with that before treatment. The knee society score after 3- and 6- month follow-up was significantly higher than that before treatment, and the score was quite with the hospital for special surgery score. The overall assessment of the knee society score after treated for 3 and 6 months was improved for more than grade Ⅰ, the visual analog scale score was decreased for more than 30%. The pain assessment items and physiological functional assessment items of Western Ontario and McMaster Universityies Ostroarthritis Index after 6-month follow-up were significantly better than those before treatment (P < 0.05); the visual analog scale score was poor after 3-month follow-up, and there was significant difference in visual analog scale score before and after treatment which was related with the pain level; the score accompanied by function and joint stiffness was significantly improved. The knee society score of Peking Union Medical College obtained four dimensions of 22 assessment projects, and the goodness-of-fit analysis showed that the scale had good goodness which had scientific nature and application value. Figures and Tables | References | Related Articles | Metrics

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Knee osteoarthritis grading affects the hidden hemorrhage after total knee arthroplasty Shi Shi-ping, Li Wei, Zhang Wei, Sun Shui, Wang Chao, Li Hui-bo 2013, 17 (35):  6234-6239.  doi: 10.3969/j.issn.2095-4344.2013.35.003 Abstract ( 545 )   PDF (781KB) ( 662 )   Save BACKGROUND: The patients receiving total knee arthroplasty are high in average age, and often accompanied with hypertension, diabetes and other basic diseases. Due to the poor physical conditions of the patients, perioperative hemorrhage becomes the important factor that affecting the safety of replacement. OBJECTIVE: To analyze perioperative hidden hemorrhage of primary total knee arthroplasty, and to explore the method of evaluating perioperative blood loss by osteoarthritis severity before total knee arthroplasty. METHODS: A retrospective analysis of 126 knee osteoarthritis patients undergoing total knee arthroplasty was conducted. All the patients were divided into two groups according to Kellgren and Lawrecne imaging classification: stage Ⅲ group and stage Ⅳ group. The hidden hemorrhage of the patients in two groups was calculated. RESULTS AND CONCLUSION: The average total blood loss of the patients was 1 560 mL, included hidden hemorrhage 865 mL (55%). The mean blood loss of stage Ⅲ group was 1 290 mL with the mean hidden hemorrhage of 684 mL (53%). The mean blood loss of stage Ⅳ group was 1 644 mL with the mean hidden hemorrhage of 921 mL (56%). Statistical analysis showed there were significant differences of total blood loss and hidden hemorrhage between two groups (P < 0.05), but there was no significant difference in the percentage of hidden hemorrhage. The results indicate that higher grade of osteoarthritis imaging classification, the more of total blood loss and hidden hemorrhage, while the change of the percentage of hidden hemorrhage is not significant. Preoperative evaluation of patients’ blood loss by osteoarthritis severity has great significance for blood management and surgical safety of patients. Figures and Tables | References | Related Articles | Metrics

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Total knee arthroplasty: Comparison between quadriceps sparing approach and medial parapatellar approach Xu Jie, Liu Chun-hua, Zhou Shi-guo, Lin Yuan 2013, 17 (35):  6240-6246.  doi: 10.3969/j.issn.2095-4344.2013.35.004 Abstract ( 702 )   PDF (857KB) ( 702 )   Save BACKGROUND: Now, domestic total knee arthroplasty surgeries mainly use medial parapatellar approach, with the disadvantages of large trauma and slower recovery. The quadriceps sparing approach is more accorded with normal anatomy, which can keep the knee extension system intact. The clinical comparison between quadriceps sparing approach and medial parapatellar approach is rare. OBJECTIVE: To compare the early effect of total knee arthroplasty through quadriceps sparing approach and medial parapatellar approach. METHODS: From January 2009 to January 2010, 55 patients (70 knees) were randomly divided into quadriceps sparing approach group (n=26, 35 knees) and medial parapatellar approach group (n=29, 35 knees). Patients in two groups received total knee arthroplasty through quadriceps sparing approach and medial parapatellar approach respectively. The incision length, operative time, postoperative drainage volume, additional amount of etoricoxib tablets, pain degree, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint, Hospital for Special Surgery Knee Score, radiographic alignment of all components and complications were compared between two groups. All the prostheses used in this study were the Sigma type prostheses provided by the rotation platform of Johnson&Johnson Company. RESULTS AND CONCLUSION: All the patients were followed-up for 12-24 months without infections, deep vein thrombosis, neurovascular injury, prosthesis instability, prosthesis loosening or displacement. Position of all the prostheses was normal in patients. The operative time in the quadriceps sparing approach group was longer than that in the medial parapatellar approach group (P=0.00), while the incision length, postoperative drainage volume, additional amount of etoricoxib tablets, visual analog scale, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score in the quadriceps sparing approach group were better than those in the medial parapatellar approach group (P < 0.05). There were no significant differences in range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score between two groups. The early effect of total knee arthroplasty through quadriceps sparing approach is better than the medial parapatellar approach, and there is no significant difference in prosthesis alignment between two methods. Figures and Tables | References | Related Articles | Metrics

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Impaction bone grafting with morselized bone in total hip revision for acetabular deficiency Pan Zhao-xun, Sun Chao, Yang Zhen-lei, Yang Xiao-ming, Cui Yan 2013, 17 (35):  6247-6253.  doi: 10.3969/j.issn.2095-4344.2013.35.005 Abstract ( 375 )   PDF (781KB) ( 453 )   Save BACKGROUND: Bone graft for acetabular reconstruction includes morselized bone graft, structural bone graft and hybrid bone graft, and the morselized bone has been widely used because of the advantages of simple production and short healing time.      OBJECTIVE: To explore the key technologies and clinical effect of impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency. METHODS: Sixteen cases of AAOS Ⅲ acetabular deficiency were treated with impaction bone grafting with morselized bone combined with metal devicesor constructive bone grafting. The hip Harris scores and radiographic data were compared before and after treatment. The effect of impaction bone grafting with morselized bone on acetabular deficiency was assessed.  RESULTS AND CONCLUSION: All the patients were followed-up at 3, 6, 12 months after surgery and every half a year successively. The pain of hip joints after operation was relieved significantly and the walking function was restored. The hip Harris score was improved from 48.00 points before surgery to 84.94 points after surgery (P < 0.01). Five cases were graded as excellent, eight cases as good, two cases as average, and one case as poor. The excellent and good rate was 81%, and the satisfying rate of the patients was 94%. The post-operative X-ray films of all the 16 patients showed that the acetabular rotation centers were recovered (near) to normal and the acetabular cups were covered well by bone. The grafting bone particles got radiological osseointegration and the acetabular cup prosthesis did not displaced, and no displacement and breakage happened to the metal devices. Impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency can effectively reconstruct the acetabular bone structure, retain and restore the acetabular bone mass, and it has good technical advantages and good clinical effects. Figures and Tables | References | Related Articles | Metrics

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Comprehensive evaluation of intramedullary fixation and extramedullary fixation in the treatment of unstable femoral intertrochanteric fractures Li Yan, Wang Dong, Sun Hai-yu, Liu Liang, Li Shu-wei 2013, 17 (35):  6254-6260.  doi: 10.3969/j.issn.2095-4344.2013.35.006 Abstract ( 527 )   PDF (926KB) ( 503 )   Save BACKGROUND: Nowadays, the internal fixation materials for the clinical treatment of unstable femoral intertrochanteric fractures are broadly divided into two categories: intramedullary fixation system and extramedullary fixation system. However, the effects of the treatments usually lack of macro evaluation. OBJECTIVE: To compare the effect of intramedullary fixation system and extramedullary internal fixation system in the treatment of unstable femoral intertrochanteric fractures. METHODS: 217 patients with unstable femoral intertrochanteric fracture (Evans typing: Ⅲ type to Ⅴ type and R type) were treated by using intramedullary fixation system and extramedullary internal fixation system: 18 cases were treated with dynamic condylar screw, 67 cases were treated with dynamic hip screw, 43 cases were treated with reconstruction nail, 72 cases were treated with proximal femoral anti-rotation blade nail, and 17 cases were treated with new generation of antegrade interlocking intramedullary nail. The operative time, length of incision, blood loss, time in bed, fracture healing time, complications and Harris hip score were analyzed and compared. RESULTS AND CONCLUSION: In the aspects of operative time, blood loss, time in bed, complications and Harris hip score, the intramedullary fixation system was superior to extramedullary internal fixation system. But there were significant differences in the aspects of length of incision and fracture healing time between two methods. The results showed that the treatment of unstable femoral intertrochanteric fractures by using intramedullary fixation system was better than the extramedullary internal fixation system, as the intramedullary fixation system could effectively shorten the operative time and reduce blood loss. This stable and reliable fixation enables patients to take early postoperative functional exercise, and could significantly shorten the time in bed and reduce the incidence of complications and it is conducive to postoperative hip function recovery. Therefore, intramedullary fixation system is an ideal method for the treatment of unstable femoral intertrochanteric fractures. Figures and Tables | References | Related Articles | Metrics

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Validation and verification of L3-L5 lumbar three-dimensional finite element model Xu Hao, Zhang Qiu-lin, Tang Hao, Chen Bo 2013, 17 (35):  6261-6266.  doi: 10.3969/j.issn.2095-4344.2013.35.007 Abstract ( 482 )   PDF (725KB) ( 769 )   Save BACKGROUND: Creation of a precise finite element model is an important basis for the finite element mechanical analysis of the spine. The reports on the precise finite element model are less. OBJECTIVE: To create L3-L5 lumbar three-dimensional finite element model and validate this model with normal CT data. METHODS: A 39-year-old male healthy volunteer with the height of 175 cm and weighted 65 kg was selected, then the L3-L5 lumbar spines were scanned with 16 row spiral CT to obtain 101 CT images with the thickness of 1.25 mm. Solid geometric model was established with Geomagic9.0 software, then determined the unit type, divided the finite element mesh, and established the finite element model for loading and calculating.  RESULTS AND CONCLUSION: A L3-L5 lumbar three-dimensional finite element model was established. It included 213 736 nodes and 799 779 elements. The ranges of motion of L3-L4 and L4-L5 segments of the model were consistent with cadaveric biomechanical testing results, verified the effectiveness of the model, so the model could be used for experimental research. Figures and Tables | References | Related Articles | Metrics

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Endoscopic interlaminar lumbar discectomy with splitting of ligamentum flavum Wang Long, Chu Ge, Zhang Hong-qi, Guo Chao-feng, Tang Ming-xing, Gao Qi-le, Qiao Wei-min, Yan Tao 2013, 17 (35):  6267-6272.  doi: 10.3969/j.issn.2095-4344.2013.35.008 Abstract ( 519 )   PDF (795KB) ( 583 )   Save BACKGROUND: Transforaminal endoscopic discectomy needs to dissociate the ligamentum flavum, and if combined with the continuous dilator and working channel, it can keep the intact ligamentum flavum no matter how small the incision may be (even 3-5 mm). OBJECTIVE: To present the technique of interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting. METHODS: We performed operations on 16 male and 14 female patients by interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting. The average age of the patients in the study was (48±15) years. The chief complaint before surgery was radiculopathy confined to one leg. The anatomic operative level was L3-4 in one case, L4-5 in 13 cases and L5-S1 in 16 cases. The ruptured disc migrated superiorly in four cases and inferiorly in seven cases, and intraoperative electromyo-graphic monitoring was performed in all surgeries. The ligamentum flavum was split, and after withdrawing the working channel, the ligamentum flavum could reset itself.  RESULTS AND CONCLUSION: The total operation time was 20-40 minutes, and the follow-up period was (149±108) days. There were no abnormal signals on the intraoperative electromyography in any cases, and the reported symptoms were immediately improved in all patients after the operation. Follow-up magneticresonance imaging showed a disappearance of the ruptured disc without defect in the ligamentum flavum. There were no operation-associated complications in all the patients. Interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting is a feasible approach. Figures and Tables | References | Related Articles | Metrics

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Biomechanical changes of lumbar segment after fusion analyzed with three-dimensional nonlinear finite element Zhang Yan-hui, Jiang Hong-chun, Li Jing, Zhang Bao-di 2013, 17 (35):  6273-6280.  doi: 10.3969/j.issn.2095-4344.2013.35.009 Abstract ( 390 )   PDF (992KB) ( 438 )   Save BACKGROUND: MATLAB has capabilities of large numerical calculation, mathematical drawing and simple finite element analysis. It can establish models rapidly and can be able to identify the grayscale with BMP and JPG format, and it can directly transform the identified data into ANSYS finite element software-readable format, thus avoiding personal error produced by the repositioning and secondary treatment in the Autocad software. OBJECTIVE: To find a simple, convenient and accurate method to construct the model of lumber fusion and to analyze the biomechanics of lumbar motion segment after lumbar fusion. METHODS: Lamellar CT and Matlab (Matrix Laboratory) scientific computing software combining Ansys finite element software was used to construct the models of lumber fusion. Then the models were loaded to analyze the biomechanical change of the fusion model. RESULTS AND CONCLUSION: The established models were loaded with axial, bending and stretching loads, and the biomechanical analysis showed that interbody fusion had the best stability among all the fusion models. Combined with joint fusion, the axial displacements of interbody, rear side and rear fusion models were decreased by 5%, 1% and 4% than that of simple interbody fusion, posterolateral fusion and posterior fusion models. Under the stretch-buckling load conditions, the rotation angles were reduced by 23%, 11% and 45%. Stress concentration to the fusion parts showed fusion block could increase the load displacement. The technology of lamellar CT, Matlab software and Ansys finite element software can accelerate the construction of lumber fusion model and make the model more accurate. Facet joint fusion combined with interbody fusion, posterolateral fusion and posterior fusion can get better lumbar stability, and this increased stability is more significant in the rear fusion. Stress distribution of posterior fusion is more reasonable. Figures and Tables | References | Related Articles | Metrics

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Magnetic resonance imaging of T2 mapping in rabbit lumbar intervertebral disc Wei Wen-jiang, Zhou Zhi-yang, Guo Wen-bo, Zhu Pan, Wu Zhi-qiang, Zhuang Wen-quan 2013, 17 (35):  6281-6286.  doi: 10.3969/j.issn.2095-4344.2013.35.010 Abstract ( 613 )   PDF (1646KB) ( 530 )   Save null Figures and Tables | References | Related Articles | Metrics

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Static balance ability of functional ankle instability patients Zhang Yang, Zhang Qiu-xia 2013, 17 (35):  6287-6292.  doi: 10.3969/j.issn.2095-4344.2013.35.011 Abstract ( 471 )   PDF (740KB) ( 473 )   Save BACKGROUND: At present, the study to balance ability of functional ankle instability patients is less. The balance ability deficiency may also be one of the important reasons for ankle repeated injury, so the research can effectively reduce the damage probability. OBJECTIVE: To explore the static balance ability characteristics of functional ankle instability patients. METHODS: Ten male subjects with unilateral functional ankle instability were enrolled as the experimental group in the study, and other 10 healthy match-paired subjects were served as the control group. Their static balance ability was measured under double feet standing and single foot standing using win-pod system, the double feet testing lasted for 30 seconds and the single foot testing lasted for 10 seconds. Evaluation parameters of balance ability were obtained. RESULTS AND CONCLUSION: During double feet testing, there were no significant differences in balance ability parameters between the experimental group and the control group whether eyes be opened or closed (P > 0.05), but the index values of double feet testing were obviously less than those of single foot testing. So we concluded that in the double feet standing, there was no significant difference in the static balance ability between functional ankle instability patients and normal persons. Moreover, the static balance ability of double feet was better than that of single feet. In the single foot standing of the affected foot, the static balance ability of functional ankle instability patients was slightly worse than that of the normal persons, especially with eyes closed. Comparison of the average swing between the X-axis and Y-axis found that in the process of maintaining balance posture, the swing direction of the body center of gravity was mainly in the anteroposterior direction. Figures and Tables | References | Related Articles | Metrics

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Lower limb walking state under different road conditions verified with virtual reality technology Wang Pei-pei, Yang Peng 2013, 17 (35):  6293-6299.  doi: 10.3969/j.issn.2095-4344.2013.35.012 Abstract ( 569 )   PDF (832KB) ( 802 )   Save BACKGROUND: In the process of studying intelligent lower limbs prosthesis controller, the identification results of road conditions are usually abstract and not easy to understand no matter what measure is taken such as making use of electromyographic signal or combining kinematic with dynamic information. OBJECTIVE: To illustrate the differences and similarities between different road conditions from the direct kinematics analysis, and to make models and simulate various road conditions by using virtual reality technology in order to make recognition results visualize. METHODS: The mechanical modeling modules Simmechanics under Simulink were used to build model diagram of human lower limbs and then we carried out kinematics analysis to the output. The differences and similarities of kinematic information were compared between different road conditions; various road conditions and scenes were built with the help of virtual reality toolbox, and drove the model by kinematics information to achieve validated simulation of different road conditions. RESULTS AND CONCLUSION: The results showed that it has a certain limitation to identify various road conditions by using intuitive kinematics analysis. More means and information should be used. Virtual reality toolbox could represent the corresponding movement scene well which is belonging to corresponding data. Simulation results showed that virtual reality modeling method can reproduce the true image of walking conditions of lower limb walking in the plains, slopes and stairs, and make the movement state reflected with data no longer monotonous abstract. This method can make the identified results visualize and can be taken as a measure to validate the results of road conditions identification, which can provide a good validated display platform for the identification of intelligent prosthetics mode. Figures and Tables | References | Related Articles | Metrics

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Systematic review on the effect of drainage on the rehabilitation of the patients after total hip arthroplasty Tian Ren-yuan, Ye Peng, Deng Jiang, Huang Wen-liang, Ma Li-kun, Lü Xue-feng 2013, 17 (35):  6300-6305.  doi: 10.3969/j.issn.2095-4344.2013.35.013 Abstract ( 325 )   PDF (636KB) ( 548 )   Save BACKGROUND: The previous studies have shown that drainage after replacement can reduce wound exudate, hematoma, infection and other complications after replacement. But many researchers believe that drainage cannot reduce the incidence of complications, but also can increase the patient’s fear of the wound, and reduce the comfort of the patients. Therefore, drainage or not after hip replacement has been a focus for clinical orthopedic surgeons. OBJECTIVE: To compare the effect of drainage versus nondrainage after total hip arthroplasty on rehabilitation of patients.  METHODS: A computer-based search was conducted on the Cochrane Library, PubMed database, CNKI database, VIP database, Wanfang database and CBM database for the related literatures from the establishment to February 28th 2013. The randomized controlled trials and quasi-randomized controlled trials on drainage versus nondrainage after total hip arthroplasty were included, and then quality assessment was conducted based on the methods recommended by the Cochrane Collaboration; Meta analysis was performed by using RevMan 5.1.2 software. RESULTS AND CONCLUSION: A total of 17 randomized controlled trials were included (including 1 838 participants), all studies were parallel randomized controlled trials. Meta analysis showed that the number of patients (relative risk=1.36, 95% confidence interval: 1.03-1.79, P=0.03), blood transfusion (mean difference=0.59, 95% confidence interval: 0.14-1.05, P=0.01), blood loss (mean difference =355.14, 95% confidence interval: 204.93-505.35, P < 0.000 1) and hospital stay (mean difference =1.04, 95% confidence interval: 0.62-1.47, P < 0.000 01) in the drainage group were higher than those in the nondrainage group, but  there was no significant difference in the complication between two groups (relative risk =0.91, 95% confidence interval: 0.64-1.30, P=0.62). Meta analysis identified that there was no effect of nondrainage on the rehabilitation of the patients. Figures and Tables | References | Related Articles | Metrics

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Analgesia after arthroscopic surgery: Randomly controlled Meta-analysis on intra-articular injection of bupivacaine placebo Yang Tuo, Gao Shu-guang, Luo Wei, Li Yu-sheng, Xiong Yi-lin, Sun Jin-peng, Lei guang-hua 2013, 17 (35):  6306-6313.  doi: 10.3969/j.issn.2095-4344.2013.35.014 Abstract ( 374 )   PDF (938KB) ( 470 )   Save BACKGROUND: Pain after arthroscopic treatment can not only affect the patient’s life quality, and is not conducive to the early reasonable exercise and functional recovery of the patients after treatment. Up to 2012, there are 18 randomized placebo-controlled trials on intra-articular injection of bupivacaine for analgesia after arthroscopic surgery, but the results are different. OBJECTIVE: To examine the efficacy and safety of intra-articular injection of bupivacaine in the management of pain after arthroscopic surgery through randomized placebo-controlled trials. METHODS: The MEDLINE database, Cochrane Central Register and Google Scholar database were retrieved for the randomized controlled trials on intra-articular injection of bupivacaine in the management of pain after arthroscopic surgery up to April 2012. The key words were “bupivacaine, intra-articular, arthroscopic, postoperative pain, placebo”.  RESULTS AND CONCLUSION: Eighteen studies (n=934) were included (461 cases in bupivacaine group and 473 cases in the placebo control group). The Meta-analysis results showed the visual analog scale score of the bupivacaine group was lower than that of the placebo control group (weighted mean difference: -1.39, 95% confidence interval: -2.17 to -0.61, P < 0.000 01), and the number of patients required supplementary analgesia was less than the placebo control group (relative risk: 0.84, 95% confidence interval: 0.62 to 1.66, P=0.010). The time from first supplementary analgesia to postoperative intra-articular injection in the bupivacaine group was longer that in the placebo control group (weighted mean difference: 157.72, 95% confidence interval: 16.43 to 299.01, P < 0.000 01). There was no significant difference in the incidence of side effect between two groups (relative risk: 0.64, 95% confidence interval: 0.29 to 1.44, P=0.48). On the basis of the currently available literature, the intra-articular of bupivacaine after arthroscopic surgery can significantly relieve pain without increasing the adverse reactions when compared with the placebo control group. Figures and Tables | References | Related Articles | Metrics

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Relative factors for osteonecrosis in the Chinese systemic lupus erythematosus patients: Meta-analysis Luo Zheng-liang, Shang Xi-fu, Li Xu, Hu Fei, He Rui 2013, 17 (35):  6314-6320.  doi: 10.3969/j.issn.2095-4344.2013.35.015 Abstract ( 403 )   PDF (791KB) ( 469 )   Save BACKGROUND: Systemic lupus erythematosus is a kind of heterogeneous disease, and the difference of clinical features may also be the risk factors of osteonecrosis besides of treatment with glucocorticoids according to the literature. However, it remains controversial on the risk factors of osteonecrosis in systemic lupus erythematosus patients. OBJECTIVE: To systematically review the major risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. METHODS: The CNKI database, CBMdisc database and Wanfang database were retrieved for the published case-control study literatures on the risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. The literatures met the inclusion and exclusion criteria were included, and a Meta-analysis was conducted by RevMan 5.0 and Stata software. Then, the pooled odd ratio and 95% confidence interval of each risk factor were calculated. RESULTS AND CONCLUSION: Ten case-control study literatures were included involving 332 cases in the case group and 986 cases in the control group. The pooled odd ratio and 95% confidence interval of each risk factor of osteonecrosis in the Chinese patients with systemic lupus erythematosus were as follows: Raynaud’s phenomenon 3.28(1.69-6.38), dental ulcer 2.95(2.13-4.09), renal involvement 1.21(0.83-1.74), vasculitis 5.64(2.84-11.21), hyperlipidemia 5.11(3.10-8.42), anti-phospholipid antibody 2.32(1.49-3.61) and joints involvement 2.02(1.33-3.07). It has been clear that the glucocorticoids is an independent risk factor of osteonecrosis in the patients with systemic lupus erythematosus. However, it is not the one and only risk factor. The following risk factors of vasculitis, hyperlipidemia, Raynaud’s phenomenon, dental ulcer, positive anti-phospholipid antibody and joints involvement are the risk factors of osteonecrosis in the patients with systemic lupus erythematosus. Figures and Tables | References | Related Articles | Metrics

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Clinical application of artificial lumbar disc replacement: Present and future Bai Wen-yuan, Gu Hong-sheng, Liao Zhen-hua, Liu Wei-qiang 2013, 17 (35):  6321-6326.  doi: 10.3969/j.issn.2095-4344.2013.35.016 Abstract ( 433 )   PDF (645KB) ( 624 )   Save BACKGROUND: The basic idea of artificial disc replacement is the intension to minimize the impact on adjacent segments based on the premise of stabilizing index segment, then prevent and reduce the incidence of adjacent segment degeneration. OBJECTIVE: To explore the indications and contraindications of artificial disc replacement, peri-operative economics considerations, long-term complications, as well as the effect of artificial lumbar disc replacement combined with fusion surgery. METHODS: The PubMed database, CNKI database and SinoMed database over the past decade were searched for the related articles. The retrospective and prospective clinical trials of artificial lumbar disc replacement were included. Repetitive studies and stale perspectives were excluded. A total of 34 articles were summarized and analyzed in the end. RESULTS AND CONCLUSION: Since the first artificial lumbar disc prosthesis designed to be commercially distributed in 1982, there have been a plenty of clinical trials on lumbar disc replacement. However, there is no answer to many problems that encountered in clinical trials. The effect of the number of replaced segment on the clinical outcomes, the effect of facet joint degeneration on the clinical outcomes, selection of the patients with the history of lumbar disc surgery, age of the patients and the rest time before disc replacement should be taken into consideration in the researches on indications and contraindications of artificial disc replacement. The intraoperative blood loss, operation time and hospital stay after replacement can be used to evaluate whether lumbar disc replacement is better than the traditional lumbar fusion surgery or not. The complications after lumbar disc replacement include heterotopic ossification, implants mechanical failure, and facet joint and adjacent segment degeneration. The combination of lumbar disc replacement and fusion surgery for the treatment of multi-segmental lumbar disc diseases can achieve complement and thus obtaining the efficacy that better than the application of one surgery alone.       Figures and Tables | References | Related Articles | Metrics

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Evaluation of bone marrow mesenchymal stem cells for the treatment of osteonecrosis of femoral head Li Rui-qi, Zhang Guo-ping, Ren Li-zhong, Li Ya-li, Lü Ya-jun 2013, 17 (35):  6327-6332.  doi: 10.3969/j.issn.2095-4344.2013.35.017 Abstract ( 424 )   PDF (699KB) ( 592 )   Save BACKGROUND: There are various methods for the treatment of osteonecrosis of femoral head, but there is no satisfactory method to promote the repair of osteonecrosis of femoral head. In recent years, bone marrow mesenchymal stem cell transplantation for the treatment of osteonecrosis of femoral head has achieved certain effect. OBJECTIVE: To review the application progress and problems of bone marrow mesenchymal stem cell transplantation for the treatment of osteonecrosis of femoral head. METHODS: A computer-based online search was performed in PubMed database, Wanfang database and CNKI database for the related articles from 1999 to 2012. The articles on the isolation, culture, differentiation, labeling and in vivo tracing of bone marrow mesenchymal stem cells were selected, as well as the basic and clinical researches on bone marrow mesenchymal stem cell transplantation for the treatment of osteonecrosis of femoral head. A total of 39 articles were included for review. RESUTLS AND CONCLUSION: At present, the method for the isolation of bone marrow mesenchymal stem cells includes adherence screening method, density gradient centrifugation, flow cytometry separation and magnetic activated cell sorting method; the commonly used method for cell labeling and tracing includes isotope tracing method, antigen labeling method, antigen labeling, fluorescent labeling and MRI contrast enhancer labeling method. The method for the treatment of osteonecrosis of femoral head with bone marrow mesenchymal stem cells includes pith drilling decompression combined with bone marrow mesenchymal stem cell injection and transplantation, intervention plus bone marrow mesenchymal stem cell transplantation, gene transfection combined with bone marrow mesenchymal stem cell transplantation and tissue engineering technology of bone marrow mesenchymal stem cells. Although, the research on the bone marrow mesenchymal stem cell transplantation for the treatment of osteonecrosis of femoral head has achieved great progress, there are still problems needed to be further solved. Figures and Tables | References | Related Articles | Metrics

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Progress of research and technology application of the treatment of fracture nonunion Wu Zuo-pei, Sun Gui-xin 2013, 17 (35):  6333-6338.  doi: 10.3969/j.issn.2095-4344.2013.35.018 Abstract ( 525 )   PDF (739KB) ( 488 )   Save BACKGROUND: Nonunion is a common clinical problem of bone fracture. For decades, with the help of internal/external fixation materials, popularization of microsurgical technique, innovation of bone graft materials, especially molecular biology techniques, breakthrough progress has been made in the treatment of nonunion. OBJECTIVE: To summarize the research progress of treatment in nonunion and to provide better technology theory and choices of method for the treatment of nonunion in future. METHODS: The PubMed database and CNKI database were retrieved by the first author for the articles related to reason and treatment method of nonunion published from January 1990 to May 2013. The key words were “fracture nonunion, treatment, progress”. For the articles in the same field, those published recently or in authorized journals were selected. RESULTS AND CONCLUSION: The repetitive and old articles were eliminated, and finally 48 articles were selected for further analysis. At present, two methods can be used in the treatment of nonunion, including nonsurgical method and surgical method, the surgical method is utilized more frequently and more efficiency in clinic. Fracture healing is the complex process involving various aspects, and once the nonunion occurred, different patients should be treated with different methods, and the combination of various surgical and nonsurgical methods can be used if necessary to obtain satisfactory effect. But all the treatment methods should pay attention to soft tissue protection. Figures and Tables | References | Related Articles | Metrics

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Stability of lumbar vertebrae with lumbar spondylolisthesis after lumbar fusion and implant internal fixation Zhu Yu-qi, Wang Jin-rong 2013, 17 (35):  6339-6344.  doi: 10.3969/j.issn.2095-4344.2013.35.019 Abstract ( 500 )   PDF (883KB) ( 833 )   Save BACKGROUND: The purpose of the treatment of lumbar spondylolisthesis is to reconstruct the spine sequence and vertebral stability, relieve nerve compression, and achieve permanent lumbar fusion. OBJECTIVE: To explore the restore of vertebral stability of the lumbar spondylolisthesis patients after lumbar fusion and implant internal fixation. METHODS: The lumbar spondylolisthesis was often divided into dysplastic, isthmic, degenerative, traumatic and pathological with Wiltse classification. The slip degree of upper vertebra relative to lower vertebra on the lumbar X-ray film was divided into five grades, and then the appropriate treatment method was selected according to the classification, grading and specific circumstances of the lumbar spondylolisthesis patients. RESUTLS AND CONCLUSION: The strong fusion and internal fixation and the rigid connection between implants and vertebra are often used to stabilize the spine and correct deformities with high bone fusion rate, thus reducing pseudoarticulation formation. Dynamic fusion and internal fixation can distribute the load conduction of rigid internal fixation with elastic material or micro-devices, thus reducing stress shielding and adjacent segment stress concentration. Dynamic non-fusion and internal fixation can change the load transfer mode of spinal motion segment, inhibit spinal movement and prevent adjacent segment degeneration, in order to make the instable lumbar spine reach its normal activity characteristics, and achieve dynamic reconstruction of lumbar sequence. Lumbar isthmus defects directly repaired with graft is suitable for the young adult with the symptoms of lumbar spondylolisthesis and without degenerative disc disease. There is no consistent option on which materials and position is suitable for graft in the lumbar spondylolisthesis patients, as well as which methods for fusion and implant internal fixation can achieve ideal effect. Figures and Tables | References | Related Articles | Metrics

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Two kinds of decompression and implant internal fixation for the treatment of cervical spinal stenosis: C5 nerve root palsy and stability Liang Wei-zhi, Gao Jin-wei, Fu Lei, Cui Xiao-hu, Jia Jun-feng 2013, 17 (35):  6345-6350.  doi: 10.3969/j.issn.2095-4344.2013.35.020 Abstract ( 403 )   PDF (1053KB) ( 467 )   Save BACKGROUND: Some scholars suggest that the nerve root palsy after cervical spinal stenosis treated with decompression and implant internal fixation is related with the cervical stability and cervical lordosis, but there is controversial. OBJECTIVE: To explore the C5 nerve root palsy and stability after cervical spinal stenosis treated with posterior laminectomy lateral mass fixation and single-door decompression laminoplasty. METHODS: Twenty-nine cervical spinal stenosis patients were selected and treated with posterior decompression and implant internal fixation. Posterior laminectomy lateral mass fixation for the treatment of cervical spinal stenosis: C3-6 lateral mass and C7 pedicel screw internal fixation was performed and caused rough surface on the facet joint; the unstable segment was confirmed according to the preoperative anteraposterior plain film and dynamic radiographs combined with MRI and CT images, and then the corresponding segments were treated with lateral mass internal fixation, single-door decompression laminoplasty and laminoplasty.   RESULTS AND CONCLUSION: All the 29 cervical spinal stenosis patients were followed-up for 8 months to 2.3 years. Among them, 14 cases were treated with posterior laminectomy lateral mass fixation, two cases had nerve root palsy in the early stage after implantation, three cases had incomplete paralysis after long-term symptom recurrence and treated with second surgery of scar remove and decompression; 15 cases were treated with single-door decompression laminoplasty, and one case had C5 never root palsy and shoulder abduction dysfunctionafter treatment, no preoperative symptom recurrence. The nerve root palsy will restored in 6 weeks for shortest and 9 months for longest. As the limitation of the case number, it is not clear whether there were significant differences in the correlation between C5 nerve root palsy and segmental stability, cervical lordosis, spinal decompression degree and the range for spinal cord shift, as well as the nerve root palsy degree and the cervical spinal stenosis recurrence caused by forward scar between two treatment methods, so accumulation observation of the cases and clinical experience are needed. Figures and Tables | References | Related Articles | Metrics

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Combined therapy of implants internal fixation and Halo-vest external fixation for the treatment of subaxial cervical fracture-dislocation Yao Guan-feng, Wang Xin-jia, Luo Bin, Wang Wei-dong, Zeng Ji-can 2013, 17 (35):  6351-6356.  doi: 10.3969/j.issn.2095-4344.2013.35.021 Abstract ( 512 )   PDF (737KB) ( 596 )   Save BACKGROUND: There is controversial in choosing the treatment method for the treatment of traumatic subaxial cervical fracture-dislocation and spinal cord injury. OBJECTIVE: To evaluate the clinical effect of implant internal fixation and Halo-vest external fixation on the stability after treatment of subaxial cervical fracture-dislocation. METHODS: A retrospective analysis was conducted on 17 patients with subaxial cervical fracture-dislocation in the Department of Orthopedics, the Second Affiliated Hospital of Shantou University Medical College between January 2009 to December 2011, including 13 male patients and 4 female patients, the age was ranged from 21-65 years, average 41.6 years. There were six cases of high falling injury, three cases of crush injury and eight cases of traffic accident injury. The hospitalization time after injury was 2 hours to 5 days, average 2.5 days. All the patients received Halo-vest external fixation under local anesthesia, then distraction gradually, and received anterior decompression graft and titanium screw fixation under reduction. The treatment effect was evaluated through Frankel classification and imaging examination. RESULTS AND CONCLUSION: All the patients were followed-up for 12-24 months, average 15.4 months. Normal anteraposterior X-ray film showed fracture reduction, the cervical vertebra restored to the normal sequence and physiological curvature; CT showed graft fusion without internal fixation fracture and loosing; according to Frankel classification, marked effect (decreased for 2 grade) in five cases, effective (decreased for 1 grade) in 10 cases, and ineffective in two cases. Implant internal fixation combined with Halo-vest external fixation is safe and reliable in the instability fixation of subaxial cervical fracture-dislocation, and can better restore the spinal sagittal alignment. Figures and Tables | References | Related Articles | Metrics

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Children’s old Monteggia fracture: Annular ligament reconstruction or not? Wang Hua-ming, Chen Zhi-long, Li Wei-ping 2013, 17 (35):  6357-6363.  doi: 10.3969/j.issn.2095-4344.2013.35.022 Abstract ( 598 )   PDF (627KB) ( 413 )   Save BACKGROUND: Radial head re-dislocation is one of the alarming complications of old Monteggia fracture. Many treatment methods have described the necessary of fracture and annual ligament reconstruction during treatment, but still unclear. OBJECTIVE: To emphasize the practicality of annular ligament reconstruction through comparing the children’s treatment in two groups. METHODS: Twelve patients with children’s old Monteggia fracture were included for retrospective analysis. All the patients were treated with radial head open reduction and internal fixation. Among them, five cases received ulna extending osteotomy and annual ligament reconstruction, and seven cases received ulna extending osteotomy without annual ligament reconstruction. The course was 3-18 months from damage to the clinical manifestations (an average of 9 months). Ten cases with Bado type Ⅰ and two cases were Bado type Ⅱ and Ⅲ. The reliability of ligament reconstruction was evaluated before and after treatment with Kim standard. RESULTS AND CONCLUSION: All the 12 cases were followed-up for 22 months (8-26 months). Evaluation according to the Kim standard after treatment showed excellent in 10 cases without abnormalities and pain, the range of motion > 250 °, and no elbow was limited, the activities of daily living was 25 points; good in two cases with mild deformity and mild or intermittent pain, the range of motion was 200°-250° with elbow limited, activities of daily living was 15 points; no poor (serious deformity, pain, range of motion < 200°, elbow severely limited, activities of daily living was 0 points). Followed-up lasted for 22 months and found that the average healing time of ulnar osteotomy was 8 weeks (6-14 weeks). The wounds were healed primarily without infection and nonunion. The results indicate that ulna extending osteotomy has great significance in keeping stability of radial head, and annular ligament reconstruction is determined by the time of injury, surgical procedures and intraoperative radial head stability. Figures and Tables | References | Related Articles | Metrics

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Pain-killer affects the healing of osteoporotic fracture     Zhang Tian-hao, Dong Ying-hai, Yu Si-ming, Zhang Chao, Yao Bing 2013, 17 (35):  6364-6374.  doi: 10.3969/j.issn.2095-4344.2013.35.023 Abstract ( 768 )   PDF (1055KB) ( 1092 )   Save BACKGROUND: Studies have shown that non-steroidal drugs have analgesic effect and can also adversely affect the fracture healing. However, the effect of non-steroidal anti-inflammatory drugs on osteoporotic fracture healing is reported less at home and abroad. OBJECTIVE: To perform the animal experiment and clinical observation with the commonly used non-steroidal anti-inflammatory drug diclofenac sodium and central inflammatory drug tramadol hydrochloride, in order to investigate the effect of pain-killer on the union of osteoporotic fracture. METHODS: Animal experiment: female rats received double side castrations and were fed for three months to make osteoporosis model. Then the rats received intramedullary nail fixation for the treatment of middle femur  fracture. All drugs were applied by intragastric administration, once per day, and lasted for 6 weeks. The animals were randomly divided into four groups. The control group was injected with normal saline after fracture; tramadol hydrochloride group was injected with tramadol hydrochloride after fracture; diclofenac sodium A group was injected with diclofenac sodium before fracture and after establishment of osteoporosis model; diclofenac sodium B group was injected with diclofenac sodium after fracture. Gray value was measured by X-ray film at different time points after operation. Clinical observation: 21 patients with osteoporotic thoracolumbar vertebral compression fractures were randomly divided into three groups: control group (n=6), tramadol hydrochloride group (n=7, 100 mg/d) and diclofenac sodium group (n=8, 75 mg/d). All patients were treated with anti-osteoporosis drugs in the same dose and required to lie on broad bed. The patients in the tramadol hydrochloride group and diclofenac sodium group received drug treatment for 1 month. The visual analogue scale score, clinical symptoms disappeared time, vertebral height variation, and L3 vertebral bone mineral density changes were recorded. RESULTS AND CONCLUSION: Animal experiment results: the quantity and density of newly formed bone callus and the gray value of fracture site on X-ray film in the diclofenac sodium A and B groups were lower than those in the control group and the tramadol hydrochloride group at 2, 3, 4 and 6 weeks after operation (P < 0.01). The quantity and density of newly formed bone callus and the gray value of fracture site on X-ray film in the diclofenac sodium B group were lower than those in the other three groups at 4 and 6 weeks after operation (P < 0.05). Clinical observation results: the visual analogue scale score of the patients in the tramadol hydrochloride group and diclofenac sodium group at the first day,1, 2 and 3 weeks after operation was lower than that in the control group (P < 0.01). There was no statistically significant difference in disappeared time of clinical symptoms between groups (P > 0.05). The average gray value of vertebral compression and L3 vertebral bone mineral density in the diclofenac sodium group at 1 month after treatment were lower than those in the control group (P < 0.05). The non-steroidal anti-inflammatory drugs can delay the osteoporotic fracture healing and degrade the intensity of fracture healing, and mainly affect early osteoporotic fracture healing. So, non-steroidal anti-inflammatory drugs should not be the first choice for acute osteoporotic fracture. Central analgesic drugs should be the first choice, such as tramadol hydrochloride. Figures and Tables | References | Related Articles | Metrics

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Sodium hyaluronate injection immediately versus 2 weeks after arthroscopic debridement for knee osteoarthritis Jiang Jun, Ni Lei 2013, 17 (35):  6375-6380.  doi: 10.3969/j.issn.2095-4344.2013.35.024 Abstract ( 804 )   PDF (665KB) ( 514 )   Save BACKGROUND: Sodium hyaluronate injection after arthroscopic debridement of knee osteoarthritis can reduce postoperative pain and improve joint function, but there is a controversy on the time for the hyaluronate injection after arthroscopic debridement of knee osteoarthritis. OBJECTIVE: To observe the time of hyaluronate injection after arthroscopic debridement of knee osteoarthritis, and to compare recent rehabilitation effect of knee sodium hyaluronate injection for knee function after arthroscopic debridement of knee osteoarthritis between injection just after knee arthroscopy and injection 2 weeks after knee arthroscopy. METHODS: The clinical data of 100 knee osteoarthritis patients undergoing sodium hyaluronate injection immediately and 2 weeks after arthroscopic debridement were analyzed with prospective randomized controlled trial method, and the preoperative visual analog scale score, Lysholm score, 6 weeks postoperative visual analog scale score, 3 months postoperative visual analog scale score, and 3 months postoperative Lysholm score were recorded. The effects of recently rehabilitation of knee joint after surgery in two groups were compared. RESULTS AND CONCLUSION: There was no significant difference in postoperative visual analog scale score between immediate injection group (6.52±2.38) and 2 weeks postoperative injection group (6.54±2.37). The preoperative Lysholm score in the immediate injection group (43.44±16.18) was lower than that in the 2 weeks postoperative injection group (51.12±16.3). The 6 weeks postoperative visual analog scale score in the immediate injection group (3.2±2.46) was significantly higher than that in the 2 weeks postoperative injection group (5.1±2.68). The 3 months postoperative visual analog scale score/Lysholm score in the immediate injection group (2.72±2.70)/(80.58±15.63) were significantly higher than those in the 2 weeks postoperative injection group (4.72±3.07)/(64.96±21.68). The results indicate that sodium hyaluronate injection immediately after arthroscopic debridement of knee osteoarthritis is more favorable for recent rehabilitation. Figures and Tables | References | Related Articles | Metrics