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    24 June 2012, Volume 16 Issue 26 Previous Issue    Next Issue
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    Three-dimensional photoelastic analysis on the stress distribution of the pelvis under normal gait based on laser rapid prototyping technology
    Sun Jian-wei, Yin Wang-ping, Zhang Chun-cai, Ren Ke, Zhi Xiao-cheng, Gao Zhen-cao, Zhu Xing-fei
    2012, 16 (26):  4751-4755.  doi: 10.3969/j.issn.1673-8225.2012.26.001
    Abstract ( 254 )   PDF (630KB) ( 337 )   Save

    BACKGROUND: Finite element technology is a digital simulation of the real stress situation; however, photoelastic technology can truly display the overall stress distribution of the test model.
    OBJECTIVE: To make the pelvis photoelastic model by laser rapid prototyping technology, and then to investigate the stress distributions of the pelvis under normal gait loading conditions by three-dimensional photoelastic analysis and to compare the result with that gained by the finite element method.
    METHODS: The pelvic potoelastic model was made by laser rapid prototyping technology, including the fifth lumbar vertebrae and bilateral proximal femur. Mass loading was imposed on the femur. Four groups of muscles forces were imposed through steel wire fixed on iliac wing, anterior superior iliac spine, posterior superior iliac spine and inferior ramus of pubis. The femur was assumed to adduct for 15° and moved from flexed 22° to extend 12° during four gait phases. After stress froze, slices were cut along the arcuate line. Isochromatic lines and isoclinic lines were observed in the field of polarized light.
    RESULTS AND CONCLUSION: ①Stress was concentrated on the center of ilium posterior superior roof of acetabulum, iliopubic eminence and cacroiliac joint, and the maximum stress was on the posterior superior roof of acetabulum. ② The main stress was transferred from posterior superior roof of acetabular to the cacroiliac joint and superior ramus of pubis partly. The area from roof to tubercle of the iliac crest loaded more stress with the femur extending. ③The stress on the acetabular area was mainly from the acetabular contact forces produced by mass loading, and the role of the muscle contraction force was limited. The three-dimensional photoelastic analysis could reflect distribution of stress on acetabulum. The result was in accordance with the data of finite element method.

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    Control of intelligent lower limb prosthesis based on finite-state machine
    Wang Meng, Chen Ling-ling, Geng Yan-li, Yang Peng
    2012, 16 (26):  4756-4759.  doi: 10.3969/j.issn.1673-8225.2012.26.002
    Abstract ( 313 )   PDF (406KB) ( 349 )   Save

    BACKGROUND: The knee damping of traditional lower limb prosthesis cannot be changed when the walking state is changing. Traditional prosthesis with limited operating range cannot follow the sound leg.
    OBJECTIVE: To achieve real-time tracking and pace following of limb prosthesis to healthy limb based on the control of intelligent lower limb prosthesis by finite-state machine.
    METHODS: The intelligent lower limb prosthesis adopted a four-bar linkage with a fixed pneumatic cylinder, and finite-state machine controlling method was in use. It sensed the current gait event, triggered the gait transition state, and adjusted the gait patterns to get the export action of the gait planning.
    RESULTS AND CONCLUSION: The results showed that the intelligent lower limb prosthesis could identify the gait and the walking speed. Different controlling strategies could be exported from the controller, and it controlled the stepper motor to adjust the size of the knee damping. The prosthetic limb side could track the health limb side on real time and follow the walking speed.

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    Establishing a three-dimensional finite element model of human lumbar spine based on CT images
    Liu Zhi-hua, Guan Wen-hao, Tan Zhong-qi
    2012, 16 (26):  4760-4764.  doi: 10.3969/j.issn.1673-8225.2012.26.003
    Abstract ( 341 )   PDF (438KB) ( 360 )   Save

    BACKGROUND: Compared with the method of experiment biomechanics, the finite element analysis methods have unique advantages. How to establish the lumbar spine finite element model accurately is the key point of the finite element analysis.
    OBJECTIVE: To develop a three-dimensional finite element model of human lumbar spine for biomechanical studies.
    METHODS: A normal adult male lumbar spine was scanned by GE 64-slice spiral CT, which obtained 351-layer pictures in DICOM format, the three-dimensional reconstruction model was established by Mimics software, and then, the model was introduced into Solidworks in the format of .stl to create physical model. Finally, the model was introduced into Ansys software, a convenient finite element model was obtained after assigning parameters and meshing. The validity of the model was verified by comparing the result with that of the in vitro biomechanical experiments.
    RESULTS AND CONCLUSION: The three-dimensional finite element model of lumbar spine was established smoothly and distinctly. There were 144 411 nodes and 88 742 units in the model. The model had a high accuracy, and it conveniently applied the load and constraints for the finite element analysis. The way in this study was an exact and practical one to establish the finite element model of lumbar spine for clinical doctors. The model could simulate the lumbar spine biomechanical experiment.

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    Finite element analysis of talar ischemic necrosis
    Huang Yun-peng, Wang Bin, Ma Yan, Li Jing-nian, Wei Jun-jie
    2012, 16 (26):  4765-4769.  doi: 10.3969/j.issn.1673-8225.2012.26.004
    Abstract ( 224 )   PDF (282KB) ( 329 )   Save

    BACKGROUND: Precise clinical treatment of talar ischemic necrosis remains controversial at present.
    OBJECTIVE: To observe the changes in the stress and its distribution on talar trochlear articular surface in case of talar necrosis at different levels.
    METHODS: The present study adopted eight ankle specimens to establish the three-dimensional finite element model of ankle. Through changes in the talar necrosis volume of these models, this study analyzed the change law of talar trochlear articular surface stress and its distribution and calculated the critical necrosis volume of traumatic foot and ankle arthritis or talar collapse that may be induced by talar ischemic necrosis.
    RESULTS AND CONCLUSION: The experiment successfully established the three-dimensional finite element model of ankle. This study found that talar trochlear articular surface stress distribution showed little change in case of talar medial and lateral necrosis at a lower level; when medial talar necrosis volume reached (26.6±1.5)%, and lateral talar necrosis volume reached (35.0±2.5)%. Stress concentration phenomenon occurred in the boundary area between talar necrosis tissue and normal osseous tissue, and the stress area took the shape of irregular pattern. It is suggested that surgical treatment should be considered due to the high-risk induction of ankle-foot traumatic arthritis or talar collapse.

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    In vivo finite element modeling and mechanical analysis of artificial hip joint
    Xu Ling-jun, Zhu Hai-bo, Zhang Yin-wang, Zhu Jian-min, Zhong Wu-xue, Zhang Hao, Chen Yun
    2012, 16 (26):  4770-4775.  doi: 10.3969/j.issn.1673-8225.2012.26.005
    Abstract ( 347 )   PDF (510KB) ( 375 )   Save

    BACKGROUND: Finite element analysis has been widely used for the study of human’s hip replacement. It is a useful method to demonstrate the stress distribution before or after hip replacement.
    OBJECTIVE: To analyze the mechanical distribution of the prosthesis and the femur by the three-dimension finite element model after hip replacement based on the CT scanning image, in order to provide the method for the evaluation of femoral prosthesis in vivo.
    METHODS: One patient with uncemented prosthesis replacement has been scanned with 64-slice CT. With the help of three-dimensional modeling software, a three-dimensional finite element model of femur was established. 1 500 N was loaded on the femoral head prosthesis, and the stress distribution of the prosthesis and the femur was analyzed, and then compared with the in vitro model and finite element model of the normal femur.
    RESULTS AND CONCLUSION: The three-dimensional finite element model has been established using the CT scanning images after the total hip arthroplasty. After loading force on the model, we found that the stress mainly distributed on the 1/3 superior part of femur, on the prosthesis where neck and stem integrated, lateral of the stem and the area contact with prosthesis distal end, and that was the true reaction for the stress distribution after replacement. It indicates that in vivo hip joint modeling is superior to in vitro modeling; in vivo modeling of artificial hip prosthesis is a new method to evaluate the prosthesis without changing the position of the prosthesis.

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    Isolation and description of the artificial joint wear debris
    Wei Hui-hui, Liu Hong-tao, Cao Xi-chuan, Jia Yu-mei
    2012, 16 (26):  4776-4780.  doi: 10.3969/j.issn.1673-8225.2012.26.006
    Abstract ( 299 )   PDF (541KB) ( 391 )   Save

    BACKGROUND: Aseptic loosening of artificial joints resulted by wear debris caused biological response is the main reason for prosthesis failure. Therefore, to obtain the artificial joints wear debris and to study the biological response is important for the improvement of artificial joint life.
    OBJECTIVE: To obtain the nanoscale artificial joints wear debris, and to further study the biological response.
    METHODS: The artificial joints wear debris was obtained by acid digestion and enzymatic degradation methods and the separation efficiency of these two methos was compared. Different sizes of particles were obtained and the morphology of nanoparticles was observed.
    RESULTS AND CONCLUSION: ①The operation cycle times of total hip simulation testing machine have a certain impact on the size and morphology of ultrahigh molecular weight polyethylene wear debris. ②The distribution range of wear debris particle size was changed from 100 μm to 1 μm. It was feasible to isolate the ultrahigh molecular weight polyethylene wear debris by acid digestion and enzymatic degradation.

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    Analgesic effect and security of tramadol/acetaminophen during perioperative total knee arthroplasty
    Guan Da-wei, Li Yan, Wang Chao, Chen Hui, Zhang Peng, Zhang Wei
    2012, 16 (26):  4781-4785.  doi: 10.3969/j.issn.1673-8225.2012.26.007
    Abstract ( 323 )   PDF (490KB) ( 378 )   Save

    BACKGROUND: Analgesia plays an important role in the rehabilitation of total knee arthroplasty (THA), which ensures effective function exercise and improves perioperative life quality.
    OBJECTIVE: To evaluate the analgesic effect and security of tramadol/acetaminophen combined with patient-controlled intravenous analgesia during perioperative THA.
    METHODS: Totally 70 patients who received unilateral THA from Affiliated Provincial Hospital of Shandong University from September 2010 to September 2011 were divided into two groups. Patient in group A (multi-model analgesia group) were treated with patient-controlled intravenous analgesia and oral tramadol/acetaminophen for 7 days after operation. Patients in group B (control group) were only treated with patient-controlled intravenous analgesia.
    RESULTS AND CONCLUSION: Visual analogue scale of the group A was lower than that of the group B at the first three days after operation (P < 0.05), but during the period of exercise, there was no statistical difference between the two groups. The range of motion and overall satisfaction with the treatment in the group A were significantly higher than those in the group B at postoperative 7 days (P < 0.05), and there was no statistical difference in the incidence of adverse reactions and severity between the two groups. The results showed that application of tramadol/acetaminophen combined with patient-controlled intravenous analgesia during perioperative THA can improve the efficiency of function exercise and satisfaction with the treatment, and without increasing the risk of adverse drug reactions.

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    Total knee arthroplasty for knee valgus deformity in the adults: Changes of tibiofemoral angle and range of motion of knee joint
    Li Guang-wei
    2012, 16 (26):  4786-4791.  doi: 10.3969/j.issn.1673-8225.2012.26.008
    Abstract ( 261 )   PDF (473KB) ( 435 )   Save

    BACKGROUND: Application of total knee arthroplasty (TKA) for knee valgus deformity can be difficult technically in many aspects and exist a lot of controversy.
    OBJECTIVE: To investigate the clinical efficiency and surgical methods of TKA for knee valgus deformity in the adults.
    METHODS: Totally 15 knees from 12 patients underwent patellar lateral approach for proper osteotomy and selective lysis of the soft tissue to regain normal biomechanics and soft tissue balance of knee were selected. Posterior stabilized prosthesis was used for TKA to obtain the stability of the knee. After the surgery, rehabilitation therapy pertinently was adopted. Before and after the surgery, tibiofemoral angle was measured. Range of motion (ROM) was examined and HSS score was evaluated.
    RESULTS AND CONCLUSION: All patients were followed up over 6 months. Tibiofemoral angle decreased from 21.47° preoperatively to 5.47° postoperatively (P < 0.01). The ROM increased from 81.33° preoperatively to 121.07° postoperatively (P < 0.01). HSS score improved from 25.47 preoperatively to 89.87 postoperatively (P < 0.01). After replacement, 1 case affected more joint effusion, 2 cases affected knee instability. There was no dislocation or subluxation of the patella. Force line of lower limb returned to normal. TKA can effectively correct the knee valgus deformity, and can significantly improve the function of the knee.

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    Application of microporous polysaccharide hemospheres in total hip arthroplasty
    Luo Dong-fang, Chen Yue-ping, Gao Hui, Chen Liang, Li Shu-zhen
    2012, 16 (26):  4792-4795.  doi: 10.3969/j.issn.1673-8225.2012.26.009
    Abstract ( 316 )   PDF (382KB) ( 626 )   Save

    BACKGROUND: Hip replacement is a mature orthopedic surgery, but it has disadvantage of large exposure and more bleeding. We need an ideal hematostatic material and method to reduce bleeding during the treatment in patients .
    OBJECTIVE: To observe the hemostasis of microporous polysaccharide hemospheres (MPH) in total hip arthroplasty (THA).
    METHODS: Totally 53 patients who treated with THA were randomly divided into experimental group (25 cases) and the control group (28 cases). Conventional topical hemostatic was used in the control group. Conventional topical hemostatic and microporous polysaccharide hemispheres were used in the experimental group. Postoperative drainage, postoperative (24 hours) amount of blood transfusion, reduction value of hemoglobin at preoperative and at the first day postoperative were compared between the two groups.
    RESULTS AND CONCLUSION: Postoperative drainage, postoperative (24 hours) amount of blood transfusion, reduction value of hemoglobin at preoperative and at the first day postoperative in the experimental group were significantly lower than those in the control group (P < 0. 05). It is indicated that MPH has a better hemostatic effect in THA.

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    Cemented hemiarthroplasty for femoral neck fractures in elderly patients
    Li Zhi-gang, Zhao De-wei, Guo Lin, Xia Chong-jun
    2012, 16 (26):  4796-4800.  doi: 10.3969/j.issn.1673-8225.2012.26.010
    Abstract ( 427 )   PDF (326KB) ( 354 )   Save

    BACKGROUND: A discussion is ongoing whether the elderly patients with femoral neck fractures should be treated with a non-cemented or a cemented hemiarthroplasty.
    OBJECTIVE: To evaluated the results of cemented hemiarthroplasty for femoral neck fractures in the patients older than 85 years with high-risk clinical problems and functional outcomes.
    METHODS: Thirty-two patients with femoral neck fractures were treated with cemented bipolar hemiarthroplasty. X-ray examination after operation was done at 1, 3 and 6 months and annually in all patients. The mean follow-up period was 2 to 5 years.
    RESULTS AND CONCLUSION: Medical complications occurred in five patients (16%) and four patients (25%) died within the follow-up period. Dislocation occurred in one patient (3%). None of the patients had heterotopic ossification. The mean Harris-hip score was 84. Cemented hemiarthroplasty can provide stability, security and good outcomes for the treatment of femoral neck fractures in elderly patients.

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    Finite element mechanical analysis of ankle joint inversion
    Guo Guo-xin, Zhao Chang-yi, Cao Lei, Ren Guo-shan
    2012, 16 (26):  4801-4806.  doi: 10.3969/j.issn.1673-8225.2012.26.011
    Abstract ( 232 )   PDF (559KB) ( 835 )   Save

    BACKGROUND: In recent years, with the wide application of finite element analysis in the field of biomechanics, studies on the ankle joint from domestic and abroad scholars have been increased. However, the study is mainly on static states, searching the literature of the past few years, reports about ankle injury in non-mid-stance have seldom been found.
    OBJECTIVE: To make finite element biomechanical analysis of the ankle three-dimensional digital model; to observe the changes of displacement distribution, shear stress and stress of every part of the ankle joint from different perspective; and to discuss the ankle injury mechanism under the condition of inversion.
    METHODS: The three-dimensional digital model of ankle that processed in Mimics and Geomagic surfale was imported into Ansys, and then made a finite element analysis of the obtained model at different inversion angles after constraining conditions, loading pressure and solving.
    RESULTS AND CONCLUSION: In this article ,10 different inversion angles of the ankle joint model were simulated successfully, that were 10°, 15°, 20°, 25°, 30°, 45°, 60°, 70°, 80° and 85°. At each inversion angle, we made finite element mechanical analysis, and obtained the distribution of displacement, shear stress, and stress of every part of the ankle joint from different spatial dimensional. After studying the datum, we draw a conclusion that the x (y, z)-displacement, xy (yz, xz)-shear stress, x (y, z)-stress were increased gradually with the increasing of the inversion angle, the maximum stress located on the lateral malleolus and the lateral part of trochlea tali, where was the most fragile part of the ankle joint to be broken. In addition, the x-displacement of talus was increased with the increasing of inversion angle, which influenced the distribution of stress on the whole ankle joint model.

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    Treatment for Mason type Ⅲ radial head fracture with open reduction and internal fixation versus prosthetic replacement: A Meta analysis
    Zhou Meng, Sun Tian-sheng, Zhang Jian-zheng, Dai He-ling, Guo Yong-zhi, Wang Xiao-kai, Zhao Jian-wen, Liu Xiao-yuan
    2012, 16 (26):  4807-4811.  doi: 10.3969/j.issn.1673-8225.2012.26.012
    Abstract ( 287 )   PDF (436KB) ( 403 )   Save

    BACKGROUND: Mason type Ⅲ radial head fracture is the comminuted fracture of the radial head, the treatment is more difficult. Prosthetic replacement versus open reduction and internal fixation are the two main modalities, but there is a certain controversy on the efficacy of these two treatment modalities.
    OBJECTIVE: To verify the effectiveness of prosthetic replacement versus open reduction and internal fixation for the treatment of Mason type Ⅲ radial head fracture through a Meta analysis which provides evidence for the clinical treatment of Mason type Ⅲ radial head fracture.
    METHODS: We searched CENTRAL (The Cochrane Library, 1993-2011), Medline (1980-2011), Biomed Central (1997-2011), Ovid (1993-2011), China Academic Journal (CNKI, 1994-2011) and Wanfang database (1993-2011). The reports on the treatment of Mason type Ⅲ radial head fracture by prosthetic replacement and open reduction and internal fixation were collected and the effect of these two modalities was compared through Meta analysis. RevMan 5.0 statistical software was used to perform the heterogeneity analysis and Meta analysis.
    RESULTS AND CONCLUSION: There were 3 controlled clinical trails and 1 randomized controlled trial, a total of 109 cases, of which 55 patients in prosthetic replacement group and 54 patients in open reduction and internal fixation group. ①Effectiveness: according to the Broberg and Morrey elbow score, prosthetic replacement group was superior to open reduction and internal fixation group in good rate, the difference was statistically significant (P= 0.001). ②Complications: the incidence of complications in the open reduction and internal fixation group was higher than that in the prosthetic replacement group, and the difference was statistically significant (P=0.001). By evaluating the efficacy and complications of prosthetic replacement versus open reduction and internal fixation for the treatment of Mason type Ⅲ radial heads, prosthetic replacement is superior to open reduction and internal fixation, with satisfactory results. But there was no significant difference of the elbow activity. In view of the less literatures and the poor quality, it needs to design a more rigorous randomized controlled trial and more case number to confirm the final conclusion.

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    Systematic review of reamed intramedullary nailing versus unreamed intramedullary nailing for femoral shaft fractures in adult patients
    Wang Xiong, Dai Qi-yi, Li Shu-zhen
    2012, 16 (26):  4812-4816.  doi: 10.3969/j.issn.1673-8225.2012.26.013
    Abstract ( 293 )   PDF (416KB) ( 422 )   Save

    BACKGROUND: Reamed intramedullary nailing and unreamed intramedullary nailing for the treatment of femoral shaft fractures is still controversial.
    OBJECTIVE: To compare the clinical effects of reamed intramedullary nailing versus unreamed intramedullary nailing for femoral shaft fracture and to evaluate the efficiency differences between the two methods.
    METHODS: Cochrane central register of controlled trials (No.9 in 2011), Medline (1966-01/2011-09), EMbase (1984-01/2011-09) and CNKI (1979-01/2011-09) were searched by computer for randomized controlled trials (RCTs) that related to reamed intramedullary nailing versus unreamed intramedullary nailing for shaft fracture of femur in the adults. Meta-analysis was performed with software RevMan5.1.2 from the Cochrane collaboration. The study was graded by GRADEpro version3.2.2 software.
    RESULTS AND CONCLUSION: Ten RCTs with 1 360 femoral shaft fractures were included containing reamed intramedullary nailing (656 cases) and unreamed intramedullary nailing (704 cases). The Meta-analysis showed that compared with unreamed intramedullary nailing, reamed intramedullary nailing for femoral shift fractures could reduce the nonunion rate (RR=0.20, 95% CI 0.07-0.82, P = 0.02), re-operation rate (RR=0.25, 95% CI 0.11-0.59, P = 0.002) and delayed healing rate (RR=0.30, 95%CI 0.14-0.64, P = 0.002), for the fixation failure rate (RR = 0.68, 95% CI 0.28-1.70, P = 0.41), mortality rate (RR 0.94, 95% CI 0.19-4.58, P = 0.94) and incidence rate of respiratory distress syndrome (RR 1.53, 95% CI 0.37-6.32, P = 0.78) had no significant statistical difference. It is indicated that reamed intramedullary nailing has better clinical effects than unreamed intramedullary nailing for femoral shaft fracture in the adults.

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    Magnetic resonance image reconstruction based on weighted compressed sensing
    Li Hong, Yang Xiao-mei, Li Qing
    2012, 16 (26):  4817-4821.  doi: 10.3969/j.issn.1673-8225.2012.26.014
    Abstract ( 326 )   PDF (413KB) ( 470 )   Save

    BACKGROUND: Compressed sensing theory is widely used in the fast reconstruction of magnetic resonance image (MRI). According to randomly undersampling the k-space data, MRI with sparsity in the transform domain can be reconstructed exactly and this can be done by solving the constrained minimization problems using non-linear optimization algorithm.
    OBJECTIVE: To enhance the sparsity of the image in transform domain and improve the quality of MRI econstruction, a new approach to weight the sparse presentation of the image is proposed in this paper.
    METHODS: The nonlinear conjugate-gradient descent algorithm was utilized to solve the weighted norm minimization. In each iteration, according to the acquired image’s sparse presentation, weighted matrix was updated to enhance the sparsity of MRI.
    RESULTS AND CONCLUSION: Several experiments were carried out with and without reweighting the norm. Results demonstrate that the proposed algorithm with weighted matrix can obviously improve the ability of image recovery.

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    Application of 64-slice spiral CT three-dimensional post-processing image for the diagnosis of the extracardiac structural anomalies
    Shen Yan-guang, Su Lan-fang, Wang Yun-hua, Huang Ting, Nie Zhong-shi
    2012, 16 (26):  4822-4828.  doi: 10.3969/j.issn.1673-8225.2012.26.015
    Abstract ( 302 )   PDF (576KB) ( 393 )   Save

    BACKGROUND: Echocardiography (ECHO) is limitied to diagnose extracardiac structural anomalies of congenital heart disease (CHD). However, compared with ECHO, multi-slice spiral CT (MSCT) has advantages of detecting the extracardiac structural anomalies intuitively and accurately.
    OBJECTIVE: To explore the influence of cardiac image quality and artifacts of extracardiac structural anomalies by 64-MSCT examination.
    METHODS: Totally 23 patients after CHD surgery were reviewed. Cardiac image quality was evaluated by five-grade score before the surgery. CT, ECHO and surgical results were compared.
    RESULTS AND CONCLUSION: ① The cardiac image quality in the greater than 6-year-old age group was better than that in the less than 6-year-old age group. The images of electrocardiograph-gated technique was superior to that of non-electrocardiograph-gated technique. ② In the 23 patients, there were 41 extracardiac structural anomalies. The diagnosis accurate rates of 64-MSCTA, ECHO and combination diagnosis were 97.56%, 72.97% and 100% respectively. There was significant difference between any two methods (P < 0.01). It is showed that 64-MSCT had advantages of detecting the extracardiac structural anomalies intuitively and accurately. Diagnosis range of 64-MSCTA was larger than that of ECHO. 64-MSCTA combined with ECHO could obtain better effect. There was significant difference between the accurate rates of volume rengdering imaging and multiplanar reformation imaging (P < 0.01). Minimum intensity projection was only appropriate for congenital tracheobronchial structural anomalies. So, it is indicated that there are different advantages in diagnosis of extracardiac structural anomalies by different MSCT post-processing reconstruction techniques.

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    Change of the nucleus pulposus size of lumbar disc herniation after treated by Touzhen and Correct-rachi
    Fan Hong-yuan, Xiang Kai-wei, Cao Jun-yan, Sun Jun
    2012, 16 (26):  4829-4833.  doi: 10.3969/j.issn.1673-8225.2012.26.016
    Abstract ( 290 )   PDF (454KB) ( 428 )   Save

    BACKGROUND: Certain methods can reduce the contents of herniated disks and the internal pressure of disks, and can reset tissue of the herniated disks in clinic.
    OBJECTIVE: To observe changes of nucleus pulposus size of lumbar disc herniation before and after therapy.
    METHODS: Sixty selected patients suffering with lumbar disc herniation were randomly divided into three treatment groups in proper order using the random numbers: Touzhen group, Correct-rachi group, the conjunction of Touzhen and Correct-rachi group. The patients were treated with different methods. Another 20 healthy people were selected as normal control group, in order to observe whether the herniated lumbar disc nucleus pulposus can return to home position through taking different treatments.
    RESULTS AND CONCLUSION: There was no remarkable difference in herniated nucleus pulposus size among the three treatment groups when compared with normal control group (P < 0.01); there was no significant difference in herniated nucleus pulposus size among the three treatment groups either before or after different treatments (P > 0.05). As for the curative effect, there was no significant difference among three treatment groups (P > 0.05). There is no remarkable difference in resetting herniated nucleus pulposus of lumbar disc herniation after accepting the three treatments.

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    Gait analysis based on surface electromyography
    Wang Jing, Wu Xiao-ming
    2012, 16 (26):  4834-4840.  doi: 10.3969/j.issn.1673-8225.2012.26.017
    Abstract ( 315 )   PDF (604KB) ( 811 )   Save

    BACKGROUND: Gait analysis is an important evaluation tool in etiological analysis and diagnosis of the human motor system and the nervous system, as well as the function, efficacy and disability evaluation, and muscle activity is the basic factor influencing walking power.
    OBJECTIVE: To analyze the surface electromyography signal changes of lower limb muscles in the process of free walking, and to study the surface electromyography characteristics and mechanism corresponding to different gait phases.
    METHODS: Seven cases of healthy people tibial anterior and lateral gastrocnemius surface electromyography signal were collected during normal gait by German Zebris FDM gait analysis system (6 m) simultaneous electromyography instrument, the signal was denoised and normalized by Matlab software, then the surface electromyography signal diagram that corresponded to various gait phases was obtained and the peak changes were observed; the 15 m free human walking bilateral tibial anterior and lateral gastrocnemius surface electromyography signals were tested by Finland ME6000 system, and then the time domain and frequency domain characteristic parameters were extracted.
    RESULTS AND CONCLUSION: Tibial anterior and lateral gastrocnemius surface electromyography signals showed characteristic changes in a gait cycle, namely the tibial anterior surface electromyography peak occurred in the heel strike, but the lateral gastrocnemius surface electromyography peak occurred in the middle-rear support phase. There was significant difference of bilateral tibial anterior and lateral gastrocnemius characteristic parameters between the dominant side and non-dominant one (P < 0.05), and the change trend was different for different muscles.

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    Bipedal gait experiment for functional electrical stimulation
    Wang Ying, Zhang Ding-guo
    2012, 16 (26):  4841-4846.  doi: 10.3969/j.issn.1673-8225.2012.26.018
    Abstract ( 264 )   PDF (680KB) ( 452 )   Save

    BACKGROUND: Functional electrical stimulation (FES) uses electrical pulse of low level to stimulate the peripheral nerve of muscles in order to restore the motor functions, and it has already achieved clinical success in area of paraplegic walking. However, the patterns of FES are inflexible, unstable and hard to operate for the end-users at present.
    OBJECTIVE: To study the synergistic action of the muscles involved in walking movements for simplifying the design of FES control patterns based on gait analysis and to make the subjects perform expected involuntary walking movements using FES.
    METHODS: According to the characteristics of bipedal walking, a method of gait research was proposed based on measurement and analysis of joint angle and electromyography signal. It served for FES system design, which generated the desired stimulation patterns for muscle groups of lower limbs, and realized the corresponding collaborative activation of the muscle groups.
    RESULTS AND CONCLUSION: Satisfactory involuntary walking of a healthy subject without self-control was realized using the FES method proposed. The results from the experiment had verified the feasibility of FES in lower limb rehabilitation. It sheds light on more complex FES control methods, and provides experimental support for clinical study on paralyzed patients in future.

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    Modic changing and typing of degenerative lumbar and the expression of tumor necrosis factor alpha and matrix metalloproteinase 3
    Jiang Shi-feng, Shen Cai-liang, Dong Fu-long, Zhang Jian-xiang, Li Yong
    2012, 16 (26):  4847-4851.  doi: 10.3969/j.issn.1673-8225.2012.26.019
    Abstract ( 297 )   PDF (422KB) ( 365 )   Save

    BACKGROUND: In recent years, a large number of reports have shown that in lumbar degenerative diseases, inflammatory cytokines play an important role, and the signals of the degenerative lumbar endplate and regional vertebral endplate are changed on MRI.
    OBJECTIVE: To investigate the effect of tumor necrosis factor alpha and matrix metalloproteinase 3 expression on Modic changes of lumbar endplate and the bone under endplate on MRI.
    METHODS: In the experimental group, 20 lumbar endplates were obtained during surgery from the patients with lumbar degeneration treated by lumbar interbody fusion. Both Modic type Ⅰ and Modic type Ⅱ contained 10 cases. As the control group, 10 lumbar endplates were also got during surgery from patients with trauma of vertebra treated with lumbar interbody fusion. The expression of tumor necrosis factor alpha and matrix metalloproteinase 3 in lumbar endplate was tested by immunohistochemical staining.
    RESULTS AND CONCLUSION: The positive ratio of tumor necrosis factor alpha and matrix metalloproteinase 3 in the experimental group was significantly higher than that in the control group (P < 0.05); the expressions of tumor necrosis factor alpha and matrix metalloproteinase 3 in Modic type Ⅰ were significantly higher than those in Modic type Ⅱ (P < 0.05); in the experimental group, the expression of matrix metalloproteinase 3 showed no correlation with the expression of tumor necrosis factor alpha. The expression of tumor necrosis factor alpha and matrix metalloproteinase 3 may promote vertebral endplates degeneration; there was significant difference of the tumor necrosis factor alpha and matrix metalloproteinase 3 expression between different Modic types.

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    A finite element method for the simulation of levator ani muscle stress under different conditions
    Song Hong-fang, Huang Yue, Ni Cheng-xiang, Lei Ling-ling, Wang Xue-ying, Liu Zhi-cheng, Ma Le
    2012, 16 (26):  4852-4856.  doi: 10.3969/j.issn.1673-8225.2012.26.020
    Abstract ( 235 )   PDF (541KB) ( 369 )   Save

    BACKGROUND: There are unique advantages to understand muscles and skeletons of the pelvic floor by building the finite element model to analyze its biomechanical mechanism.
    OBJECTIVE: To build the finite element model of the m. levator ani and to analyze its stress distribution in a number of conditions to provide reference for further understanding pelvic floor dysfunction in terms of mechanics.
    METHODS: The geometry structure of the m. levator ani was reconstructed based on magnetic resonance imaging of the pelvic floor using the medical imaging software MIMICS and the stress distribution of the m. levator ani was simulated using the finite element method.
    RESULTS AND CONCLUSION: The maximum stress position was the same in any condition. When the active contraction pressure of the m. levator ani was zero its maximum stress was lowest in rest condition, but when the active contraction pressure of the m. levator ani was highest its maximum stress was also highest in severe tension condition. High abdominal pressure will produce high stress in the m. levator ani for the seven conditions and is easy to damage the m. levator ani.

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    Movement system of bionic colon diagnostic robot
    Gao Yuan, Yan Guo-zheng, Gao Peng, Chen Wen-wen, Liu Hua
    2012, 16 (26):  4857-4862.  doi: 10.3969/j.issn.1673-8225.2012.26.021
    Abstract ( 358 )   PDF (636KB) ( 626 )   Save

    BACKGROUND: Recently, the research of colon diagnostic robot has been opened up in several research institutes with the ultimate goal of using for clinical application. The developed robot was small-size, autonomous control and a kind of collection of diagnostic and cure.
    OBJECTIVE: To design an inchworm-like colon diagnostic robot for diagnosing the colon tumors.
    METHODS: The robot was driven by the micro motor. The axial mechanism realized the function that stretching out and drawing back on both way. A stroke step of the robot was 32.8 mm. The radial mechanism realized the function that clamping the colon for long-diameter. The maximum size of clamping diameter was 58.7 mm. The camera in the front of the robot worked as a visual navigation. The biopsying mechanism could finish a whole biopsying operation.
    RESULTS AND CONCLUSION: The experiments were preformed in the glass tube and pig intestines, the robot could move forward, backward and park. That validates the robot is practicability.

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    Finite element analysis on rehabilitation training device for balance dysfunction
    Guo Xing-hui, Cui Hai-po, Xu Xiu-lin
    2012, 16 (26):  4863-4866.  doi: 10.3969/j.issn.1673-8225.2012.26.022
    Abstract ( 272 )   PDF (482KB) ( 508 )   Save

    BACKGROUND: A rehabilitation training device has been designed by us for the balance dysfunction.
    OBJECTIVE: To analyze the strength and stiffness of the rehabilitation training device.
    METHODS: Strength and stiffness analysis was performed using the working interface Workbench of finite element analysis software ANSYS. Five different working conditions were considered. The device's gravity loading and the patient’s weight loading were applied on the finite element model under the same constraints. The stress distribution and deformation were gained for the different working conditions.
    RESULTS AND CONCLUSION: Under the five kinds of conditions, the area of stress concentration and maximum deformation was roughly same, and the values were positive correlated with angle. The maximum equivalent stress was less than the yield limit of material, which means that the strength of rehabilitation training device could meet the requirement of design. In the sight of the maximum stress and deformation, the device's design tended to be conservative, and the weight of the whole device could be reduced through the structure optimization. For a complicated model, the new working interface Workbench of ANSYS had higher efficiency than the Classic interface.

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    Design and realization of signal processing platform of multi-parameter wearable medical devices
    Tan Xin, Liu Qian-cheng, Xu Bin-feng
    2012, 16 (26):  4867-4871.  doi: 10.3969/j.issn.1673-8225.2012.26.023
    Abstract ( 262 )   PDF (420KB) ( 448 )   Save

    BACKGROUND: Multi-parameter wearable medical devices have physiological signal detection and processing modules, signal feature extraction and data transmission basic function modules which can implement a non-invasive detection and diagnosis on the human body.
    OBJECTIVE: To increase the detection rate and verification accuracy rate of QRS waves detection for electrocardiogram signal by the signal processing platform applied to wearable multi-parameter devices which require timeliness and accuracy.
    METHODS: A type of multi-parameter wearable medical devices signal processing platform was designed. A QRS-wave detection algorithm was established based on linear approximation distance thresholding algorithm, wavelet transformation and threshold detection by TMS320VC5509 DSP system.
    RESULTS AND CONCLUSION: The DSP can greatly increase the speed of QRS-wave detection, and the results can be practically used for multi-parameter wearable device detection of abnormal electrocardiograph.

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    Gait adjustment of intelligent lower limb prosthesis based on fuzzy control
    Yue Hua, Yang Peng, Chen Ling-ling, Geng Yan-li
    2012, 16 (26):  4872-4876.  doi: 10.3969/j.issn.1673-8225.2012.26.024
    Abstract ( 370 )   PDF (384KB) ( 425 )   Save

    BACKGROUND: Traditional lower limp prosthesis only allows single walking speed which cannot change with the gait, so the pace is also fixed single and cannot adapt to different speeds. The adaptability of traditional prosthesis is poor.
    OBJECTIVE: To achieve the gait following of the prosthesis by fuzzy control methods.
    METHODS: Four-bar linkage with a fixed pneumatic cylinder was adopted as the mechanism of the prosthesis joint. A fuzzy control rule was proposed to control the valve opening base on the changes of the gait cycle. The prosthesis leg swing speed was regulated by a needle valve whose orifice opening was adjusted by a permanent magnet linear step motor.
    RESULTS AND CONCLUSION: While the speed was changed, the knee angle of prosthesis also slightly changed. Maximum value did not exceed 80°. Prosthetic gait change was less than 11°. Amputees could adapt to different walking speeds. The gait changes between the two legs were basically the same and the symmetry index was more than 90%. The experiments showed that the gait cycle can control the needle valve to achieve the adjustment of pace. The control method for walking speed adjustment is feasible.

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    Block-extend Infomax algorithms in fetal electrocardiogram extraction
    Gou Mei-mei, Huang Hua
    2012, 16 (26):  4877-4880.  doi: 10.3969/j.issn.1673-8225.2012.26.025
    Abstract ( 318 )   PDF (371KB) ( 366 )   Save

    BACKGROUND: Fetal electrocardiogram is an important parameter in perinatal period for fetus growing. How to extract the fetal electrocardiogram from maternal electrocardiogram quickly and effectively has become an important research topic.
    OBJECTIVE: To use the block-extend Infomax algorithm for the separation of the fetal electrocardiogram quickly and effectively.
    METHODS: Block-extened Infomax and statistics into four ranks were combined to study the relate rules which make the non-cross element of weight covariance matrix minimum, and improve the astringency of arithmetic.
    RESULTS AND CONCLUSION: Extended infomax algorithm could achieve the separation of super-Gaussian and sub-Gaussian signal. The convergence rate of the algorithm presented in the paper was faster than that of the extended infomax algorithm. Extended Infomax algorithm could effectively extract the fetal electrocardiogram. The amount of the data treated by the block-extend Infomax algorithm was less than that treated by the extended infomax algorithm, and the iteration number of the block-extend Infomax algorithm was smaller than that of the extended infomax algorithm, so the fetal electrocardiogram could be separated quickly and effectively.

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    Development of knee prosthesis replacement and application of digital molding technology
    Zhao Jun, Zhang Yu-yan, Liu Hui
    2012, 16 (26):  4881-4885.  doi: 10.3969/j.issn.1673-8225.2012.26.026
    Abstract ( 205 )   PDF (595KB) ( 388 )   Save

    BACKGROUND: With the further studies of the materials and biomechanics of knee prosthesis, prosthesis design is constantly updated. How to improve the geometric accuracy of prosthesis and to reconstruct the biologically functional knee joint are the key issues in clinic.
    OBJECTIVE: To summarize the clinical application of different knee prostheses, and to explore individualized program for three-dimensional (3D) reconstruction of knee joints, which provides a biomechanical foundation for design and replacement of artificial knee prosthesis.
    METHODS: An online retrieval of CNKI and Wanfang databases was conducted by reviews for experimental researches, related reviews and clinical originals related to the preparation and design of knee prosthesis, artificial knee replacement and the application of digital modeling technology for knee prosthesis design. Old documents and information about the patients treated with conservative treatment were excluded.
    RESULTS AND CONCLUSION: A total of 27 documents were involved. The further understanding of biomechanics and anatomy of knee joint causes more requirements of patients for the function of knee prosthesis. Digital technology for knee reconstruction provides a new idea and technical method for the accuracy of knee joint geometric measurements and replacement, provide anatomical data for tibial prosthesis design, in a broader attempt to improve the adaption between the prosthesis and the cross section, as well as the joint stability, and reduces the loosening and other complications, and extends the life of the prosthesis. The image-based project is a feasible approach for the 3D knee reconstruction; it can clearly and intuitively conduct multi-angle observations of morphological characteristics of knee joints, thus serving as a teaching method for local anatomy of joints and providing reliable data for clinical application.

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    Pathogenesis and therapy progress of aseptic loosening of artificial joint prosthesis
    Liu Feng, Zhang Chao, Yao Zhen-qiang, Yang Zhao, Meng Zeng-dong
    2012, 16 (26):  4886-4891.  doi: 10.3969/j.issn.1673-8225.2012.26.027
    Abstract ( 298 )   PDF (567KB) ( 391 )   Save

    BACKGROUND: In recent years, with gradually further understanding the mechanism of the formation of inflammatory membrane and osteoclasts and activation, application of drugs to reverse the pathology of aseptic loosening of artificial joints has achieved fruitful progress.
    OBJECTIVE: To review the pathogenesis and therapy progress of aseptic loosening of artificial joint.
    METHODS: PubMed database was retrieved for articles with the key words of “Artificial joints, Aseptic loosening, Osteoclast, Tumor necrosis factor-a, Interleukin-1, Drug treatment, Gene Therapy, Bone loss” in English, and CNKI database was also retrieved with the key words of “artificial joints, prosthesis aseptic loosening, osteoclasts, tumor necrosis factor-a, interleukin-1, drug therapy, gene therapy, bone loss” in Chinese. Articles related to the pathogenesis of aseptic loosening of the prosthesis and drugs for aseptic loosening of the prosthesis prevention were included, and duplicate documents were eliminated.
    RESULTS AND CONCLUSION: Totally 29 articles were included for review. Drugs for aseptic loosening of artificial joint were mostly involved in clinical use. Emphasis and difficulty of the current study is how to decrease adverse reactions and increase effective local drug concentration around the prosthesis in long term use of these drugs. In recent years, transgenic approach used to prevent and treat aseptic loosening of prosthesis is the latest research progress, although significant results have been achieved, human security of gene therapy is unresolved, therefore, these studies still are in vitro and animal experiments.

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    Pathogenesis of aseptic prosthesis loosening after artificial prosthesis implantation
    Ma Yu-chao, Tian Jing
    2012, 16 (26):  4892-4897.  doi: 10.3969/j.issn.1673-8225.2012.26.028
    Abstract ( 263 )   PDF (570KB) ( 315 )   Save

    BACKGROUND: There are many clinical researches on aseptic loosening of artificial prosthesis, but the exact pathogenesis is still unclear.
    OBJECTIVE: To review the pathogenesis of prosthesis aseptic loosening after artificial prosthesis implantation.
    METHODS: A computer-based online search of PubMed and CNKI was performed to search related articles published between 2006 and 2011 with the key words of “artificial prosthesis, aseptic loosening” both in English and Chinese. A total of 77 articles were obtained, and finally 38 articles were included.
    RESULTS AND CONCLUSION: Aseptic loosening after long-term total hip replacement is one of the main failure reasons. In the recent years, analysis of revision total hip replacement for failed hip arthroplasty showed that aseptic loosening is the chief reason. The mechanism of aseptic loosening mainly includes mechanical mechanisms, biological and other mechanisms. With further research and the improvement of implantation method and prosthetic materials, aseptic loosening will eventually be minimized, so that the service life of prosthesis will be longer.

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    Prethrombotic state gene predictions and diagnosis of venous thromboembolism after large traumatic surgery including orthopedic joint replacement and implant placement
    Wang Qiang, Zhao Xue-ling
    2012, 16 (26):  4898-4902.  doi: 10.3969/j.issn.1673-8225.2012.26.029
    Abstract ( 219 )   PDF (595KB) ( 459 )   Save

    BACKGROUND: At present, we pay more attention on the early genetic diagnosis of venous thromboembolism after traumatic or orthopedic surgery.
    OBJECTIVE: To summarize the mature gene research used to diagnosis the venous thromboembolism after orthopedic surgery.
    METHODS: CNKI database and PubMed database (2000-01/2011-01) were searched through Web with the key words of “venous thrombosis, deep venous thrombosis, pulmonary embolism, genes, diagnosis” or “thrombosis, DVT, PE, gene”.
    RESULTS AND CONCLUSION: Recent clinical and basic research showed that venous thromboembolism was a typical polygenic hereditary disease. And we also found some mutant gene related to high blood coagulation was closely related with venous thrombosis. These mutant gene included prothrombinase V, antithrombin Ⅲ, protein C, protein S, plasminogen, fibrinogen, heparin cofactor Ⅱ, thrombomodulin and prothrombinase Ⅻ. Understanding of the hereditary pathogenic gene mechanism for venous thromboembolism was in favor of early diagnosis and treatment and reduced the harm.

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    Effect of knee physiological anatomy environment on knee biomechanical properties
    Zhang Mei-juan
    2012, 16 (26):  4903-4907.  doi: 10.3969/j.issn.1673-8225.2012.26.030
    Abstract ( 241 )   PDF (543KB) ( 636 )   Save

    BACKGROUND: The understanding of the knee biomechanical properties is critical to understand the design and operative principles of the knee prosthesis.
    OBJECTIVE: To summarize the relationship between peripheral mechanics environment and biomechanics of the knee joint, and to investigate the stability and injury mechanism of the knee joint.
    METHODS: The CNKI database and PubMed database (1998-01/2011-08) were used to search the related articles about biomechanics of the knee joint. The keywords of “knee joints, ligament, meniscus, cartilage, biomechanical” in English and Chinese were put into the title and the abstract to search the articles. The articles that related to the biomechanics of the knee joint were selected, and for the articles in the same field, those published recently or in the authorized journals were selected. There were 163 articles after the initial survey. Then 25 articles related to biomechanics of the knee joint were selected to review.
    RESULTS AND CONCLUSION: The stability of the knee joint relies on the articular bone, and also depends on the constraints of the anterior and posterior cruciate ligament, the balance of internal and external collateral ligament and extensor mechanism, as well as the power balance of quadriceps and hamstrings, especially depends on the balancing and stabilizing effect of the internal and external collateral ligament. It indicates that the anatomical environment of the knee joint determines the complexity of the knee joint in the biomechanical properties of loading, action and stability. Therefore, understanding the physiological structure and anatomical characteristics of the knee joint is of benefits to study the biomechanical characteristics of the knee joint, and that is important to study the pain, injury and tissue engineering of the knee joint.

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    Application of finite element analysis technology in lumbar spine biomechanics
    Chen Ji-bao, Xi Chun-yang, Jiao Li-gang, Yan Jing-long
    2012, 16 (26):  4908-4912.  doi: 10.3969/j.issn.1673-8225.2012.26.031
    Abstract ( 333 )   PDF (518KB) ( 480 )   Save

    BACKGROUND: Mathematical form of the finite element method is used to summarize the general structure, shape, material properties, load boundary conditions of the spine, and to observe the impact on the entire structure by changing one parameter.
    OBJECTIVE: To analyze the establishment method of the lumbar finite element model and the application of the finite element software in lumbar spine biomechanics, as well as the application of the finite element analysis technology in the changes of activity and stress of the adjacent segments after lumbar fusion.
    METHODS: PubMed database and CNKI database were used to search the articles published from 1990 to 2010 on the effect of the finite element analysis technology on the changes of stress of the lumbar fusion segments and adjacent segments after modeling of the lumbar spine and different lumbar spine fusion.
    RESULTS AND CONCLUSION: Finite element analysis technology was widely used in medicine and became the important part. As for spine, the finite element analysis could fully understand the influence of different fusion and variety of fixation methods on its changes of biomechanics, which could improve fusion and optimize the fixation devices. But finite element analysis was the theoretical analysis; the future research would combine with the animal experiments and long-term clinical follow-up, which played an important clinical significance on the prediction of a good long-term efficacy of the surgery and prevention of complications.

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    Application of finite element analysis in mechanism of lumbar disease by Chinese medicine bonesetting massage manipulation
    Qin Da-ping, Zhang Xiao-gang, Song Min
    2012, 16 (26):  4913-4917.  doi: 10.3969/j.issn.1673-8225.2012.26.032
    Abstract ( 226 )   PDF (622KB) ( 557 )   Save

    BACKGROUND: Changes of lumbar spine biomechanics and characteristics of action mechanism during the Chinese medicine bonesetting massage manipulation for lumbar disease are transformed into the digital signal using finite element analysis method. This is an effective and advanced research method of digital orthopaedic.
    OBJECTIVE: To summarize the mechanism of Chinese medicine bonesetting massage manipulation for lumbar disease by the finite element analysis method.
    METHODS: A computer-based retrieval was performed by the first author to search PubMed, Medline, Vip, CNKI, Wanfang, digital journals of Chinese medical association and Google network databases for articles concerning the mechanism of Chinese medicine bonesetting massage manipulation for lumbar disease using the finite element analysis method (2000-01/2011-10) with the key words of “3-D finite element analysis method, lumbar disease, bonesetting massage manipulation” in English and Chinese. A total of 92 papers were retrieved. According to inclusion and exclusion criteria, 37 papers were included in final analysis.
    RESULTS AND CONCLUSION: Establishment of three-dimensional finite element model for lumbar can better simulate clinical condition of various waist techniques and get consistent results with biological mechanics experimental. Through the computer graphics technology the result can be displayed qualitatively and quantitatively. However, there are few studies on the action mechanism, biomechanical characteristics, clinical quantitative and evaluation standard of Chinese medicine bonesetting massage manipulation by the finite element analysis. The mechanism of Chinese medicine bonesetting massage manipulation for lumbar disease by using digital analysis is further studied to provide mechanics basis for clinical application, quantified and optimized theory and new ideas for experimental study.

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    Utilization of virtual reality technology in computer-based case simulation system
    Sun Xin, Wang Li-mei, Liu Yi-xin, Han Song-tao, He Ying
    2012, 16 (26):  4918-4922.  doi: 10.3969/j.issn.1673-8225.2012.26.033
    Abstract ( 433 )   PDF (630KB) ( 464 )   Save

    BACKGROUND: Virtual reality technology applied research in the field of medicine has achieved fruitful results and shows a good prospect, it is an important tool of digital medical research.
    OBJECTIVE: To introduce the design and application of computer-based case simulation system with virtual reality technology.
    METHODS: A computer-based search was performed on CNKI database, VIP database, Wanfang database and EBSCO database for the relate articles from 1991 to 2011 with the key words of “case simulations, CCS, virtual reality” in English and “virtual reality, case simulation” in Chinese. A total of 85 articles were obtained and finally 20 articles were included according to the inclusion criteria.
    RESULTS AND CONCLUSION: The application of virtual reality technology in the medical field has become more and more wide. The case simulation system designed by virtual reality technology provides the medical workers a new interactive skill training methods. The simulation of the patient’s disease status by the interactive computer software is realized, and the clinical course is simulated realistically. And the assessment of the practical skills for the users were achieved, including basic inspection capacity, use and judgment of the high-tech diagnostic techniques, judgment of check results, diagnostic capability, drug treatment capacity, ability to use non-drug treatment and the comprehensive treatment capacity. The virtual simulation system platform has a good prospect in medical education and clinical skills training.

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    Research trend of factors influencing range of motion after artificial total knee replacement
    Wang Jiu-hui
    2012, 16 (26):  4923-4926.  doi: 10.3969/j.issn.1673-8225.2012.26.034
    Abstract ( 248 )   PDF (475KB) ( 413 )   Save

    BACKGROUND: Range of motion after artificial total knee replacement is the key to evaluate whether the patients are satisfied with the treatment or not, as well as the main outcome measures of functional recovery of joint knee.
    OBJECTIVE: To analyze the trends in the field of joint activity after artificial total knee replacement and to explore the influence factors of joint activity after artificial total knee replacement.
    METHODS: A total of 244 research articles are found by searching related literature on joint activity after artificial total knee replacement in CNKI database by the author, with the key words of “Knee”, “Artificial joint”, “Artificial prosthesis” and “Range of motion” both in Chinese and English, from 2002 to 2011. A total of 211 related articles were included in the final analysis according to inclusion criteria and exclusion criteria. The influence factors were analyzed from the aspects of the joint activity before knee replacement, type of prosthesis and rehabilitation training after replacement.
    RESULTS AND CONCLUSION: The number of research literature related to joint activity after artificial total knee replacement was gradually increased in CNKI over the past decade among which 2010 is the most productive year (n=38, 18.0%). According to the key words, knee replacement was widely used in the treatment of osteoarthritis disease, but the fund of related research literature was far from being enough. Journal of Clinical Rehabilitative Tissue Engineering Research published the most related articles with the help of the column of hard tissue implants (n=41, 19.4%). The bibliometric analysis provides valuable reference for Chinese medical workers in the field of artificial total knee replacement. There are many factors influencing joint activity after artificial total knee replacement, as well as lots of controversies. Clinicians should continuously improve the treatment techniques and rehabilitation training methods to recover the function of joint knee in patients.

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    Two-year follow-up of screws versus percutaneous K-wire for the treatment of Bennett fractures in Buechler zone 2
    Xia Yi-fan, Wu Qing, Wei Peng, Chen Lu
    2012, 16 (26):  4927-4930.  doi: 10.3969/j.issn.1673-8225.2012.26.035
    Abstract ( 220 )   PDF (393KB) ( 318 )   Save

    BACKGROUND: There are a lot of methods for the treatment of Bennett fractures; however, there is no uniform therapeutic regimen and evaluation criterion for the more prone Buechler zone 2 Bennett fractures.
    OBJECTIVE: To compare the function recovery of open reduction screw fixation and percutaneous pinning for the treatment of Buechler zone 2 Bennett fractures.
    METHODS: Patients with Buechler zone 2 Bennett fractures were randomly divided into the screw group and the K-wire group; the patients in the screw group were treated by open reduction screw fixation and the patients in the K-wire group were purposed by close reduction percutaneous fixation. The disabilities of the arm, shoulder and hand score were used to evaluate the function recovery.
    RESULTS AND CONCLUSION: The disabilities of the arm, shoulder and hand score of the screw group were lower than those of the K-wire group after fixation, 1-year follow-up and 2-year follow-up (P < 0.05). The functional recovery of open reduction screw fixation is better than percutaneous K-wire fixation for Buechler zone 2 Bennett fractures.

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    Posterior longitudinal ligament resection by Smith-Robinson technique combined with metallic fixation for single-level cervical disc herniation
    Sun Peng, Xue Yuan, Wang Pei, Zhao Hua-jian, Li Peng, Li Zi-long
    2012, 16 (26):  4931-4935.  doi: 10.3969/j.issn.1673-8225.2012.26.036
    Abstract ( 315 )   PDF (441KB) ( 345 )   Save

    BACKGROUND: Smith-Robinson technique combined with metallic fixation is widely used for the treatment of prolapse of single-level cervical intervertebral disc, but it is controversial to resect the posterior longitudinal ligament (PLL).
    OBJECTIVE: To observe the effects of resection of PLL by Smith-Robinson technique combined with metallic fixation for treating prolapse of single-level cervical intervertebral disc.
    METHODS: A total of 45 patients who underwent the PLL resection by the Smith-Robinson technique combined with bone grafting with peek Cage and titanium plate internal fixation for treating prolapse of single-level cervical intervertebral disc at the Department of Orthopedics, General Hospital of Tianjin Medical University between 2005 and 2008 were retrospectively analyzed.
    RESULTS AND CONLUSION: All patients received a 12-36 months follow-up. Compared with preoperation, the mean JOA score was significantly increased (P < 0.05) and the visual analogue scale score was significantly decreased at a 12 months follow-up (P < 0.05). The segmental Cobb angle and disc height were significantly improved postoperatively (P < 0.05). At the last follow up a solid fusion was achieved in 100% and no graft displacement was noted. Excellent clinical results of 30 cases, good in 13 cases, 2 cases in fair, and poor in 0 case, the fine rate was 95.6%. It suggested that PLL resection by Smith-Robinson technique not only achieved the maximum pressure to the spinal cord and nerve root but also prevented the subsidence of the graft and angulation of the fused segment effect.

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    Three internal fixation methods for humeral shaft fracture
    Guo Hu
    2012, 16 (26):  4936-4940.  doi: 10.3969/j.issn.1673-8225.2012.26.037
    Abstract ( 268 )   PDF (426KB) ( 356 )   Save

    BACKGROUND: At present, the intramedullary nailing fixation and plate fixation are the two main ways for the fixation of bone fracture. Inter-locking intramedullary nail with its wide indication, small trauma, stable fixation and other advantages has become the gold standard for the treatment of long bone fracture.
    OBJECTIVE: To compare the clinical effect of minimally invasive locking plate, expandable intramedullary nail and inter-locking intramedullary nail fixation for the treatment of humeral shaft fracture.
    METHODS: Sixty-six patients with humeral shaft fractures were divided into three groups according to different fixation methods. The three groups were treated with minimally invasive locking plate, expandable intramedullary nail and inter-locking intramedullary nail fixation respectively. The routine fix approach was applied in the three groups, and the healing time and the complications in the three groups were compared.
    RESULTS AND CONCLUSION: There was no significant difference of the healing time among three groups. There was no significant difference of complications among three groups after fixation (P > 0.05), but different in each group. Through this clinical observation, we can come to conclusion that the methods of three groups have good clinic curative effect in the treatment of humeral shaft fractures. In the clinical treatment, we should choice reasonable fixed way according to the kind of fracture and the extent of the damage.

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