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    26 November 2013, Volume 17 Issue 48 Previous Issue    Next Issue
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    Three-dimensional reconstruction of human Neiguan point structure based on digitized virtual reality technology
    Liu Yan-xiang, Jiang Jun, Yan Zhen-guo, Guo Yi, Zhuang Tian-ge, Shao Shui-jin, Zhang Li-sheng, Liu Jia-lin
    2013, 17 (48):  8301-8306.  doi: 10.3969/j.issn.2095-4344.2013.48.001
    Abstract ( 418 )   PDF (2159KB) ( 1395 )   Save

    BACKGROUND: Based on the integration of virtual reality technology with acupoints, acupuncture can be expressed three-dimensionally.
    OBJECTIVE: To explore the structure of points through reconstructing digitalized three-dimensional visualization of Neiguan (PC6) structure based on VOXEL-MAN and Micro-XCT.
    METHODS: Muscles and other tissues adjacent with Neiguan (PC6) were segmented and merged based on the VOXEL-MAN system combined with the anatomical knowledge of acupoints; nerves and blood vessels were performed with three-dimensional reconstruction; the needle-inserting animation of Neiguan (PC6) was obtained by running script file. Three-dimensional visualization and virtual needle-inserting researches of Neiguan (PC6) were performed. Nature of the acupoints was detected by the Micro-XCT-200 machine additionally. 
    RESULTS AND CONCLUSION: The visualization of the anatomical structure of local Neiguan (PC6) was  completed, and the localization and expression of Neiguan (PC6) in the digitized virtual human were realized. The Neiguan (PC6) structure was researched with Micro-XCT-200, and showed there was no new tissue. Local three-dimensional reconstruction of the acupoint structure could help to display the anatomical structure of acupoints and simulate the acupuncture process. It could also help to observe the relationship between the needle body and the surrounding tissues during needle-inserting, which supplying a good basis not only for exploring the security of needle-inserting, but also for improving the clinical effect of acupuncture. The research on the structure of acupoint Neiguan (PC6) by Micro-XCT-200 provides further experimental evidence for the hypothesis of three-dimensional acupoint.

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    Preventive analgesia of Celebrex for patients receiving total knee arthroplasty
    Lin Zi-hong, Wang Hai-xing, Chen Gui-hao, Wang Liang-ze, Shen Zi-wei, Ma Yuan-chen, Liao Jun-xing, Zheng Qiu-jian
    2013, 17 (48):  8307-8312.  doi: 10.3969/j.issn.2095-4344.2013.48.002
    Abstract ( 158 )   PDF (807KB) ( 531 )   Save

    BACKGROUND: The preemptive analgesia is still a controversial issue. Existing studies have not paid much attention to effects of preoperative factors on the hypersensitivity of peripheral and central mechanisms. Visual analog scale scores cannot subjectively and repeatedly reveal patient’s pain.
    OBJECTIVE: To investigate the validity of the preventive analgesia effect of Celebrex in patients with total knee arthroplasty.
    METHODS: Patients with osteoarthritis of the knee who received total knee arthroplasty were accessed by Pittsburgh sleep quality index, self-rating depression scale and self-rating anxiety scale. In all, thirty patients were enrolled in the study. They were randomized into Celebrex group and vitamin C group, and each group had 15 patients. The patients in the Celebrex group and vitamin C group took 200 mg Celebrex and vitamin C, respectively, twice a day from day 2 to day 4. Both of their knees were evaluated by resting visual analogue scale and moving visual analogue scale in the evening of day 1 before treatment and day 3 after treatment. Meanwhile, the pain threshold and pain tolerance were accessed by a pain-threshold machine.
    RESULTS AND CONCLUSION: No statistical significance of the changes of resting and moving visual analogue scale scores was found in both knees in the Celebrex group (P > 0.05). The pain threshold of both knees were significantly increased (P < 0.05), and the severe knee, which had less visual analogue scale scores than the minor one, turned out to increase more obviously than the minor knee (P > 0.05). There were no significant changes in the pain tolerance in both knees (P > 0.05). The changing values of resting or moving visual analogue scale were not significantly correlated with the pain threshold and pain tolerance (P > 0.05). There were no significant changes in visual analogue scale scores, pain threshold and pain tolerance in both knees of the vitamin C group (P > 0.05). Celebrex could increase the pain threshold of patients receiving total knee arthroplasty, especially the severe knee, which indicates that the Celebrex is good for the preventive analgesia. Comparatively speaking, the pain threshold might be more sensitive than visual analogue scale in revealing the change of pain after analgesia. There is no significant correlation between visual analogue scale score and the hypersensitivity of pain.

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    Hidden blood loss in total knee arthroplasty under high negative pressure drainage
    Yu Chang-chun, Yang Ming-lu, Du Xing-sheng
    2013, 17 (48):  8313-8318.  doi: 10.3969/j.issn.2095-4344.2013.48.003
    Abstract ( 384 )   PDF (647KB) ( 591 )   Save

    BACKGROUND: Usually, amount of bleeding during replacement and drainage amount after replacement were recorded to evaluate the amount of bleeding in patients with arthroplasty. These are dominant blood loss. Studies demonstrated that recessive blood loss exceeded 50% of total amount.
    OBJECTIVE: To compare the blood loss during total knee arthroplasty under high negative pressure drainage and common negative pressure drainage and to assess the effect of high negative pressure drainage on hidden blood loss in total knee arthroplasty.
    METHODS: A total of 60 patients undergoing lateral total knee arthroplasty were equally divided into high negative pressure drainage group and conventional drainage group (control group). We calculated the total blood loss (dominant blood loss and hidden blood loss) and blood transfusion amount with the Gross equation. The recovery after surgery and complications were compared.
    RESULTS AND CONCLUSION: In high negative pressure drainage group, the total blood loss was (646±184) mL and the hidden blood loss was (215±128) mL. In the control group, the total blood loss was (867±296) mL and the hidden blood loss was (457±268) mL. The total blood loss and hidden blood loss in the high negative pressure drainage group were significantly less than those in the control group (P < 0.05). The average blood transfusion amount was 224 mL in the high negative pressure drainage group and 467 mL in the control group. Following unilateral total knee arthroplasty, total blood loss, hidden blood loss and blood transfusion amount after arthroplasty were less in the high negative pressure drainage group than those in the control group. In particular, the decrease in hidden blood loss was helpful to observe and treat the pathogenetic condition and to avoid potential risk, and benefits the recovery of knee joint function after surgery.

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    Soft tissue release processing in knee flexion contracture during knee replacement
    Qian Ke-jun, Jiang Yu
    2013, 17 (48):  8319-8324.  doi: 10.3969/j.issn.2095-4344.2013.48.004
    Abstract ( 202 )   PDF (708KB) ( 559 )   Save

    BACKGROUND: Soft tissue releasing is a major means of correcting knee flexion contracture, and the soft tissue releasing methods are different for different knee joint diseases and degrees of deformity. Ideal soft tissue balance can gain a clear functional recovery and deformity correction from severe knee flexion contracture after total knee arthroplasty.
    OBJECTIVE: To study the proper handling of knee flexion contracture and soft tissue releasing in total knee arthroplasty.
    METHODS: Twenty-six cases of knee deformity in 20 ° to 60 ° receiving primary total knee arthroplasty were retrospectively studies. Steps of soft tissue releasing and residue deformity after each step were recorded. Postoperative follow-up was 12 months on average.
    RESULTS AND CONCLUSION: The 26 cases were recovered from knee flexion deformity after soft tissue release. Posterior capsular release was carried out in all cases to different extents, and the flexion deformity and postoperative range were corrected and greatly improved, respectively. These indicate that the posterior capsular release and lateral collateral ligament release can correct most of the flexion deformity, but increasing the distal femoral osteotomy is not necessary.

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    Comparison of Cryo/cuff Systems and intermittent cold compress with hypertonic saline following total knee arthroplasty
    Xu Xiao-hua, Li Xiao-feng, Xiong Yuan-fei
    2013, 17 (48):  8325-8330.  doi: 10.3969/j.issn.2095-4344.2013.48.005
    Abstract ( 324 )   PDF (859KB) ( 612 )   Save

    BACKGROUND: Swelling after knee arthroplasty can produce tension bullae, worsen pain, and even block venous return. Thus, intraventricular pressure of osseous fascia increases, which can block arterial blood circulation, even induce osteofascial compartment syndrome.
    OBJECTIVE: To evaluate efficacy of Cryf/cuff Systems and intermittent cold compress with hypertonic saline following total knee arthroplasty.
    METHODS: A total of 60 patients with unilateral total knee arthroplasty were randomly assigned into two groups. Persistent freezing group received treatment with Cryo/cuff Systems after arthroplasty, and intermittent cold group received intermittent cold compress with hypertonic saline after arthroplasty.
    RESULTS AND CONCLUSION: Significant differences in circumference differences in superior patellar pole, patellar midpoint, and thickest point of gastrocnemius muscle were detected between persistent freezing group and intermittent cold group at 1 and 2 days after total knee arthroplasty (P < 0.05), but no significant difference was detectable at day 3. Visual analogue scale scores at rest and during activity were significantly lower in the persistent freezing group than those in the intermittent cold group at 1 and 2 days after total knee arthroplasty (P < 0.01), but no significant difference was visible at day 3. Range of motion was better in the persistent freezing group than that in the intermittent cold group at 1, 2 and 3 days (P < 0.01), but no significant difference was observed at 1 and 2 weeks. Mean skin temperature was higher in the persistent freezing group than that in the intermittent cold group at 3 days (P < 0.05). Results suggested that Cryf/cuff Systems could lessen tissue swelling and pain, increased range of motion compared with intermittent cold compress with hypertonic saline at 1 and 2 days after total knee arthroplasty, but no significant difference was detected at day 3. That is, intermittent cold compress with hypertonic saline can reach the same effect as Cryf/cuff Systems at day 3.

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    Crowe IV developmental dysplasia treated by total hip arthroplasty with subtrochanteric osteotomy
    Gu Jian-ming, Du Hui, Shao Hong-yi, Zhou Yi-xin
    2013, 17 (48):  8331-8336.  doi: 10.3969/j.issn.2095-4344.2013.48.006
    Abstract ( 195 )   PDF (580KB) ( 482 )   Save

    BACKGROUND: Crowe IV developmental dysplasia of the hip is rarely seen clinically. However, when treated with routine total hip arthroplasty, severe deformities in the bone and soft tissue can lead to high rate of operation failure and increased occurrence of complications. Total hip arthroplasty in combination with subtrochanteric osteotomy may be an option to resolve this problem.
    OBJECTIVE: To retrospectively analyze the clinical outcome and safety of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy in 17 cases.
    METHODS: Twenty-one hips (17 cases) of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy were retrospectively analyzed and followed for at least 2 years from January 2006 to June 2011. Complications, hip function, and radiological changes were evaluated.
    RESULTS AND CONCLUSION: The mean follow-up period was (48.0±20.5) months. Harris’s score was increased postoperatively (P < 0.05). The main complains were lower limb length discrepancy, difficulty in standing up from squatting, muscle weakness, and soft tissue tightness. One greater trochanter fracture occurred and was fixed by hook plate fixation. There were four femoral shaft splits treated by cerclage. One patient represented with femoral nerve palsy and got partial recovery until the latest follow-up. There was no deep infection, dislocation or prosthesis loosening. Crowe IV developmental dysplasia of the hip could be effectively treated by total hip arthroplasty in combination with subtrochanteric osteotomy, which requires high surgical techniques to control the complications. Further follow-up is required for long-term results.

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    Femoral head replacement for unstable intertrochanteric fractures in aged patients
    Wang Guo-zhu, Mu Hui-jie, Nu Er-lan, Liu Li-bing, Wang Cheng-wei
    2013, 17 (48):  8337-8342.  doi: 10.3969/j.issn.2095-4344.2013.48.007
    Abstract ( 152 )   PDF (659KB) ( 493 )   Save

    BACKGROUND: Undergoing femoral head replacement in senile osteoporosis patients with intertrochanteric fracture is a challenging problem.
    OBJECTIVE: To explore the clinical effect of the use of joint installation and fracture reduction on the treatment of unstable intertrochanteric fractures in elderly patients.
    METHODS: A total of 21 elderly patients with unstable intertrochanteric fractures underwent femoral head replacement. Simultaneously, we collected clinical data of 20 elderly patients with unstable intertrochanteric fractures undergoing internal fixation of dynamic hip screw. Operation time, blood loss amount, time of walking practice after replacement, complications, and Harris score were compared between the two groups. Clinical effects in patients with femoral head replacement were observed.
    RESULTS AND CONCLUSION: All patients were followed up for averagely 20 months (ranged from 6 months to 36 months). After replacement, the incision was first healing. The operation time of femoral head replacement was short; blood loss amount was less; the time of walking practice was early. However, no significant difference in Harris score was detected between the two groups (P > 0.05). After femoral head replacement, no infection, inversion and shift, or hip joint loose occurred. Results suggested that correct anteversion angle, eccentricity and femoral calcar size should be identified before the implementation of artificial joint replacement for the elderly femoral intertrochanteric fracture. After implantation of the prosthesis, reduction and fixation of trochanter and femoral calcar bony landmarks are simple easily operated surgery. It can reduce blood loss amount, shorten operation time and elevate clinical effects.

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    Percutaneous pedicle screw-rod fixation using Sextant system in the treatment of thoracolumbar fractures: follow-up evaluation
    Ming Jiang-hua, Zheng Hui-feng, Zhao Qi, Chen Qing, Wang Gang
    2013, 17 (48):  8343-8348.  doi: 10.3969/j.issn.2095-4344.2013.48.008
    Abstract ( 537 )   PDF (708KB) ( 684 )   Save

    BACKGROUND: The effects of both conservative and traditional open reduction and internal fixation are dissatisfactory in the treatment of thoracolumbar fractures, however, minimal-invasive percutaneous pedicle screw-rod systems provide a new available method.
    OBJECTIVE: To investigate the clinical effect of percutaneous pedicle screw fixation using Sextant minimal-invasive system in the treatment of thoracolumbar fractures.
    METHODS: A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or open pedicle screw fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics, Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrolled in this study. They showed no neurological signs and symptoms. The operative time, intraoperablood loss, postoperative drainage amount, length of hospital stay, pre- and post-operative Cobb angle and anterior vertebral body height ratio were recorded and compared between two groups. 
    RESULTS AND CONCLUSION: Except two patients in open pedicle screw fixation group were lost after discharge, all other patients were followed up for 8-14 months. There were significant differences in operative time, intraoperative blood loss, postoperative drainage amount and length of hospital stay between two groups (P=0.000 0). The post-operative Cobb angle was significantly lower while anterior vertebral body height ratio was significantly higher at one week than those before fixation in two groups (P=0.000 0). No significant difference was found in correction loss between two groups at 8 months after operation. Experimental findings indicate that, percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, understanding the correct indications is very important for clinical application.

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    Topping-off technique for the protection of degenerative intervertebral disc
    Zhao Cheng, Xu Jian-guang, Lian Xiao-feng, Li Hao, Qiu Man-le
    2013, 17 (48):  8349-8354.  doi: 10.3969/j.issn.2095-4344.2013.48.009
    Abstract ( 585 )   PDF (662KB) ( 505 )   Save

    BACKGROUND: Topping-off technique can be used for fixation treatment through the combination of fusion and interspinous dynamic device, in order to prevent or slow down the adjacent lumbar segment degeneration. 
    OBJECTIVE: To obverse the protective effect of Topping-off technique (posterior lumbar interbody fusion procedure combined with the fixation of dynamic interspinous device Coflex) for the degenerative intervertebral disc.
    METHODS: A total of 32 patients with degenerative lumbar diseases who had been treated with Topping-off technique were included in this study. The Oswestry disability index, the Japanese Orthopaedic Association scores, range of motion for Coflex implanted segment and during the relative signal intensity of the Coflex implanted segment in MRI image were recorded and calculated preoperatively and the entire follow-up period.
    RESULTS AND CONCLUSION: All patients were followed-up for 20.6 months averagely. Up to the last follow-up, the Oswestry disability index and Japanese Orthopaedic Association scores were significantly improved when compared with those before treatment (P < 0.001). There was no significant difference in the range of motion for Coflex implanted segment before and after treatment (P=0.19). The relative signal intensity of the Coflex implanted segment was significantly improved when compared with that before treatment (P < 0.01). The clinical application of the Topping-off technique showed a protective effect on the intervertebral disc.

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    Long-term influence of selective consecutive three-level appliance of Solis cage on cervical curvature
    Chen Yan, Huang Yang-liang, Zhong Yi
    2013, 17 (48):  8355-8360.  doi: 10.3969/j.issn.2095-4344.2013.48.010
    Abstract ( 242 )   PDF (740KB) ( 367 )   Save

    BACKGROUND: With the understanding of pathology of cervical diseases, cervical curvature has become one of the important indexes of long-term clinical outcome. To restore and maintain cervical curvature has a profound impact on cervical long-term stabilization and cervical biomechanical environment.
    OBJECTIVE: To evaluate long-term influence of selective consecutive three-level appliance of intervertebral Solis cage on cervical curvature for spondylotic myelopathy.
    METHODS: From June 2008 to December 2010, 22 spondylotic myelopathy patients were treated with consecutive three-level anterior cervical Solis fusion. There were 14 males, 8 females, with an average age of 45.1 years (ranged from 26-73 years). There were two cases of C2/3/4/5, seven cases of C3/4/5/6, 12 cases of C4/5/6/7, and one case of C5/6/7/T1, totally 66 intervertebral spaces. All cases were followed up for 2 years.
    RESULTS AND CONCLUSION: Average blood loss amount was 40 mL (20-80 mL). Average operation time was 121 minutes (100–175 minutes). After follow-up for 30.7 months, all segments were fused. There was no implant migration or vertebral body collapse. Pre-operative JOA score was 11.94±3.61, 15.56±1.13 at 6 months post-operation, and 15.21±1.85 at 2 years after implantation. Pre-operative cervical curvature was (1.86±3.24) mm, (4.83±1.78) mm at 6 months post-operation, and (4.44±3.36) mm at 2 years after implantation. There were significant differences between pre-operative and at 6 months post-operation, pre-operative and at 2 years post-operation (P < 0.05). There was no significant difference between 6-month and 2-year post-operation (P > 0.05). Results indicated that selective consecutive three-level appliance of intervertebral cage for spondylotic myelopathy could improve cervical curvature and have long-term favorable clinical outcomes.

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    Meta analysis of intramedullary nail versus plate fixation in treatment of extra-articular distal tibial fractures
    Li Jian-gang, Wang Lei, Dong Zhe, Wang Feng-feng, Ma Gai-ping, Liu Mei-mei, Hu Fang
    2013, 17 (48):  8361-8367.  doi: 10.3969/j.issn.2095-4344.2013.48.011
    Abstract ( 166 )   PDF (582KB) ( 580 )   Save

    BACKGROUND: Intramedullary nail and traditional steel plate fixation have been widely used in the treatment of distal tibial (extra-articular) fractures, but these two kinds of methods have shortcomings. Some control studies attempt to answer the advantages and disadvantages of the issue on the treatment of extra-articular distal tibial fractures with intramedullary nail and steel plate fixation, but the conclusions are different.
    OBJECTIVE: To determine the efficiency and safety of intramedullary nail and plate fixation in the treatment of extra-articular distal tibial fractures by Meta analysis.
    METHODS: PubMed, Embase, Cochrane Library, CBMdisc, Weipu information database and Wanfang were searched by computer, and relevant Chinese and English orthopedic journals were hand-searched. Controlled trials related to intramedullary nail and plate fixation in the treatment of extra-articular distal tibial fracture were included. The quality of trials was critically assessed. RevMan 5.0 software was used for data analysis.
    RESULTS AND CONCLUSION: Four articles were included. Meta analysis showed that compared with the plate fixation, the malunion rate of the intramedullary nail for extra-articular distal tibial fractures increased. There was no statistical difference in the rate of nonunion rate, delayed fracture healing, and infection rate after operation. These indicate that intramedullary nail and plate fixation both have good effects on fracture healing.

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    Treatment of subtrochanteric femoral fractures with proximal femoral nail antirotation
    Zhao Hai-sheng, Xu Yao-zeng, Wang Gui-xian, Li Rong-qun
    2013, 17 (48):  8368-8373.  doi: 10.3969/j.issn.2095-4344.2013.48.012
    Abstract ( 398 )   PDF (823KB) ( 419 )   Save

    BACKGROUND: Biomechanical examinations have shown that intramedullary devices are stronger and have the advantages of fixation stability, which can reduce the risk of malunion and fixation failure. The choice of fixation implant is demanded and controversy in the fixation of subtrochanteric femoral fractures.
    OBJECTIVE: To evaluate the therapeutic effects of proximal femoral nail antirotation on the treatment of subtrochanteric femoral fractures.
    METHODS: Between June 2006 and November 2011, 17 patients with traumatic subtrochanteric fractures of the femur who received proximal femoral nail antirotation were selected from First Affiliated Hospital of Soochow University and retrospectively analyzed. There were nine cases of Seinsheimer type Ⅴ, two cases of Seinsheimer ⅡB, one case of Seinsheimer ⅢB and four cases of Seinsheimer Ⅳ, and one case of Seinsheimer type Ⅴ involving ipsilateral femoral shaft. Injury cause: high-energy injuries in16 cases, and low-energy damage in one case. Operation time, intraoperative bleeding, fracture healing time and limb functional recovery were recorded.
    RESULTS AND CONCLUSION: All the patients were followed for 8-24 months, 16.2 months on average. Postoperative X-ray films showed that the fracture healing time was averagely 5.4 months. All of the fractures were recovered well that subtrochanteric fractures, intertrochanteric fractures and femoral shaft fractures were all healed. There was no fracture displacement, internal fixation loosening and varus deformity. Only one case showed difficulties in nail insertion. Excellence rate of Harris hip functional scores was 88.2% postoperatively. Proximal femoral nail antirotation is a reasonable design, and the helical blade can resist the rotation and stabilize the angle. The proximal femoral nail antirotation has better effects, which is an ideal internal fixation for subtrochanteric femoral fractures.

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    Simvastatin compounded with Bio-Oss repairs rabbit mandibular defects
    Wang Yang, Jiao Xin, Liang Heng-yan, Ge Zhen-lin
    2013, 17 (48):  8374-8380.  doi: 10.3969/j.issn.2095-4344.2013.48.013
    Abstract ( 306 )   PDF (2648KB) ( 497 )   Save

    BACKGROUND: Studies have shown that simvastatin can promote bone formation, but there is still controversial on the osteogenic mechanism and osteogenic effect.
    OBJECTIVE: To explore the osteogenesis effect of the composite of simvastatin and Bio-Oss versus simple Bio-Oss material on the repair of rabbit mandibular defects.
    METHODS: Twelve New Zealand white rabbits were selected to establish alveolar bilateral mandibular defects models. The composite of simvastatin and Bio-Oss was implanted randomly in one side of defect region; Bio-Oss was simply implanted in the other side of defect region. Both sides were covered with Bio-Gide bilayer collagen membrane. Four rabbits in each group were sacrificed at 4, 8 and 12 weeks after implantation, and the general observation X-ray film, oral cone-beam CT imaging observation and histopathologic study and quantitatively were conducted to quantitatively and qualitatively comparative analyze the alveolar bone formation in the graft region.
    RESULTS AND CONCLUSION: At 4, 8 and 12 weeks after implantation, new bone formation was found and increased with time prolonging. With the gradual degeneration of high resistance fire Bio-Oss bone meal, the bone mineral density at different time points of the simvastatin composite Bio-Oss group was lower than that of the simple Bio-Oss group (P < 0.05). The percentage of bone formation in the simvastatin composite Bio-Oss group was significantly higher than that in the simple Bio-Oss group (P < 0.05). Simvastatin could accelerate Bio-Oss degradation and promote new bone formation in bone defects repairing.

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    Postoperative complications of complex proximal humeral fractures after treated with proximal humeral internal locking system plate fixation
    Ma Fu-yuan, Yang Tie-yi, Jiang Rui, Zhang Yan, Liu Yue, Shao Jin
    2013, 17 (48):  8381-8387.  doi: 10.3969/j.issn.2095-4344.2013.48.014
    Abstract ( 370 )   PDF (843KB) ( 564 )   Save

    BACKGROUND: Proximal humeral internal locking system fixation for complex humeral fractures via deltoid splitting approach provides good clinical results, but certain complications still existed.
    OBJECTIVE: To explore the postoperative complications and the related risk factors for displaced three-part and four-part fractures of proximal humerus treated with proximal humeral internal locking system fixation via  deltoid-splitting approach, and to propose the corresponding countermeasures.
    METHODS: 106 cases with displaced three-part and four-part fractures of proximal humerus were retrospectively analyzed. The relationship between postoperative complications and the related risk factors was analyzed with Logistic regression analysis.
    RESULTS AND CONCLUSION: A total of 81 patients were followed-up for 12 to 30 months. The mean Constant score at 12 months after operation was (76.57±4.70) points. The postoperative complications occurred in 31 patients (38.3%) of which impingement syndrome involved in 16 cases (19.8%), head-shaft angle loss in six cases (7.4%), head-shaft angle loss combined with screws cut-out in two cases (2.5%), pure screws cut-out in two cases (2.5%), humeral head necrosis in two cases (2.5%), fat liquefaction in five cases (6.2%). Single factor analysis showed that there were significant differences in the superiorly located greater tuberosity, superiorly located plate and Neer classification between impingement group and un-impinged group (P < 0.05). There were statistically significant differences in age, postoperative medial cortical defects and Neer classification between head-shaft angle loss group and un-loss group (P< 0.05). By means of logistic regression analysis, the superiorly located greater tuberosity, superiorly located plate and Neer classification were the individual predictors for postoperative impingement syndrome; postoperative medial cortical defect and Neer classification were the individual predictors for postoperative head-shaft angle loss.

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    Biomechanical properties of a magnesium alloy absorbable rib intramedullary nail
    Teng Ji-ping, Yang Zhi-yin, Cheng You-shuang, Ni Da, Zhu Zhi-jun, Zhu Yu-ming
    2013, 17 (48):  8388-8393.  doi: 10.3969/j.issn.2095-4344.2013.48.015
    Abstract ( 354 )   PDF (837KB) ( 852 )   Save

    BACKGROUND: At present, the materials that are successfully applied in rib fracture internal fixation mainly include titanium, nitinol rib encircling bone bonding plate, imported poly-L-lactic acid absorbable rib nails and anatomical plate.
    OBJECTIVE: To study the biomechanical characteristics of new magnesium alloy absorbable rib intramedullary nail in the rib fracture fixation, and to compare with imported poly-L-lactic acid absorbable rib intramedullary nail in order to provide scientific basis for clinical application.
    METHODS: Thirty fresh adult fifth rib specimens were collected, and the specimens were used to make models for the middle rib fractures. The specimens were fixed with AZ31B magnesium alloy absorbable rib intramedullary nail (magnesium alloy group) and poly-L-lactic acid absorbable rib intramedullary nail (poly-L-lactic acid group), and the normal rib specimen group was set as control. The biomechanical characteristics of the nails in each group were tested with stress analysis.
    RESULTS AND CONCLUSION: Three-point bending strength measurement results showed that the bending strength in the magnesium alloy group was close to the normal value of the specimen (P > 0.05), and there was significant difference in the bending strength between magnesium alloy group and the poly-L-lactic acid group (P < 0.05). Torsional strength measurement showed that there was no significant difference in torsional strength between magnesium alloy group and the normal specimens, and the results showed that the magnesium alloy was better than poly-L-lactic acid in fixation (P < 0.05). Tensile tests showed that the tensile strength and anti-pulling force of the magnesium alloy fixation were better than those of poly-L-lactic acid fixation (P< 0.05). The results indicate that the magnesium alloy absorbable rib intramedullary nail is better than poly-L-lactic acid absorbable rib intramedullary nail in strength and tensile strength, which is the ideal fixation material for rib fixation.

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    A meta-analysis of clinical effects of Bryan cervical disc replacement versus anterior cervical discectomy and fusion
    Li De-yi, Zhang Xu, Liu Chuan, Wu Ji-sheng
    2013, 17 (48):  8394-8400.  doi: 10.3969/j.issn.2095-4344.2013.48.016
    Abstract ( 243 )   PDF (747KB) ( 421 )   Save

    BACKGROUND: Bryan cervical disc replacement and anterior cervical discectomy and fusion have a dispute in the treatment of cervical spondylosis.
    OBJECTIVE: To evaluate the clinical effects of Bryan cervical disc replacement and anterior cervical discectomy and fusion by meta-analysis, thereby providing clinical evidence for treatment strategy of cervical spondylosis. 
    METHODS: The authors searched Medline, PubMed, EMBASE, OVID, CBM, CNKI and also searched manually seven relevant Chinese orthopedic journals for articles pertinent to clinical research of Bryan cervical disc replacement and anterior cervical discectomy and fusion. Extracted data included the range of motion of the cervical spine, visual analog scale score, neck disability index, the Japanese Orthopaedic Association score. Meta-analysis and forest plots were conducted with RevMan4.2.2 Software.
    RESULTS AND CONCLUSION: There are eight articles in the meta-analysis, including 883 patients (430 patients receiving Bryan cervical disc replacement, and 453 patients receiving anterior cervical discectomy and fusion). Meta-analysis did detect statistically significant differences in the range of motion of the cervical spine at 3 months and 24 months postoperatively between the two groups, but did not detect statistically significant differences in visual analog scale score, neck disability index, the Japanese Orthopaedic Association score between the two groups. These findings indicate that Bryan cervical disc replacement is superior to anterior cervical discectomy and fusion in the range of motion of the cervical spine. However, the current literature offers no evidence to support superiority of the Bryan cervical disc replacement over the anterior cervical discectomy and fusion.

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    Diagnosis and treatment of thrombosis during the perioperative period of joint replacement
    Li Shao-fei, Zhao Jian-ning, Guo Ting
    2013, 17 (48):  8401-8406.  doi: 10.3969/j.issn.2095-4344.2013.48.017
    Abstract ( 207 )   PDF (702KB) ( 480 )   Save

    BACKGROUND: The coagulation function of patients after joint replacement is enhanced during the perioperative time, the coagulation disorder can easily lead to the deep vein thrombosis, which will seriously affect the rehabilitation and prognosis of patients. The embolus falling off from venous thrombosis can lead to acute pulmonary embolism, severe cases can be life-threatening. So the early diagnosis of postoperative deep vein thrombosis and acute pulmonary embolism is very important.
    OBJECTIVE: To review the research progress of clinical diagnosis of thrombosis in the perioperative patients after orthopaedic joint replacement.
    METHODS: A computer-based retrieve in PubMed database and CNKI database were conducted by the first author for the articles on the clinical diagnosis of thrombosis in the perioperative patients after orthopaedic joint replacement from January 2008 to May 2013 with the key words of “arthroplasty, deep venous thrombosis, pulmonary artery embolism, risk factor, diagnostic approach, anticoagulant, perioperative period, research progress” in English and Chinese. A total of 165 articles were screened out, and finally 50 articles were included according to the inclusion criteria.
    RESULTS AND CONCLUSION: After joint replacement surgery, various risk factors were associated with the etiology and pathogenesis of deep venous thrombosis, such as vascular and tissue impairments, limb fixation, pain stress, and hemorrhagic fluid caused coagulation disorder, were the main reasons to thrombosis. Deep vein thrombosis and pulmonary embolism had variety of clinical manifestations, many diagnostic approaches were widely applied in clinic, but each one has its laminations. So the positive diagnosis intervention should be performed according to the common clinical manifestations, generally begin from the routine examinations of ultrasound and electrocardiogram, and the combination of various methods was preferred if necessary in order to increase the positive diagnosis rate to the maximum extent, and take drug intervention immediately after diagnosis to avoid the happening of adverse events. Several new types of oral anticoagulants appear in clinical trials, and the outcomes are very promising, but the widely clinical application needs further observation.

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    Comparison of different implants for internal fixation of intra-articular fractures of the proximal tibia
    Yang Chao
    2013, 17 (48):  8407-8412.  doi: 10.3969/j.issn.2095-4344.2013.48.018
    Abstract ( 226 )   PDF (842KB) ( 459 )   Save

    BACKGROUND: Intra-articular fractures of the proximal tibia are complex periarticular fractures, for which, the best implant is the focus of clinical attention.
    OBJECTIVE: To explore the application methods and therapeutic effects of different implants in the internal fixation of intra-articular fractures of the proximal tibia in order to choose the appropriate implants.
    METHODS: From April 2006 to May 2012, 41 patients with intra-articular fractures of the proximal tibia combined with ligament tissue injury were selected at the Second Department of Orthopedics, the 401st Hospital of Chinese PLA, who had received different implant internal fixations. According to the Schatzker classification, there were 18 cases of type IV, 12 of type V, and 11 of type VI. Bone defect also be bone; simultaneously or two rows ligament tissue repair observed fracture healing and functional recovery. Bone grafting was given in patients with bone defects, and ligament tissue repair was done simultaneously or at the second stage. Fracture healing and functional recovery were observed.
    RESULTS AND CONCLUSION: All the 41 patients were followed up for 6-36 months. Bristol scores in all the patients were 32-50, with a mean score of 46. Excellent was in 20 cases, good in 13 cases, and fair in eight cases. The excellent-good rate was 80%. Implants were removed in 29 of 41 cases within 12-28 months after treatment. Treatment methods are selected based on the type of fractures. Good reduction and stable internal fixation are necessary. Less Invasive Stabilization System can provide the maximal stability and lead to lowest probability of axial and lateral fracture deviation and the lowest incidence of complications, which is the best choice.

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    Comparison of various drainage methods for postoperative cerebrospinal fluid leakage in cervical vertebra
    Ma Liang, Sheng Wei-bin, Deng Qiang
    2013, 17 (48):  8413-8418.  doi: 10.3969/j.issn.2095-4344.2013.48.019
    Abstract ( 859 )   PDF (854KB) ( 583 )   Save

    BACKGROUND: Numerous studies have demonstrated various therapeutic methods for cerebrospinal fluid leakage after spinal column surgery, including intraoperative and postoperative measures. Few studies addressed the therapeutic methods of cerebrospinal fluid leakage after cervical vertebra surgery using lumbar subarachnoid catheter drainage.
    OBJECTIVE: To evaluate the therapeutic efficacy of sustainable drainage and lumbar subarachnoid catheter drainage for cervical postoperative cerebrospinal fluid leakage.
    METHODS: 923 patients underwent cervical spine surgery in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, China from June 2009 to October 2012. There were 24 cases of postoperative cerebrospinal fluid leakage with an incidence of cerebrospinal fluid leakage of 2.6% (24/923). The dural laceration that could not be repaired or be found induced cerebrospinal fluid leakage. Of them, 12 cases received lumbar subarachnoid catheter drainage (catheter group), and 12 cases received sustainable drainage (drainage group).
    RESULTS AND CONCLUSION: Compared with the drainage group, the duration of cerebrospinal fluid leakage was significantly shorter in the catheter group (P < 0.05). In the catheter group, one case affected cerebrospinal fluid infection. In the drainage group, two cases experienced cerebrospinal fluid cyst and one case suffered from cerebrospinal fluid infection. They were cured by symptomatic treatment. A total of 24 cases were followed up for 9-12 months. None of them affected cerebrospinal fluid leakage, cerebrospinal fluid infection or cerebrospinal fluid cyst. Results demonstrated that lumbar subarachnoid catheter drainage in the treatment of cervical postoperative cerebrospinal fluid leakage has a good effect.

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    Allograft cancellous bone combined with autologous red marrow for treatment of periarticular fractures
    Kong Zhi-gang, Chen Yong-bao, Sun Lei
    2013, 17 (48):  8419-8428.  doi: 10.3969/j.issn.2095-4344.2013.48.020
    Abstract ( 99 )   PDF (315KB) ( 446 )   Save

    BACKGROUND: Bone defects often occur after the reduction of periarticuar fractures, and bone grafting is required to fill bone defects, thereby to make the early support of articular surface and prevent the collapse and shift of the articular surface. Allograft cancellous bone is the transplant material for the treatment of bone defects, but its osteogenesis ability is poor. Autologous red marrow has osteogenesis ability. Therapeutic efficiency of allograft cancellous bone combined with autologous red marrow for periarticular fractures is still yet to be assessed.
    OBJECTIVE: To study clinical effect of locking plate fixation and allograft cancellous bone combined with autologous red marrow in the treatment of periarticular fractures.
    METHODS: Forty-three cases of periarticular fractures were incorporated into the Orthopaedics Department of the Third Hospital of Hebei Medical University. After cutting the articular surface anatomically, composite particles of the red marrow and allograft cancellous bone were implanted into bone defects, and then, an anatomic locking plate was used. Medial lateral or bilateral locking plate was used for tibial plateau fractures. Dorsal or volar locking plate was used for distal radius fractures, and distal tibial medial or lateral locking plate was used for distal tibial fractures.
    RESULTS AND CONCLUSION: Forty-three patients were followed up for 12 months to 6 years, an average of 4.3 years. X-ray films and CT scans review showed that 43 patients’ collapse fracture all reached bony union. Fresh fracture healing time was 2-6 months, an average of 4 months; the healing time for old fracture was 3-   7 months, an average of 5.5 months. After bone grafting, 43 patients all had no significant immune rejection, two cases showed more wound exudates, and the wound was healed by dressing after 2 weeks. One case had wound infection, the wound was healed after 4 weeks of draining and dressing, and the infection had no recurrence following up for 4 years and 1 month. Forty patients were satisfied with bone grafting, accounting for 93%, and three cases dissatisfied, accounting for 7%, based on Mankin and Komender’s standard assessment. The results confirmed that allograft cancellous bone combined with autologous red marrow transplantation can play a supporting role in treating periarticular fractures to prevent the collapse of the articular surface and fracture displacement, and to provide reconstruction materials for periarticular defects. Its long-term goal is fracture healing.

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    Optimized surgical treatment for osteoporotic hip fractures in the elderly
    Chen Peng, Liu Wen-he, Yan Lin-lin, Guo Zhi-wen, Tang Xin-wen, Hu Wei-wen, Cao Xi-wen, Wang Fu-jian, Li Yang, Chen Jia-yu
    2013, 17 (48):  8429-8436.  doi: 10.3969/j.issn.2095-4344.2013.48.021
    Abstract ( 135 )   PDF (358KB) ( 492 )   Save

    BACKGROUND: Active surgical treatments are preferred for elderly hip fractures. Individual fixation method is chosen according to fracture site, type, age and whether there are basic diseases in internal medicine, which plays an important role in the successful treatment of elderly hip fractures.
    OBJECTIVE: To explore the effects of optimized surgical treatment on osteoporotic hip fracture in the elderly.
    METHODS: Totally 176 patients with osteoporotic hip fracture were treated by different methods between January 2000 and January 2012, including 63 males and 113 females, with a mean age of (76.7±6.3) years. Out of the 84 cases of interchanteric fracture, seven cases were treated with conservative methods, 34 cases were treated with dynamic hip screw internal fixation, 18 cases were treated with cannulated screw internal fixation, seven cases were treated with anatomical plate internal fixation, 12 cases were treated with bipolar femoral placement, and six cases were treated with total hip arthroplasty. Out of the 92 cases with femoral neck fractures, 40 cases were treated with bipolar femoral placement, 37 cases were treated with total hip arthroplasty and 15 cases were treated with cannulated screw internal fixation. Modified Harris hip function scores were used to evaluate the therapeutic effects of different treatment methods. Complications were observed.
    RESULTS AND CONCLUSION: Seventy-six cases of interchanteric fractures and 85 cases of femoral neck fractures were followed-up for 8-26 months with an average of (5.7±1.3) months. Three cases suffered from post-operative infection, and one case died due to cardio-pulmonary failure in 10 days after operation. Both intraoperation and postoperative complications included femoral head cutting, intraoperative fracture, internal fixation and prosthetic loosening, postoperative fracture, avascular necrosis of femoral head, coxa vara, legs shorten, and delayed fracture healing. The incidence rates of complications in patients undergoing bipolar femoral placement and total hip arthroplasty were significantly lower than those treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P < 0.05). The outcomes of the treatment according to Harris scoring criterion were better in patients treated with bipolar femoral placement and total hip arthroplasty than in patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P < 0.05). No significant differences were found in the incidence rate of complications and Harris scores among patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P > 0.05). No significant differences were found in the incidence rate of complications and Harris scores between patients treated with bipolar femoral placement and total hip arthroplasty (P > 0.05). These findings indicate that the treatment of osteoporotic hip fracture in the elderly can achieve satisfactory results if the comprehensive therapies are given. Bipolar femoral placement and total hip arthroplasty are preferred for elderly femoral neck fractures.

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    Predicting the prognosis of elderly hip fracture: Difference in two kinds of scores
    Wu Liang, Yang Tie-yi, Hao Wei, Zhang Yan, Liu Yue, Fan Xin-bin
    2013, 17 (48):  8437-8442.  doi: 10.3969/j.issn.2095-4344.2013.48.022
    Abstract ( 338 )   PDF (592KB) ( 607 )   Save

    BACKGROUND: Patients with elder hip fracture has more complications, poor affordability and high perioperative risk, so the preoperative full preparation and evaluation are needed. 
    OBJECTIVE: To predict the accuracy of the prognosis of elderly patients with hip fracture through comparing the difference between American Society of Anesthesiologists score and Daping orthopedics operation risk scoring system for senile patients.
    METHODS: A retrospective study was performed on 300 cases with elderly hip fracture selected from January 2011 to December 2012 from Department of Orthopedics, Gongli Hospital of Pudong. American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients were conducted before treatment, and the predictive values of two scoring systems on the incidence of complications and mortality were compared.
    RESULTS AND CONCLUSION: According to the American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients, 148 cases and 97 cases had complications respectively. On the contrary, the actual number of complications was 89. The former predicted value was significantly higher than the actual value, and there was no significant difference between the latter forecast value and the actual value. The numbers of death predicted by American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients were 27 cases and six cases, but the actual number of death was three cases, indicating that former predicted value was significantly higher than the actual value, and there was no significant difference between the latter predicted value and the actual value. The American Society of Anesthesiology score has a certain errors in predicting the postoperative complications and mortality of patients with elderly hip fractures, but it is simple and useful in clinic. The Daping orthopedics operation risk scoring system for senile patients can accurately evaluate elderly hip fracture operation risk, and can predict the postoperative complications and mortality more objective when compared with the American Society of Anesthesiology score.

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    Bone graft and internal fixation for the treatment of hemivertebrae and severe congenital kyphoscoliosis: Effectiveness and safety of three-dimensional correction
    Wang Xiao-ping, Lu Ming, Ma Hua-song, Zhou Jian-wei, Yuan Wei, Niu Jing, Cui Kai, Chen Yang, Huang Zi-rui, Qin Liu-hua, Zheng Rui, Zhang Jing
    2013, 17 (48):  8443-8448.  doi: 10.3969/j.issn.2095-4344.2013.48.023
    Abstract ( 206 )   PDF (643KB) ( 497 )   Save

    BACKGROUND: Clinical treatment of hemivertebrae-induced congenital scoliosis is a complex medical problem.
    OBJECTIVE: To find the optimal treatment for hemivertebrae accompanied by congenital scoliosis.
    METHODS: Totally 142 hemivertebrae patients who had received surgical treatment in the Department of Orthopedics, the 306 Hospital of Chinese PLA, China from 2010 to 2012 were enrolled. The main surgical treatment was hemivertebrae resection and bone fusion with internal fixation, apical osteotomy for severe scoliosis and spinal shortening with internal fixation, one-stage posterior thoracolumbar osteotomy with internal fixation, spinal decompression with internal fixation.
    RESULTS AND CONCLUSION: After treatment, the average correction rate was 70.9% for scoliosis and 71.7% for kyphosis. The follow-up period was 14-35 months, with an average of 23.4 months. By the end of the final follow-up, the loss rate for Cobb’s angle was 7.3% for scoliosis and 7.7% for kyphosis. Follow-up X-ray films showed bone fusion and internal fixation without loosening, fracture, and decompensation. Implementation of one-stage posterior thoracolumbar osteotomy with internal fixation can effectively correct hemivertebrae-induced kyphoscoliosis to obtain a satisfactory spinal sagittal and coronal balance.

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    CT-guided percutaneous intervention combined with rehabilitation integration treatment for lumbar disc herniation
    Dai De-chun, Tong Guo-hai, Bian Lian-long, Tang Chun-lin, Zhu Wei-fang, Mei Lin-feng, Shi Chang-gen, Jiang Hao, Hang Fang-jie
    2013, 17 (48):  8449-8454.  doi: 10.3969/j.issn.2095-4344.2013.48.024
    Abstract ( 606 )   PDF (941KB) ( 486 )   Save

    BACKGROUND: CT-guided percutaneous intervention and rehabilitation techniques are both classic programs for diagnosis and treatment of lumbar disc herniation. Is the combination of CT-guided percutaneous intervention and rehabilitation techniques preferentially used for treatment of lumbar disc herniation?
    OBJECTIVE: To evaluate the curative effect of CT-guided interventional injection combined with rehabilitation integration treatment for lumbar disc herniation and to analyze prognostic factors.
    METHODS: Eighty-eight patients with lumbar disc herniation were subjected to CT-guided interventional injection combined with rehabilitation integration treatment from May 2010 to May 2013. Injection medicine consisted of betamethasone, tanshinone Ⅱ A sulfonate, neurotropin, normal saline and iohexol. Rehabilitation integration treatment included traction, manipulation, acupuncture, transcutaneous electrical nerve stimulation and thermal magnon. Macnab criteria and Chinese version of Oswestry low back pain disability questionnaire were used to assess the curative effects in comparison with the 112 patients receiving only CT-guided interventional injection that were reported previously. The prognostic factors, such as age, disease course time and herniation type of target segment were testified by correlation analysis.
    RESULTS AND CONCLUSION: Totally 77 patients were completely followed up for 1 year. There were excellent outcomes in 64 cases, while favorable outcomes in 7 cases, fair outcomes in 5 case, poor outcome in 1 case, with a better outcome rate of 92%.There was a significantly decreased trend in Oswestry disability Index scores at 1, 6, 12 months during the follow-ups (P < 0.01). No severe complications occurred in all the included patients. The curative effects were improved in term of better outcomes rate compared with the 112 patients receiving only CT-guided interventional injection, but there was no significant difference (P  > 0.05). The young group (≤ 45 years) had better outcomes than the older group (> 45 years; P  < 0.01). In addition, disease course time and herniation type of target segment were not statistically significant risk factors predicting clinical results (P  > 0.05). These findings indicate that CT-guided interventional injection combined with rehabilitation integration treatment could relieve lower back pain and radical leg pain effectively and decrease life disability level.

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    Imaging comparison for avascular necrosis of the femoral head induced by different etiologies
    Zhang De-zhou, Yi Xue-bing, Zhong Jian
    2013, 17 (48):  8455-8460.  doi: 10.3969/j.issn.2095-4344.2013.48.025
    Abstract ( 215 )   PDF (620KB) ( 489 )   Save

    BACKGROUND: Imaging examination is the main strategy for clinical diagnosis of avascular necrosis of the femoral head. However, comparative studies of imaging findings between different causes of avascular necrosis of the femoral head are rarely reported.
    OBJECTIVE: To compare imaging findings between different causes of avascular necrosis of femoral head, and to determine whether the imaging findings of different causes of avascular necrosis are different.
    METHODS: A total of 54 cases of avascular necrosis of the femoral head (60 hips) were confirmed by clinical and imaging findings, and divided into idiopathic, alcoholic, hormonal and femoral neck fractural groups according to the causes. X-ray, CT, MRI findings of these four kinds of avascular necroses were analyzed.
    RESULTS AND CONCLUSION: Sixty hips of avascular necrosis of the femoral head included 12 idiopathic hips, 21 alcoholic hips, 15 hormonal hips, and 12 femoral neck fractural hips. X-ray and CT main performances were as follows: “star sign” deformation or disappearance of the femoral head; positive “crescent” sign, mild 
    bone fracture, mild collapse of the articular surface; femoral head deformation, bone fracture, articular surface collapse, hip degeneration. MRI of four categories of avascular necroses appeared as phase Ⅰ: line-like low signal of weight-bearing area of femoral head on T1WI, high signal on T2WI as the main change. Phase Ⅱ: clear boundary crescent-shaped uneven signal on T1WI, T2WI displayed moderately higher, uneven slightly lower signal around, showing a typical two-line sign. Phase Ⅲ: femoral head deformation, subchondral fracture, collapse, crescent formation, zonal low signal on T1WI, medium or high signal on T2WI. Phase Ⅳ, Ⅴ: complete destruction of articular cartilage, joint space narrowing, significant collapse and deformation of the femoral head, non-specific secondary osteoarthritis of the acetabulum, such as sclerosis, cystic degeneration and marginal osteophyte. The X-ray, CT, MRI performances of four types of avascular necroses at the same period were basically the same.

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