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28 May 2010, Volume 14 Issue 22 Previous Issue    Next Issue

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Meta analysis of total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in elderly patients Liao Liang, Zhao Jin-min, Su Wei, Sha Ke, Ding Xiao-fei 2010, 14 (22):  3991-3995.  doi: 10.3969/j.issn.1673-8225.2010.22.001 Abstract ( 151 )   PDF (370KB) ( 579 )   Save BACKGROUND: Total hip arthroplasty (THA) and hemiarthroplasty (HA) are effective therapies for displaced femoral neck fractures in eldery patients, but the choice of two procedures in the clinical treatment remains controversial. OBJECTIVE: To assess the effects of THA versus HA for optimal treatment of femoral neck fracture in the elderly. METHODS: A computer-based online search of Cochrane central register of controlled trials (first book in 2009), Medline (1966-01/2009-05), EMbase (1984-01/2009-05) and CBM (1979-01/2009-05), CNKI (1979-01/2009-05). Only RCTs that comparing THA with HA in treatment of femoral neck fracture in the elderly were included in a meta-analysis regarding mortality, reoperations and complications. The analysis was performed with software RevMan5.0.18 from the Cochrane collaboration. RESULTS AND CONCLUSION: A total of 7 RCTs with a total of 648 participants were included. The meta-analysis showed the mortality and postoperative infection rates between THA and HA groups were not significantly different; the average operating room time and blood loss volumes in the THA group were greater than the HA group (P < 0.001). Revision in long-term follow up in the THA group were lower than the HA group (RR = 0.28, 95%CI = 0.12-0.66, P = 0.003). The dislocation in medium-term follow-up in the THA group were greater than the HA group (RR=3.45, 95%CI =1.29-9.19, P = 0.01). The rate of the pain in long-term follow-up in the THA group were lower than the HA group (RR = 0.12, 95%CI = 0.05-0.30, P < 0.000 01). The mobility in the THA group was better than the HA group (RR = 1.32, 95%CI = 1.04-1.68, P = 0.02). Results suggest that, in short-term follow up there was no difference in mortality, reoperation, dislocation, pain, mobility, wound infection rates between the THA and the HA groups; the dislocation occurred in the THA group more frequently than the HA group in medium-term follow up; while, the revision and pain occurrance in the THA group were less than the HA group, and the mobility of the THA group was more superior than the HA group in long-term follow up. Related Articles | Metrics

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Role of cervical three-dimensional motion on contact pressures of facet joint Zhao Wei-dong, Xu Bo, Zhang Mei-chao, Fan Ji-hong 2010, 14 (22):  3996-3999.  doi: 10.3969/j.issn.1673-8225.2010.22.002 Abstract ( 117 )   PDF (302KB) ( 463 )   Save BACKGROUND: Contact pressure of facet joint acts an important role in physiological motion. However, there is lack of direct measurement for contact pressures of cervical facet joint. OBJECTIVE: To measure the contact pressure variation of facet joint following cervical multi-level three-dimensional motion and to explore effect of cervical facet joint on stress distribution and segment motion regulation. METHODS: Totally 6 adult fresh cervical spinal specimens (C2-7) were tested. Pressure sensitive film was put into left-side facet joints of C3-4, C4-5 and C5-6 segments. Firstly, 75 N of the follower load was applied, and then a three-dimensional movement was performed with the continuous load model. Contact pressures of facet joint were measured in 0 Nm and 2.0 N•m (flexion/extension, left/right lateral bending) and 4.0 N•m moment (left/right axial rotation). RESULTS AND CONCLUSION: In the neutral position, contact pressure of left-side facet joint of C3-4, C4-5 and C5-6 received 20.6%, 20.0% and 21.3% load of the 75 N follower loads respectively. Contact pressure of left-side facet joint increased significantly in extension, left lateral bending and right axial rotation in all segments (P < 0.05), but not obviously changed in flexion, right lateral bending and left axial rotation. There was no significance among three segments (P > 0.05). Contact pressure variation of facet joint was affected by facet inclined degrees and load direction. It is indicated that cervical facet joint acts an important role in stress distribution and segment motion regulation. Related Articles | Metrics

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Biomechanical analysis of simulating pulling, extension and compression on the three-dimensional finite element model of lumbar segments Zhang Xiao-gang, Dong Jian-hua, Yang Xue-feng, Li Ju-bao, Li Yan-hong 2010, 14 (22):  4000-4004.  doi: 10.3969/j.issn.1673-8225.2010.22.003 Abstract ( 136 )   PDF (407KB) ( 557 )   Save BACKGROUND: Computer and finite element methods have been used to explore manipulation treatment. OBJECTIVE: To explore the mechanism of manipulation treatment of lumbar intervertebral disc protrusion, investigate a way consistent with the treatment of biomechanics and confirm the safety scope of the manipulation of lumbar disorders. METHODS: One adult male volunteer with no spinal disorders, aged 28 years, 170 cm height and 60 kg body mass was subjected to CT scanning of the L3-S1 using Adina component-based software, and assigned different materials attributes to different tissues to establish lumbar spine finite element model. The level of lumbar spine position, extension 10 °, flexion 30 ° were set and subjected to pulling, extension and compression loads to observe force change of lumbar intervertebral disc, nucleus pulposus and annulus fibrosus. RESULTS AND CONCLUSION: Under pulling, extension and compression states, the intervertebral disc displayed the most obvious displacement, strain and stress changes at lumbar flexion 30 °, suggesting treatment of lumbar spinal disorders is safe in certain conditions. Related Articles | Metrics

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Multiple-plane reconstruction of the proxinal femoral canal using three-dimensional CT scans: A morphological study   Zuo Jian-lin, Liu Lin, Ying Hong-liang, Lin Ye, Gao Zhong-li, Wang Wen-jun 2010, 14 (22):  4005-4009.  doi: 10.3969/j.issn.1673-8225.2010.22.004 Abstract ( 95 )   PDF (317KB) ( 356 )   Save BACKGROUND: The morphological characteristics of the proximal femoral canal are crucial for the fitting and long-term stability of the femoral stem, but there is still no morphological study on the multiple-plane reconstruction of the proximal femoral canal applying the three-dimensional CT scans. OBJECTIVE: To find out the three-dimensional morphological characteristics of the proximal femoral canal, which can be used as guidelines for operation and prosthesis design. METHODS: A total of 50 pieces (25 pairs) of normal Chinese corpse femurs were harvested from the Anatomy Department, School of Basic Medicine of Jilin University. CT scan and then multiple-plane reconstructions of these femurs were done. Standard planes were selected from the coronal, sagittal and axial reconstruction images, and the following parameters were measured: the bow angle of femur, the length of the proximal femoral canal, the inclination angle of calcar on the sagittal plane, the inclination angle of the medial wall of the metaphyseal canal and the anteversion angle of the femoral neck. Pearson binary correlation analysis was applied to clarify the correlation of these parameters. RESULTS AND CONCLUSIONS: The length of the proximal femoral canal was (175.6±8.6) mm; the bow angle was (10.6±1.8)°. On the sagittal plane the inclination angles of calcar in the medial, middle and lateral part were (12.7±1.2)°, (6.3±0.9)° and (0.3±0.06)° respectively. The inclination angle of the medial wall of the metaphyseal canal was (18.8±2.7)° and the anteversion angle was (11.0±2.3)°. Correlation analysis showed a positive correlation between the bow angle and the anteversion angle. On the sagittal plane the axis of the calcar rotated toward the axis of the proximal femoral canal from medial to lateral. Although the proximal femur shows a bowing appearance, the proximal femoral canal is straight. For primary total hip arthroplasty, straight femoral stem fits better the proximal Chinese femoral canal. The inclination angle of the medial wall of the metaphyseal canal should use an important parameter for prosthesis selection. Related Articles | Metrics

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Establishment of three-dimensional finite element model of maxillary anterior teeth, periodontal tissues and orthotic devices    Lu Hong-fei, Ai Hong, Mai Zhi-hui, Chen Qi, Chen Yue 2010, 14 (22):  4010-4013.  doi: 10.3969/j.issn.1673-8225.2010.22.005 Abstract ( 121 )   PDF (249KB) ( 431 )   Save BACKGROUND: Teeth and their sustentacular tissues are characterized by irregular shapes, variant mechanical properties, as well as complex stress distribution, which result in difficulty in simulating their stress states. A series of maxillary dentition finite element model (FEM) with high precision has been established since Tanne established the first maxillary central incisor finite element model. However, studies with regard to maxillary anterior teeth combined with orthotic devices are rarely reported.  OBJECTIVES: To establish a high precision three-dimensional FEM of maxillary anterior teeth segment-periodontal tissues-orthotic devices using thin-layer CT technique combined with image processing softwares and three-dimensional modeling. METHODS: A healthy young woman was selected to get CT scan on maxillary anterior teeth segment, periodontal supporting tissues, treatment devices and a three-dimensional FEM was generated, including maxillary anterior teeth segment, periodontal tissues (periodontium, cortical bone, cancellous bone) and orthotic devices (brackets and wire). RESULTS AND CONCLUSIONS: The three-dimensional FEM of maxillary anterior teeth was established, and divided by three pyramid tetrahedron structure, which consisted of 131 920 elements and 194 321 nodes. The three-dimensional FEM of maxillary anterior segment exhibits a better geometric similarity and mechanical similarity. By simplifying periodontium as linear elastic material, this model benefits further analysis and optimizations biomechanical design.   Related Articles | Metrics

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Establishment of a three-dimensional finite element model of rapid canine tooth movement in periodontal ligament distraction   Zhao Xi, Mi Cong-bo, Jumanjiang•Maimaiti, Li Jiang-bo, Wang Wei, Han Rui 2010, 14 (22):  4014-4017.  doi: 10.3969/j.issn.1673-8225.2010.22.006 Abstract ( 177 )   PDF (286KB) ( 542 )   Save BACKGROUND: To accelerate orthodontic movement speed and shorten treatment course is the focus in recent studies. Some researchers propose the concept of peridental ligament distraction osteogenesis, which is one special application type of distraction osteogenesis. This method has been used in clinical orthodontic treatment and can accelerate canine teeth movement, significantly shorten treatment duration, and improve correction efficacy. It provides a novel approach to shorten long treatment course. OBJECTIVE: To establish three-dimensional finite element model (3-D FEM) with better similarity of rapid canine tooth movement in periodontal ligament distraction. METHODS: By using scanning of spiral CT with 64 rows, the sectional image data in DICOM of TMJ, mandible and lower tooth were acquired. With the help of Mimics, Geomagic Studio 8.0, Unigraphics NX and Ansys 11.0 software, the 3-D FEM of rapid canine tooth movement in periodontal ligament distraction, including TMJ, mandible, lower tooth and periodontal ligament was established. RESULTS AND CONCLUSION: A 3-D FEM of rapid canine tooth movement in periodontal ligament distraction was established, which consisted of 39 060 elements and 76 103 nodes. Furthermore, we could add or delete the framework according to different research demands. Related Articles | Metrics

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Analgesia following artificial joint replacement joint replacement: Nerve block based on gait analysis Zhang Hao-hua, Yan Song-hua, Xu Li, Yang Jin, Liu Zhi-cheng 2010, 14 (22):  4018-4022.  doi: 10.3969/j.issn.1673-8225.2010.22.007 Abstract ( 116 )   PDF (248KB) ( 388 )   Save BACKGROUND: Analgesia following artificial joint repacement commonly utilizes patient-controlled method, which has many side effects. Continuous peripheral nerve block analgesia is safe and effective, but it may affect activity of patients following artificial joint repacement due to local numbness. Currently, studies are few regarding gait analysis used to evaluate effect of different analgesia methods on early activities of patients following artificial joint repacement. OBJECTIVE: To compare the effect of continuous nerve block (including femoral nerve block and fascia iliaca compartment block) and patient-controlled intravenous analgesia (PCIA) for postoperative pain control on gait after total hip and knee replacement. METHODS: A total of 17 volunteer subjects were selected including 7 injected with PCIA after operation, 6 with femoral nerve block and 4 with fascia iliaca compartment block. Subjects were asked to walk at their own paces with barefoot on a 10 m walkway with a 0.5m footscan® plate (footscan® from RSscan International, Olen, Belgium). Barefoot walking gaits were compared before and after replacement.  RESULTS AND CONCLUSION: There were no significant differences between continuous nerve block and PCIA for postoperative pain control in the parameters (P > 0.05). The parameter changes in patients undergoing fascia iliaca compartment block were less than PCIA patients (P < 0.05). Of 17 patients, effects of fascia iliaca compartment block were superior over PCIA, and femoral nerve block was similar to PCIA following artificial joint replacement. Related Articles | Metrics

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Accuracy of multi-slice spiral CT images assisting mini-implant anchorage surgery Chen Jing-yi, Shan Li-hua, Liu Ying-qi, Jiao Jian-jun, Shi Dong-ye 2010, 14 (22):  4023-4026.  doi: 10.3969/j.issn.1673-8225.2010.22.008 Abstract ( 130 )   PDF (296KB) ( 460 )   Save BACKGROUND: Compared with traditional orthodontic anchorage, bone implant anchorage displays advantages in treating intractable cases. However, the failure rate exists. To extend and apply the miniscrew anchorage system, the key methods  improved the stability of miniscrews, which is based on accurate diagnosis and analysis to the local alveolar bone. OBJECTIVE: To evaluate the accuracy of various multi-slice spiral CT (MSCT) images assisting implant anchorage surgery and explore the factors associated with the accuracy. METHODS: Following design of the implant anchorage angles in various MSCT images accurately, 32 titanium miniscrews were implanted in procine skull. The anchorage angles on MSCT images again and the buccalingual breaths of alveolar process by insert angle were measured. The skulls were dissected, and the implant anchorage angles and the breadths of alveolar process were measured on anatomic bone samples. The various MSCT images data and pits’ skull sample data were compared. RESULTS AND CONCLUSION: Their concordance correlations between MSCT length and angle measurement data and the anatomic bone samples were good. But all MSCT data were smaller than the anatomic samples data. The accuracy of 2D images was better than 3D images. The measurement accuracy of angles was better than lengths. The accuracy of axial sections were better than that of cross-sections in 2D and 3D MSCT images. MSCT images can provide accurate quantity information in the ration 1:1 to material object. It is accurate and reliable that MSCT images assist implant anchorage surgery. On measurement, the 2D axial and 2D cross-sectional images play the most important role on clinical application. The measurement accuracy of cross-sectional images is affected by scanning plane of MSCT radio active rays. Related Articles | Metrics

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Evoked potential analysis and dipole localization by magnetic stimulation on acupoint of Shenmen (HT 7) acupoint Geng Yue-hua, Xu Gui-zhi, Yu Hong-li, Chen Ya-jing, Li Wen-wen 2010, 14 (22):  4027-4031.  doi: 10.3969/j.issn.1673-8225.2010.22.009 Abstract ( 134 )   PDF (328KB) ( 471 )   Save BACKGROUND: Magnetic stimulation is a new kind of non-invasive and painless stimulation technique, which can substitute acupuncture or electric acupuncture. Electroencephalogram (EEG) can show the active state of brain nerves, thus, magnetic stimulating acupoint related to brain nerves, measuring and analyzing the EEG signals can study the effect of magnetic stimulation on acupoint. OBJECTIVE: To stimulate acupoint of Shenmen (HT 7) using magnetic stimulation with different frequencies, in addition, to study the evoked potentials (EPs) and dipole localization of EEG at 4 states. METHODS: A total of 6 male and 4 female volunteers were selected, aged 20-30 years. They had no experimental experience or formal psychiatric history. They kept eyes closing during the experiment. Magnetic stimulate acupoint of Shenmen (HT 7) at right hand of volunteers in frequencies of 3 Hz, 1 Hz and 0.5 Hz. The experiment of every frequency was divided into 4 tests: quiet, magnetic stimulation, mock stimulation and mock point. The amplitude and latency of EPs at 4 states and the coronal, sagittal and axial plane of dipole localization of EPs were observed. RESULTS AND CONCLUSION: The 4-states experiments of 0.5 Hz and 1 Hz had no obvious EPs. Quiet state and mock stimulation state of 3 Hz had no obvious EPs. Magnetic stimulation state induced EP of P300, somatosensory evoked potentials and other potentials were restrained. Mock point induced P300 and also induced obvious SEPs and other potentials. Dipole localized to magnetic stimulation state and mock point state. It can be defined that there are two dipoles by Principal Components Analysis PCA. The dipoles of magnetic stimulation state located in frontotemporal area, the dipoles of mock point state were dispersed. The EEG signals were obviously restrained when magnetic stimulate on acupoint of Shenmen (HT 7). It also has the effect of adjusting neural function the same as acupuncture. Related Articles | Metrics

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Clinical application of individual digital reconstruction technology in cranio-maxillofacial deformities Ou Fei, Duan Shi-jun, Zhang Jin-ge, Gong Ha-ni, Tian Wei-dong, Tang Wei 2010, 14 (22):  4032-4035.  doi: 10.3969/j.issn.1673-8225.2010.22.010 Abstract ( 167 )   PDF (264KB) ( 539 )   Save BACKGROUND: Because of the complexity of skeleton anatomy relationship of cranio-maxillofacial region, traditional methods cannot exactly exhibit the characteristics of cranio-maxillofacial region deformities, and cannot simulate preoperative surgery. Digital model surgery technique can provide a real cranial phantom, reflect details of skull structure, and exactly solve some problems such as cranio-maxillofacial repair symmetry. OBJECTIVE: To explore clinical application effects of individual digital surgery in reconstruction and repair of cranio-maxillofacial complex deformities. METHODS: A total of seven patients with cranio-maxillofacial complex deformities were selected from West China Stomatology Hospital, Sichuan University between 2008 and 2009. CT scanner was employed to scan the patient heads and faces and to obtain three-dimensional data. Through the computer aid design combined with three-dimensional reconstruction, preoperative precise diagnosis of cranio-maxillofacial anomalies and surgery simulation design were successfully performed. Meanwhile, three-dimensional bionic cranium models and individual prosthesis could be fabricated with reverse engineering and rapid prototyping techniques, which resulted in the well restoration of complex deformity. RESULTS AND CONCLUSION: Based on computer aid design-computer aid manufacture technique, the individual digital surgery will significantly promote the accuracy in cranio-maxillofacial plastic surgery and increase the clinical therapy effects. What’s more, it simplified the operative procedure, shorten operation time and decrease surgical risk. These suggested that individual digital surgery possesses high clinical practical value in reconstruction and repair of cranio-maxillofacial complex deformity. Related Articles | Metrics

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Coronary artery stent heating under alternating current magnetic field Wang Rui, Zhao Ling-yun, Liu Ji-guang, Tang Jin-tian 2010, 14 (22):  4036-4040.  doi: 10.3969/j.issn.1673-8225.2010.22.011 Abstract ( 142 )   PDF (391KB) ( 355 )   Save BACKGROUND: The safety of drug eluting stent is still in dispute. Local heating can be performed by exposing magnetic medium to alternating current (AC) magnetic field. The stents are mainly composed of alloy, so it is possible to heat under magnetic field, but few reports have been obtained in China or abroad. OBJECTIVE: To study the temperature increasing of coronary stent under the AC magnetic field, and to explore the effects of magnetic field parameters (frequency and current intensity), as well as stent materials on the temperature increasing. METHODS: Coronary stents of different materials: 316L stainless steel, Ni-Ti alloy and Co-Cr alloy were placed in the AC magnetic field. Temperature increasing induced by the AC magnetic field of various process parameters (frequency and current intensity, angle between the stent axis and the field direction) was examined by Cu-CuTi thermo-couple. RESULTS AND CONCLUSION: Stent materials had great effect on the temperature increasing induced by magnetic field, among which 316L stainless steel had the highest heating effect. Temperature increasing would be restricted with increasing of the angle between the stent axis and the field direction. Higher temperature increasing was observed at higher AC magnetic frequency and current intensity. Related Articles | Metrics

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Rigidfix femoral fixaion device versus Intrafix tibial fixaion device in arthroscopic reconstruction of anterior cruciate ligament using autografts of hamstring tendon  Tu Jun, Xu Bin 2010, 14 (22):  4041-4046.  doi: 10.3969/j.issn.1673-8225.2010.22.012 Abstract ( 117 )   PDF (320KB) ( 435 )   Save BACKGROUND: Tendon source, bone tract localization, tendon and bone healing and postoperative rehabilitation have achieved agreement. However, it remains controversial in tendon fixation pattern.  OBJECTIVE: To retrospectively evaluate clinical results of arthroscopic anterior cruciate ligament (ACL) reconstruction by use of hamstring autograft with femoral fixation via Rigidfix system and tibial fixation via Intrafix system. METHODS: A total of 30 patients that had been treated with arthroscopic ACL reconstruction by use of hamstring autograft with femoral fixation via Rigidfix system and tibial fixation via Intrafix system in the Second Department of Orthopaedics Surgery, First Affiliated Hospital of Anhui Medical University from February 2008 to August 2009, including 9 females and 21 females, aged 31 years (range 18-49 years). Preoperative examinations showed positive results of 30 cases in anterior drawer test, 28 positive for Lacheman test, 23 positive for pivot shift test. The Lysholm knee joint scores were (59.2±5.2). The treatment effect was observed during follow-up following rehabilitative treatment. RESULTS AND CONCLUSION: The mean follow-up period was 13 months (range, 6 to 18 months). No patient had serious complication, and all patients could go back to work. All Pivot shift tests were negative, 1 patient in Lacheman test was Ⅰ and 1 was Ⅱ. The mean Lysholm score was 93.1± 4.3 postoperatively, significantly increased compared with preoperative scores (P < 0.05). On the basis of the final International Knee Documentation Committee grade, 25 knees were normal, and 5 were nearly normal. Rigidfix femoral fixaion device and Intrafix tibial fixaion device in anterior cruciate ligament reconstruction by use of hamstring autograft are effective, useful, and reproducible. Related Articles | Metrics

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Daily living activities and effect evaluation following total hip replacement: Community return visit  Wei Xin-ping, Li Xiao-liu, Xing Xiao-yan, Zhang Xiao-yang 2010, 14 (22):  4047-4049.  doi: 10.3969/j.issn.1673-8225.2010.22.013 Abstract ( 163 )   PDF (201KB) ( 356 )   Save BACKGROUND: Hip replacement is a reconstruction of the hip joint function with a significant efficacy in orthopedic surgery. When lying in bed for a long period of time after replacement and failing to perform rehabilitation, the patients might have different degrees of motor weakness and joint contractures, affecting the restoration of joint function and surgical efficacy. OBJECTIVE: To explore a return visit after hip replacement rehabilitation to continue the life activity and efficacy evaluation. METHODS: A total of 28 patients, aged 78.2 (68-81) years, 16 males and 12 females, were selected, who were admitted for the hip joint replacement. The patients were randomly divided into treatment and control groups. Patients from the reatment group were discharged into the community health service centers at 15 days after hip replacement for rehabilitation exercise for 1 month, according to the stability of prosthesis, patient age, and physical condition, such as replacement time. The control group was only followed up without the associated rehabilitation. Two groups were followed up at 1 day, 1 and 6 months in the community health service centers subjected to Harris and Barthel assessment by muscle strength. RESULTS AND CONCLUSION: Treatment group was followed up, but in the control group 1 case was admitted to the central hospital due to falling-caused fracture, 1 case died of heart attack, 2 cases did not go back or get in touch, and 4 were off return visit. The activities of daily living index, Harris Assessment and Barthel Index score significantly improved in two groups of patients at 1 day, 1 and 6 months in community health center, and 1, 6-month above parameters in the treatment group were significantly greater than the control group (P < 0.01). Results suggest that functional training in the community health service center improves of daily living activity and function efficacy of patients after total hip replacement. Related Articles | Metrics

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Venous thromboembolism following total hip replacement and acute physiology and chronic health evaluation scores: A retrospective analysis of 98 cases Zhao Jin-zhu, Song Zhan-zhao, Hu Jian, Xu Peng, Sun Pei-feng, Tao Chun-sheng, Chen Jun 2010, 14 (22):  4050-4052.  doi: 10.3969/j.issn.1673-8225.2010.22.014 Abstract ( 137 )   PDF (201KB) ( 360 )   Save BACKGROUND: There are many risk factors for venous thromboembolism (VTE) following total hip replacement, which involves several clinical subjects. There remains no systematic and reliable evaluation system. Frequently, Doppler ultrasound has been used to identify VTE. Acute physiology and chronic health evaluation (APACHE Ⅱ) has been widely used for severity degree and prognosis evaluation of ICU patients. OBJECTIVE: To evaluate the correlation between APACHEⅡ scoring and VTE after total hip replacement.  METHODS: APACHE Ⅱ scores (preoperative, VTE and pulmonary thromboembolism, PTE) of 98 patients (106 hip joints) who were treated by total hip replacement in the 401 Hospital of Chinese PLA from 2000 to 2005 were analyzed retrospectively. The APACHE Ⅱ scores were compared between the VTE group and non-VTE group, as well as PTE group and non- PTE group. RESULTS AND CONCLUSION: There were no significances in APACHE Ⅱ scores between VTE group and non-VTE group   (P > 0.05). The APACHE Ⅱ scores were significantly greater in PTE group compared with non-PTE group (P < 0.05). Results show that there is no correlation between APACHE Ⅱ and VTE in early stage; but the APACHE Ⅱ scores were correlated with PTE following VTE. Moreover, the higher the APACHE Ⅱ scores, the greater risk for PTE is. Related Articles | Metrics

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Three hip replacements for avascular necrosis of the femoral head in 67 patients: 2-year follow-up   Lai Xiao-yu, Gao Hui 2010, 14 (22):  4053-4055.  doi: 10.3969/j.issn.1673-8225.2010.22.015 Abstract ( 114 )   PDF (238KB) ( 306 )   Save BACKGROUND: Traditional total hip replacement requires several revisions. The effect of reconstruction of femoral neck even femoral head by total hip replacement has been widely accepted. OBJECTIVE: To compare the effect and complications of three hip replacements (collum femoris preserving, stemless hip prosthesis, and resurfacing arthroplasty) for avascular necrosis of the femoral head. METHODS: A total of 67 cases of avascular necrosis of the femoral head were selected from January 2005 to July 2007. They were respectively treated with collum femoris preserving (n=22), stemless hip prosthesis (n=20), and resurfacing arthroplasty (n=25). All patients were followed up at least for 2 years. The patients were evaluated before, 1 and 2 years after surgery by Harris score, X-ray, hip and prosthesis-related bad events and revision. RESULTS AND CONCLUSION: During the 2-year follow-up, no revision was performed in resurfacing arthroplasty group, and the Harris scores were significant greater than the other two groups (P < 0.05). One case was subjected to revision in stemless hip prosthesis, and 2 in collum femoris preserving. Results from the present study show that compared with collum femoris preserving and stemless hip prosthesis, resurfacing arthroplasty may be the more effective treatment for avascular necrosis of femoral head with less complications and lower rate of revision. Related Articles | Metrics

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Total hip arthroplasty for ankylosing spondylitis in 24 cases Li Qi-yi, Jin Jin, Weng Xi-sheng, Lin Jin, Qiu Gui-xing, Zhang Yi-dan 2010, 14 (22):  4056-4059.  doi: 10.3969/j.issn.1673-8225.2010.22.016 Abstract ( 136 )   PDF (317KB) ( 427 )   Save BACKGROUND: Total hip arthroplasty (THA) has become an effective treatment to improve joint function and life quality of patients with ankylosing spondylitis (AS), but there are high risks compared with THA for other diseases. OBJECTIVE: To evaluate the clinical efficacy of THA in treating the hip joint involvement of AS. METHODS: A total of 24 AS patients (33 hip joints) underwent THA. All the patients had obvious restriction in daily life before operation: 9 cases had to walk with the help of crutches, 1 case had to sit on wheelchair, 22 cases had severe pain and 10 cases (15 hip joints) were stiff. The mean Harris score was 41.9 averagely and the mean total range of the hip joint movement was 45.4° before surgery. The prosthesis involved biotype in 18 cases (24 hips), cemented 3 cases (5 hips), and mixed type 3 cases (4 hips) and made of metal alloy shaft and polymer polyethylene liner. RESULTS AND CONCLUSION: All patients were followed up with an average of 23 months. Pain was totally relieved in 28 patients (84.9%) at the last time of follow-up. Only one patient still needed a crutch to walk. The Harris score of hip joint was 80.1 averagely, including 10 hips excellent, 18 good, 4 passable, and 1 poor, with an excellent and good rate of 84.8%. The mean total range of the hip joint movement was 159.6° after surgery. The subjective satisfactory rate was 87.5%. According to Brooker system, 2 hips (6%) appeared heterotopic ossification, one was of Class I and the other Class III. There was no dislocation, infection, fracture, nerve injury or loosening of the prosthesis. No revision was performed. THA is an effective method in treating affected hip joint of AS. It can relieve the pain of the joint, restore the hip function and improve the life quality of the AS patients. Related Articles | Metrics

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Metal augmentation and intramedullary stem in total knee arthroplasty revision for repair of bone defect and joint stability: A follow-up of 12 cases  Huang Hua-yang, Zheng Xiao-fei, Li Ping-yue, Wang Ze-jin 2010, 14 (22):  4060-4063.  doi: 10.3969/j.issn.1673-8225.2010.22.017 Abstract ( 141 )   PDF (422KB) ( 342 )   Save BACKGROUND: Total knee arthroplasty revision is technically challenging compared with primary arthroplasty. Bone defect or injury of lateral collateral ligament increases the difficulty of prosthesis fixation, component alignment and stability reconstruction. OBJECTIVE: To explore the clinical results of metal augmentation and intramedullary stem in total knee arthroplasty revision.  METHODS: A retrospective study was performed through the use of metal augmentation and intramedullary stem for uncontained bone defects (AORI Type Ⅱ) in 12 total knee arthroplasties from February 2004 to January 2008, including 8 cases revision due to aseptic loosening and 4 cases due to infection. The prosthesis was OPTETRAK.CCK. The patients were followed up after revision, and evaluated by HSS scores. RESULTS AND CONCLUSION: The patients were followed up for a mean of 21 months (range, 6 to 37 months). Clinical evaluation revealed that the mean knee score of the HSS had improved from 27 points preoperatively to 75 points postoperatively, and the mean range of motion had increased from a flexion arc of 63° to 97°. Except a delayed healing in one case, no lower limb phlebothrombosis or pulmonary infection occurred. Metal augmentation for uncontained bone defects and soft tissue balance combined with intramedullary stem is feasible to accomplish, it provides immediate secure fixation to host bone, and enhances success rate of knee arthroplasty revision. Related Articles | Metrics

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Issues regarding Delta III reverse shoulder arthroplasty Wei Yu-xian, Huang Wei 2010, 14 (22):  4066-4069.  doi: 10.3969/j.issn.1673-8225.2010.22.019 Abstract ( 197 )   PDF (320KB) ( 500 )   Save BACKGROUND: Delta Ⅲ is a novel reversed prosthesis for the shoulder. It inverts standard techniques for cuff tears, and supplements the concept used for revision surgery after previous failure of hemi- or total arthroplasty for shoulder joints. OBJECTIVE: To introduce the new concept of mechanism, components, operative techniques and common complications of Delta III prosthesis in clinical settings, to provide a reference for clinical practice. METHODS: A computer-based online search of Pubmed (http://www.ncbi.nlm.nih.gov/PubMed) and matrise orthopedie (http://www.maitrise-orthopedie.fr) was performed for articles published between 1991 and 2010 with key words “reverse shoulder arthroplasty, Grammont shoulder, Delta shoulder”. Chinese articles were not included. Repetitive articles were excluded. A total of 177 articles were collected and 31 were analyzed. RESULTS AND CONCLUSION: Delta Ⅲ prosthesis included humerus and glenoid cavity ends. Delta Ⅲ reverse shoulder arthroplasty could obviously relieve pain and improve range of motion, particularly on abduction, but it seems to have no further effect on rotations. Satisfaction is quite good, but the trouble exists at a high rate of scapular notching and dislocation, which results in revision. The value and its benefits are required to be evaluated in domestic clinical practice. Related Articles | Metrics

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Clinical application of non-fusion internal fixation in treating lumbar degenerative disease Liu Peng, Li Wa-li 2010, 14 (22):  4070-4073.  doi: 10.3969/j.issn.1673-8225.2010.22.020 Abstract ( 161 )   PDF (292KB) ( 427 )   Save BACKGROUND: The spinal fusion is used extensively in the treatment of the lumbar degenerative disease. But there were a series of the symptoms such as lumbar destabilization, change of lumbar dynamics, accelerated degeneration of adiacent segment and spinal stenosis by massive clinical observations. OBJECTIVE: To review the clinical application of non-fusion internal fixation in treating lumbar degenerative disease. METHODS: The PubMed database was researched by computer to search documents published between January 1997 and December 2009 with key words of “lumbar spinal fusion, destabilization, non-rigid fixation” in English. Totally 84 papers were selected. RESULTS AND CONCLUSION: Lumbar spinal fusion is still the standard method for treating lumbar instability, however, lumbar spinal fusion may accelerate the degeneration of adjacent segment, and the lumbar fusion rate was not proportional to clinical satisfactory rate. There is no quantitative standard for evaluating range of intervertebral motion, but the ideal dynamical fixation should guarantee the spinal stabilization and recover the range of motion to the largest extent. Recently, a large number of studies concerning non-fusion fixation technology have been performed in China and abroad. Non-fusion internal fixation is a surgery method for treating lumbar degenerative disease which meets physiological need and reduces a series of harmful complications. This method can avoid fusion of degenerative segment. Related Articles | Metrics

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Import and domestic metal-metal hip prostheses for total hip replacement: 1 year follow-up of Chinese populations      Pan Yan-kang, Long Teng-he, Huang Min, Liu Yu-heng 2010, 14 (22):  4074-4077.  doi: 10.3969/j.issn.1673-8225.2010.22.021 Abstract ( 155 )   PDF (380KB) ( 279 )   Save OBJECTIVE: To compare the clinical safety and long-term effect between import and domestic metal-to-metal hip prosthesis in hip replacement. METHODS: A computer-based online search was performed for related articles published between January 1969 and December 2009, with key words “hip replacement, bulk metal hip” in English. Articles related with biomaterials and tissue-engineered vessels were included. Repetitive studies or Meta analysis were excluded. A total of 14 articles were discussed. A total of 63 patients (71 hips) undergoing bulk metal total hip replacement in Department of Joint Surgery, Fourth Hospital of Guangxi Medical University were divided into two groups. Group A was treated with the fourth generation bulk metal hip prosthesis (A.K.), and group B was treated with the fourth generation bulk metal hip prosthesis (Depuy, USA). Harris scores for hip joint, range of motion, X-ray radiolucent zone, leg length discrepancy and complications during 1 year follow up were compared. RESULTS: Artificial hip joint was divided into 4 types according to femoral and acetabular materials: metal-polyethylene, ceramics-polyethylene, ceramics-ceramics, metal-metal. And the metal-metal prosthesis included bulk metal hip and metal surface replacement. Clinical results showed that group A was followed up for 15-28 months and group B for 13-26 months. At 1 year following replacement, Harris scores were 89 (range 65-98) in group A, and 92 (71-99) in group B (P > 0.05). Range of motion was 37° in group B and 35° in group A (P > 0.05). Keg length discrepancy was 5.1 mm (2-1 1 mm) in group B and 6.8 mm (5- 14 mm) in group A (P > 0.05). X-ray radiolucent zone (≤1 mm) was observed in two groups (4 cases in group A and 1 in group B). In addition, 1 case of group B developed dislocation. CONCLUSION: Import and domestic bulk metal hip prostheses are safe and effective in treating hip joint diseases and exhibit similar short-term effect. Related Articles | Metrics

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Color Doppler ultrasound application in deep vein thrombosis formation and hip/knee osteoarthrosis following artificial joint replacement      Yu Lin 2010, 14 (22):  4078-4081.  doi: 10.3969/j.issn.1673-8225.2010.22.022 Abstract ( 120 )   PDF (308KB) ( 458 )   Save OBJECTIVE: To evaluate the clinical application value of ultrasound in deep vein thrombosis (DVT) formation and hip knee osteoarthrosis following artificial joint replacement. METHODS: A computer-based online search of CBM and CNKI was performed for self-control and randomized controlled trials regarding DVT formation following artificial joint replacement, as well as hip and knee osteoarthrosis using color Doppler ultrasound published between 1993 and 2010. Repetitive studies and Meta analysis were excluded. RESULTS: A total of 721 cases undergoing hip or knee joint replacement were involved, and 756 hip (knee) joints were subjected color Doppler ultrasound examination. A total of 17 control studies were collected, involving 1 591 knee joints. All studies did not describe allocation concealment or blind methods. Results show that color Doppler ultrasound is sensitive and specific in examination of DVT following artificial joint replacement. Ultrasound feature of rheumatoid arthritis is mainly characterized by thickened synovial membrane, and knee osteoarthritis is characterized by cartilage and bone destruction. CONCLUSION: Ultrasound can clearly observe DVT and venous valve function following joint replacement, and can serve as the first choice for monitoring DVT before and after hip/knee joint replacement to observe thrombus to provide reliable evidence for clinical diagnosis and treatment. In addition, ultrasound examination is highly sensitive and specific and therefore can provide objective evidence for diagnosis and treatment of hip, knee joint and surrounding soft tissues. Related Articles | Metrics

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Wearing performance of hip prosthesis materials and the influential factors Zhang Jian-lin, Zhao Jun-hua, Ye Jun, Luan Yan-jun 2010, 14 (22):  4082-4085.  doi: 10.3969/j.issn.1673-8225.2010.22.023 Abstract ( 97 )   PDF (370KB) ( 1242 )   Save OBJECTIVE: To compare the wearing performance of different artificial hip joint materials to propose measures for preventing prosthesis loosening. METHODS: A computer-based online search was performed for related articles published between January 1993 and October 2009 with key words “prosthesis loosening, hip, wear debris, hip prosthesis” in Chinese and English. Articles related to artificial hip prosthesis wearing and the influential factors were included. Repetitive studies or Meta analysis were excluded. A total of 28 articles regarding artificial hip prosthesis wearing and the influential factors were included. RESULTS: Operation methods, prosthesis installation, joint weight loading-induced micromovement between prosthesis and host bone are contributed to hip prosthesis loosening. The biological factor-wear debris may regulate late process of hip prosthesis loosening. Therefore, studies of mechanical and the biological factors may reveal cause of hip prosthesis loosening. CONCLUSION: Joint prosthesis wearing-induced wear debris is a key factor in the late process of hip prosthesis loosening. Improvement of host bone quality and prosthesis design and materials can better prevent and treat hip prosthesis loosening. Related Articles | Metrics

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Hip prosthesis replacement and clinical rehabilitation treatment Long Hui 2010, 14 (22):  4086-4089.  doi: 10.3969/j.issn.1673-8225.2010.22.024 Abstract ( 85 )   PDF (318KB) ( 398 )   Save OBJECTIVE: To explore the method and effect of rehabilitative functional training following hip replacement. METHODS: A computer-based online search of PubMed database (http://www.ncbi.nlm.nih.gov/PubMed) and Wanfang database (http://www.wanfangdata.com.cn) was performed for articles regarding hip joint prosthesis replacement and rehabilitative treatment following hip replacement, with the key words “artificial, replacement, rehabilitation, hinesiatrics, hip joint prosthesis” in English and “artificial hip joint prosthesis, replacement, rehabilitation training” in Chinese. Repetitive studies were excluded. RESULTS: The rehabilitation following hip replacement is to relieve hip pain, correct hip deformity, improve hip functional status and better quality of life. Early continuous, directional rehabilitation training can reduce postoperative complications, accelerate hip functional restoration and shorten hospital stay. There are significant period differences between rehabilitation training and weight loading following prosthesis implantation, which should be performed according to prosthesis designs. Rest is important in the first 3 months of rehabilitation training to prevent severe pain. Retrieved data show that operation and rehabilitation treatment greatly improved hip function and reduced complications. In addition, the mental state of patients at different stages, degree and intensity of training should be paid attention. It is necessary to prevent injury during rehabilitation treatment. Therefore, the passive flexion exercise should be performed under the guidance of rehabilitation therapist to prevent tendon breakage of quadriceps femoris. The range of motion at 2 weeks postoperatively is the most important, which may maximize hip prosthesis function improvement. CONCLUSION: Early functional exercise following replacement should be performed step by step, from passive to active. The process is muscle stretch and contraction, joint flexion and extension, standing out of bed, assisted walking and independent walking. Related Articles | Metrics

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Bio-tribological characteristics of artificial knee joints  Zhao Yan, Wang Yu 2010, 14 (22):  4090-4092.  doi: 10.3969/j.issn.1673-8225.2010.22.025 Abstract ( 89 )   PDF (274KB) ( 402 )   Save OBJECTIVE: To explore the dynamic features of knee flexion movement to provide relative movement and stress distribution for studies on artificial knee joint bio-tribology. METHODS: A computer-based online search of CNKI was performed for articles related to artificial knee movement and friction published between 1994 and 2009 with key words “knee prosthesis, biomechanics, wearing debris, bionic lubrication”. Outdate articles and repetitive studies were excluded, and 22 articles were included. RESULTS: Dynamic finite element models of knee joint including bone and soft tissues following total hip replacement are established. Three dimensional relative movement parameters of knee flexion and extension, as well as contact position and stress of tibial and hip and femoral joints are obtained using finite element analysis. CONCLUSION: Artificial knee joint wearing performance is influenced by many factors. Many studies focus on some factor alone, and mainly describe experimental results, but not further exploration of joint movement and wearing mechanism. Studies of artificial knee joint movement and wearing performance should combine kinematics and mechanics with wearing status for prediction of wearing. Related Articles | Metrics

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Application of artificial knee joint in sports injury  Xie Zheng-yang, Shi Yong, Liu Zhi-yuan 2010, 14 (22):  4093-4096.  doi: 10.3969/j.issn.1673-8225.2010.22.026 Abstract ( 102 )   PDF (341KB) ( 448 )   Save OBJECTIVE: To evaluate the application of artificial joint replacement in sports injury. METHODS: A computer-based online search was performed for related articles published between January 1993 and October 2009 with the key words “artificial knee joint, arthroplasty, sports injury, knee joint injury”. Articles related to knee joint sports injury and artificial joint replacement were included, and repetitive and Meta analysis were excluded. A total of 46 articles were included, which introduced biomechanical features of knee sports injury and artificial knee joint development and application in sports injury. RESULTS: Knee sports injury includes abrasion, contusion, fracture, dislocation, tearing, and strain. Severe joint injury, fracture and bone breakage can recover by operation, even artificial joint replacement. Artificial joint replacement can eliminate pain focus, pain, restore motion range of joint, and effectively adjust limb length. Moreover, artificial joint replacement displays precise and expected effect. However, there are some complications, such as prosthesis loosening, wearing or fracture. Prosthesis material selection is important in knee joint replacement, which should be durable and prevent rejection. CONCLUSION: Artificial knee joint has been developed rapidly in recent years, which solve joint diseases. Developing materials and biology will improve materials, particularly prosthesis individualized design. Artificial knee joint replacement can be applied for patients with severe knee sports injury. Related Articles | Metrics

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Strategy and efficacy of primary knee replacement Liang Wei-zhi, Qi Feng, Yao Dong, Li Hui-jun, Li Dong-li 2010, 14 (22):  4097-4100.  doi: 10.3969/j.issn.1673-8225.2010.22.027 Abstract ( 111 )   PDF (402KB) ( 305 )   Save OBJECTIVE: To investigate the factor impacting the initial effect of replacement for osteoarthritis of the knee and the countermeasures. METHODS: A computer-based online search of VIP database was performed for articles published between January 1994 and October 2009, with the key words “knee joint, osteoarthritis, knee joint replacement, deep venous thrombosis, infection, prosthesis loosening”. A total of 22 articles were included and analyzed.  RESULTS: Artificial knee joint was selected according to condition of disease, joint limitation range, fixation pattern and meniscus functions. Guiding the knee rehabilitation, strictly aseptic operation, the use of preventive antibiotics can prevent infection, postoperative pain precise, and early functional training, and application of drugs for prevention of deep vein thrombosis drug can increase the certainty of subjective satisfaction, and improve recovery of joint activities. CONCLUSION: With developing surgical techniques and prosthesis, artificial knee replacement is improved. However, many issues require further investigation. Related Articles | Metrics

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Bionics of artificial joint materials and the clinical application Meng Zhao-qin 2010, 14 (22):  4101-4104.  doi: 10.3969/j.issn.1673-8225.2010.22.028 Abstract ( 80 )   PDF (323KB) ( 735 )   Save OBJECTIVE: To analyze metal materials, polymers, ceramics and carbon material-made artificial joints and explore advantages and disadvantages of each material, so as to provide new thoughts for developing novel lower limb prosthesis material and improving useful life in combination with bionics METHODS: With “artificial joint, prosthesis metarial, bionics” as key words, a computer-based online search of Wanfang database (http://www.wanfangdata.com.cn/) was performed for experiments and clinical application of bionic artificial joint materials published between January 1993 and October 2009. Repetitive studies or Meta analysis were excluded. A total of 22 articles were included, and bionics principles of artificial joint, research status of artificial joint materials, as well as bionics and clinical application of artificial joint were discussed. RESULTS: Metal materials, polymers, and ceramics have been clinically used for artificial joint materials. Novel materials with wear-resistance and atoxic effect, in particular compound coating materials and bionic cartilage materials, are beeing explored to accelerate development of prosthesis similar to human joint.   CONCLUSION: Artificial joint bionics is a system engineering invovling multiple subjects and requires further research and development of artificial joint materials. In addition, based on structural and functional features, joint movement force following artificial joint replacment should be explored to reduce wearing speed. Individualized aritificial joint should be designed to better match patient body structure, joint appearance, size, functional features and physical capacity. Related Articles | Metrics

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Deep venous thrombosis following artificial joint replacement  Liu Ye, Pan Liang 2010, 14 (22):  4105-4108.  doi: 10.3969/j.issn.1673-8225.2010.22.029 Abstract ( 136 )   PDF (319KB) ( 497 )   Save OBJECTIVE: To explore the cause and prevention of deep venous thrombosis. METHODS: A computer-based online search of VIP database was performed for articles related to the formation and prevention of deep venous thrombosis following artificial joint replacement, published between January 1998 and October 2009, with the key words “deep venous thrombosis, cause, diagnosis, prevention”. The data were collected, and references of each article were reviewed. A total of 26 articles were included. RESULTS: Deep venous thrombosis following joint replacement is related to age, gender, cancer history, previous thrombosis, obesity index, anesthesia approach, bone cement, operation and trauma. Bed rest, affect limb raising, anticoagulation, thrombolysis and thrombus removal by operation can be used to prevent thrombus. The combination of above two or three methods has been recommended. CONCLUSION: Monitor of early deep venous thrombosis and systematic anticoagulation are important for venous thrombosis prevention. However, there remains no medicine (or combination application) that can treat deep venous thrombosis following joint replacement. The best medicine and medication pattern require further exploration. Related Articles | Metrics

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Application advances of pedicle screw fixation for thoracolumbar fractures   Wang Xu, Li Yong-min, Gu Shou-shan 2010, 14 (22):  4109-4112.  doi: 10.3969/j.issn.1673-8225.2010.22.030 Abstract ( 104 )   PDF (339KB) ( 456 )   Save OBJECTIVE: To introduce application and advances of pedicle screw internal fixation in treating thoracolumbar fracture. METHODS: A computer-based online search of PubMed database (http://www.ncbi.nlm.nih.gov/PubMed) and CNKI database (www.cnki.net/index.htm) was performed for related articles with key words “vertebral pedicle screw, thoracolumbar fracture, internal fixation” in English and Chinese. Articles related to anatomic basis, biomechanical analysis, clinical application and advantages and disadvantages, published in authoritative journals recently in the same filed were included. A total of 31 articles were finally included. RESULTS: Transpedicular internal fixators can effectively restore vertebral height and physiological curve to recover and fix the displaced bone block to original position to decompress the neural tube. Pedicle screw fixation can provide strong fixation, correct deformity, maintain spinal three-dimensional position, and provide good biomechanical stability. Recently, the combination of various techniques and development of minimal invasive technique increase posterior approaches for thoracolumbar fracture, which are all on the basis of pedicle screw fixation. CONCLUSION: Pedicle screw fixation is an effective technique for thoracolumbar internal fixation and can be used for various thoracolumbar instabilities, in particular the thoracolumbar fractures. Related Articles | Metrics

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Plate internal fixation for limbs fractures Xiao Min, Zhang Qiang 2010, 14 (22):  4113-4114.  doi: 10.3969/j.issn.1673-8225.2010.22.031 Abstract ( 118 )   PDF (236KB) ( 386 )   Save OBJECTIVE: To explore the effect and announcements of plate internal fixation for limbs fractures to help fracture treatment. METHODS: A computer-based online search of CNKI (2002/2009) and Medline database (Pubmed: 2004/2007) was performed for articles related to limbs fractures with the key words “limb fracture, plate, internal fixation”. Outdated articles and repetitive studies were excluded. A total of 8 articles were included. RESULTS: The treatment regimen of limb fractures is selected according to patient age, general condition, fracture site, local soft tissue condition, and patient requirements. Therefore, individualized regimen is needed. In addition, it is important to understand the biological features of plate implantation and fracture healing, skeleton continuity and integrity, fixation skills, protect blood supply around fracture ends, and consider the position relationship between plate fixation and local soft tissue.  CONCLUSION: There are many factors that lead to failure of plate internal fixation for fractures. Plate internal fixation should be performed according to related principles and skills to treat fracture ends in accordance with fracture healing biological features. In addition, step-by-step rehabilitation and follow-up are important. Related Articles | Metrics

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Stent implantation and changes in QT dispersion and corrected QT dispersion in patients with coronary atherosclerotic heart disease Liu Xiao-fang, Zhang Fu-li 2010, 14 (22):  4115-4118.  doi: 10.3969/j.issn.1673-8225.2010.22.032 Abstract ( 102 )   PDF (290KB) ( 373 )   Save OBJECTIVE: To explore the clinical application features of stent implantation and its effect on QT dispersion (QTd) and QTd correction in patients with coronary atherosclerotic heart disease. METHODS: A computer-based online search of Wanfang and CNKI databases was performed for articles regarding effect of stent on QTd in patients with coronary atherosclerotic heart disease. Repetitive articles or outdate studies were excluded. RESULTS: A total of 22 articles were included. Common stents include metal bare and drug stents. Metal bare stent implantation is simple with memory effect and good biocompatibility. However, early restenosis incidence is high. Drug stent effectively reduces restenosis incidence, but the long-term safety remains unclear. In addition, the high cost and skiu limit its application. Stent implantation significantly shortens QTd and corrected QTd clinically. CONCLUSION: Stent implantation significantly shortens QTd and corrected QTd, effectively improves myocardial reperfusion, reduces malignant cardiovascular events incidence, and improves long-term prognosis. However, further researches are still needed to check whether different types of stent implantation induce corresponding changes in QTd. Related Articles | Metrics

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Cerebrovascular stent types and hyperperfusion syndrome following stenting Zhang Xuan-qin 2010, 14 (22):  4119-4122.  doi: 10.3969/j.issn.1673-8225.2010.22.033 Abstract ( 192 )   PDF (344KB) ( 560 )   Save OBJECTIVE: To discuss cerebravascular stent type and analyze complications following stenting. METHODS: A computer-based online search was performed for related articles published between January 2000 and December 2009 with the key words “cerebrovascular, support, hyperperfusion syndrome, complication”. Articles regarding cerebravascular stent and hyperperfusion syndrome following stenting were included. Repetitive studies or Meta analysis were excluded. Finally, 20 articles were included, and the causes for complications following stenting were discussed. RESULTS: Currently, stenting has been demonstrated to effectively treat intracranial and extracranial artery stenosis-induced ischemic cerebrovascular disease. According to stent structure and quality, the endovascular stent is divided into metal, polymer, and eluting stents. Metal stent can meet the mechanical requirements, but it has poor compatibility. The rough surface of stent greatly affects restenosis. Hyperperfusion syndrome is a rare but severe complication following angioplasty. It occurs in vascular bed adaptable to hypoperfusion following vascular automatic regulation failure, characterized by increased intracranial blood flow. Capillary bed perfusion pressure is greatly increased, which leads to blood brain barrier damage and brain swelling and intracranial hemorrhage. CONCLUSION: Surface modification of coating materials, improvement of biocompatibility, minimization of complication and rejection following stenting are required in further study. Related Articles | Metrics

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Multiple regression analysis on influential factors of vertebroplasty in the treatment of thoracolumbar vertebral compression fractures: Are they correlated with implant fixation, instrument types, and vertebral segment? Sun Jian-zhong, Ma Tai, Ding Ren, Shi Guan-tong, Fu Qiang, Hou Tie-sheng 2010, 14 (22):  4123-4126.  doi: 10.3969/j.issn.1673-8225.2010.22.034 Abstract ( 78 )   PDF (216KB) ( 351 )   Save BACKGROUND: Vertebroplasty is used widely in spinal surgery, and its effect is favorable. There are few reports on the influential factors, and only a small amount of individual factors are discussed. OBJECTIVE: To analyze 22 possible factors to find factors that affect vertebroplasty treatment of thoracolumbar compression fracture, and to establish the multiple linear regression equation. METHODS: A total of 61 patients with vertebral compression fractures were followed up for an average time of 17 months. The visual analog scale (VAS) scores of patients were determined before and after treatment, and the average value of each patient was obtained. The patients were interviewed to assess treatment results. Relationship between influential factors and VAS was analyzed using SAS9.1.3 software. RESULTS and CONCLUSION: The treatment effect of vertebroplasty was positive. The outcome of the vertebroplasty surgery was correlated with the course of the disease, the characteristics of the used surgery instruments and internal fixation treatment. Sky instruments were better than Kyphon ones. Moreover, appropriate internal fixation using pedicle screw system, operation indications, and early diagnosis and treatment of vertebral compression fractures are highlighted in vertebroplasty. Related Articles | Metrics

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Expansive pedicle screw placement fixation for the treatment of senile osteoporotic thoracolumbar vertebral fractures: 18-month follow-up data of 16 cases within one year in the same institution  Xiao Wei-ping, Zhong Fa-ming, Li Yong, Lü Jin, Ke Qiao-ning, Tang Min-yu 2010, 14 (22):  4127-4130.  doi: 10.3969/j.issn.1673-8225.2010.22.035 Abstract ( 108 )   PDF (245KB) ( 464 )   Save BACKGROUND: For the elderly osteoporotic patients with osteoporotic thoracolumbar vertebral fractures, the inadequate ordinary power of pedicle screws in control or excessive load after the operation results in the loosening or prolapse of pedicle screws, leading to fixation failure or pseudoarthrosis. OBJECTIVE: To observe effects of expansive pedicle screw (expansive pedicle screw, EPS) implantation for internal fixation of thoracolumbar osteoporotic fracture in the aged. METHODS: A total of 16 patients with osteoporotic thoracolumbar vertebral compression fractures, 6 males and 10 females, aged 73.6 (59-83) years. There were single vertebral compression fractures in 11 cases, two vertebral fractures in 5 cases (non-leap fractures), of which there was burst fracture in 4 cases. There were T12 in 7 cases, L1 in 10 cases, L2 in 3 cases, and L4 in 1 case; preoperative spinal cord and nerve root compression in 4 cases. Expansive pedicle screw fixation placement was adopted, for a spinal cord compression spinal space-occupying more than 50%, laminectomy was performed. Fixed rods were installed, relying on a fixed bar to squeeze into the outer screw inside the hollow bolt, a pre-bend good stick was installed to restore vertebral height so that fractures reduced, burst fractures were subjected to transverse autologous iliac bone and articular process grafting. RESULTS AND CONCLUSION: The wound of postoperative 16 patients healed without wound infection, cerebrospinal fluid leakage, or postoperative death. Postoperative X-ray and CT examination showed that the fracture had been reduced, and spinal cord compression disappeared. After 6 to 24 months follow-up, X-ray films showed fusion, without internal fixation loosening, fracture, false joint formation, or significant back pain. Postoperative vertebral anterior and posterior edge heights were significantly increased compared with preoperative heights (P≤0.01). Kyphosis range corrected was 11°-27°. Under the circumstances of no increase in screw length and diameter as well as decreased risk for vertebral pedicle fracture, expansive pedicle screw placement provides more reliable strength compared with the ordinary screw fixation and is an ideal fixation device for osteoporotic thoracolumbar vertebral fractures in aged patients. Related Articles | Metrics

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Effectiveness between kyphoplasty and pedical screw fixation for treatment of thoracolumbar burst fractures  Liu Xian-yi, Li Chun-de, Yi Xiao-dong, Lin Jing-rong, Liu Hong, Lu Hai-lin, Li Hong, Yu Zheng-rong 2010, 14 (22):  4131-4134.  doi: 10.3969/j.issn.1673-8225.2010.22.036 Abstract ( 114 )   PDF (326KB) ( 415 )   Save BACKGROUND: Following burst fractures, the vertebral posterior wall is not complete, and cannot stop bone cement perfusion. Therefore, thoracolumbar burst fracture has become contraindication of kyphoplasty. However, the patients with thoracolumbar burst fracture are always complicated with severe internal diseases, and cannot undergo conventional open reduction and internal fixation. Minimally invasive kyphoplasty may be the only choice for them. Currently, there are few reports regarding kyphoplasty and pedical screw fixation for treatment of thoracolumbar burst fractures. OBJECTIVE: To compare the effectiveness between kyphoplasty and pedical screw fixation for treatment of thoracolumbar burst fractures.  METHODS: A total of 27 patients with thoracolumbar burst fractures were selected from Department of Orthopedics, Peking University First Hospital between September 2005 and October 2008, including 12 cases treated with kyphoplasty and 15 treated with pedical screw fixation. The operating time, the effect and time of pain relief, the complication in operation and postoperation were evaluated. RESULTS AND CONCLUSION: The mean operating time of pedical screw fixation group was 55 minutes, pain relief was detected on the 5th-7th days postoperatively with a mean relief rate of 69.3%; there was no neural complication in pedical screw fixation group. The mean operating time of kyphoplasty group was 37 minutes, pain was relieved on the first day postoperatively with a mean relief rate of 86.2%; 3 cases developed bone cement leakage but no neural complication in kyphoplasty group. The purpose of pain relief can all be obtained by kyphoplasty and pedical screw fixation for treatment of thoracolumbar burst fractures, the mean operating time of pedical screw fixation group is longer than that of kyphoplasty group, but bone cement leakage in kyphoplasty group should be considered. Kyphoplasty may be a new choice for thoracolumbar burst fractures. Related Articles | Metrics

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Curative effect of cervical spinal cord injury without fracture or dislocation using three surgical methods Zhan Yi, Wu Zeng-hui, Zhang Kai, Ma Xiang-yang, Mai Xiao-hong 2010, 14 (22):  4135-4138.  doi: 10.3969/j.issn.1673-8225.2010.22.037 Abstract ( 120 )   PDF (440KB) ( 390 )   Save BACKGROUND: In recent years, the development of anatomy, imaging, surgical technology and the deepening understanding of studies significantly improve the treatment of cervical spinal cord injury without fracture or dislocation (CSCIWFD). OBJECTIVE: To observe effect of anterior reconstruction of spinal stability, posterior decompression and lateral mass fixation, anterior decompression and posterior reconstruction of spinal stability for treatment of CSCIWFD. METHODS: A total of 27 CSCIWFD patients from the General Hospital of Guangzhou Military Command between October 2003 and December 2005 were retrospectively analyzed, including 22 males and 5 females, who were admitted to hospital within 7 days after injury and treated by anterior decompression and reconstruction of spinal stability, single-door and posterior lateral mass fixation, anterior decompression and posterior reconstruction of spinal stability according to their damage. Treatment effect was evaluated by Frankel grading, and improvement rate was calculated by JOA score. RESULTS AND CONCLUSION: All patients were followed up for 6 to 33 months, with an average of 18 months. Imaging results showed full decompression, well fixed internal fixation, no loosening or fracture phenomena. In addition, fusion segments were well after 1 year of bone fusion. The neurological symptoms of 27 patients were improved when they were discharged. Except one case of Frankel A with no significant recovery, the remainders were 1 to 4. Postoperative JOA score was significantly improved compared with the preoperative: the anterior decompression and reconstruction of spinal stability group was improved by 50%, posterior lateral mass of a single door and fixed group by 53%, anterior and posterior reconstruction of spinal stability by pressure group by 51%. All patients did not develop complications in blood vessels or nerve injury during implantation or follow-up. Results show that appropriate surgical procedure can obtain good effect according to features of CSCIWFD. Related Articles | Metrics

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Management of tumorous long bone pathological fractures: Allogeneic bone reconstruction, graft reconstruction or prosthesis replacement? Liu Yan-cheng, Hu Yong-cheng, Xia Qun, Miao Jun, Zhang Ji-dong, Xu Bao-shan, Ji Ning 2010, 14 (22):  4139-4143.  doi: 10.3969/j.issn.1673-8225.2010.22.038 Abstract ( 153 )   PDF (409KB) ( 422 )   Save BACKGROUND: There are many reports regarding pathological fractures, but follow-up of large samples are few and the diagnosis methods vary, leading to lacks of uniform rule. OBJECTIVE: To discuss the diagnosis and treatment of tumorous long bone pathological fractures. METHODS: From August 2002 to August 2009, 143 consecutive hospitalized pathological patients were enrolled, including 100 long bone fractures involving 96 tumorous fractures, 4 multiple site, 32 metastases, 24 primary malignant tumors, 29 benign tumors, and 15 giant cell tumors. The diagnosis and treatments of pathological fractures were retrospectively analyzed. RESULTS AND CONCLUSION: All the patients were followed up for 6 to 56 months with an average of 26.5 months. Violence-induced fractures were classified into four groups: 18 cases of spontaneous, 29 cases of functional activities, 46 cases of minor injuries, and 7 cases of severe injuries. A total of 76 patients complained discomforts such like pain at fracture cites. In 13 cases with metastases, resection of mass was followed by construction prosthesis with no local recurrences; 11 patients with metastases were treated with intramedullary nail, with 2 cases recurrences, and 2 cases died. Operation was not accepted in 3 cases. Of patients with osteosarcoma accepting limb sparing operation, 4 cases accepted amputation, all of which had no relapses but with lung metastases in 3 patients; 3 cases with malignant fibrous hisfiocytoma were resected and followed by construction prosthesis; 2 cases accepted amputation, one of which was misdiagnosed and died at last follow-up. Pathological fractures should be highly suspected in minor injury patients. Treatment of pathological fractures should consider multiple factors such as specific tumor character and fracture locations. It is a better way to choose arthroplasty for fractures adjacent to joints. Related Articles | Metrics

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Application of HoffmannⅡ metal external fixator in treatment of open tibiofibular fracture Xia Rui, Kong Rong, Fang Shi-yuan, Li Shou-min, Yu De-wan, Zhang Guang-ping 2010, 14 (22):  4144-4149.  doi: 10.3969/j.issn.1673-8225.2010.22.039 Abstract ( 145 )   PDF (488KB) ( 455 )   Save BACKGROUND: Plate fixation is limited in treating comminuted tibiofibular fracture complicated by soft tissue injury. External fixation is appropriate for open tibiofibular fracture. Early external fixator can treat high energy-induced complicated fracture, but its application is limited due to complex operation, long duration or high cost. OBJECTIVE: To explore the method and short-term effect of HoffmannⅡ metal external fixator on open tibiofibular fracture. METHODS: A total of 25 cases of open tibiofibular fracture were treated with HoffmannⅡ metal external fixator from October 2008 to October 2009. HoffmannⅡ metal external fixator was purchased from Stryker, and the Apex titanium needle comprising titanium alloy Ti6AI-4V had good biocompatibility. The functional exercise was performed the day following upper limb fixation, and the patients were asked to walk assisting with stick 3 days following lower limb fixation. X-ray was shot to observe callus growth to confirm fixator extraction time. RESULTS AND CONCLUSION: All patients were followed up for 3-15 months. Of them, 18 cases had bony union in primary stage. The average time of bone union was 8-12 months, and the average time of using external fixator was 4.5 months. Two cases had delayed bony union using bone graft, and five patients were followed up; one case had bone infection, and four cases with local infection. Results show that external fixator displayed advantages in treating open tibiofibular fracture, such as tapping of screws, free adjustment of fixture and connection frame, less trauma, simple operation and favorable functional recovery. Related Articles | Metrics

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Metallic implants for distal humerus fracture in 20 elderly people: Comparison with 7 cases undergoing conservative treatment Wang Zheng-yu, Xu Zhu-jun, Hu Xu-feng, Dong Li-jun, Xie Jia-bing, Yang Min 2010, 14 (22):  4150-4154.  doi: 10.3969/j.issn.1673-8225.2010.22.040 Abstract ( 88 )   PDF (344KB) ( 402 )   Save BACKGROUND: In young patients, open reduction and internal fixation with plate fixation are advantageous which yields 65%-100% good and excellent results. Due to osteoporosis and poor whole-body condition, whether elderty patients need internal fixation of metallic implants is not clear.  OBJECTIVE: To investigate the treatment outcome of fractures of distal humerus using plate and to compare the treatment outcome with that of treated non-surgically or young patients.  METHODS: From January 2002 to June 2006, 27 elderly patients with distal humerus fracture treated in the First Department of Orthopaedics, Yijisan Hospital, Wannan Medical College were recruited. Their mean age was 68 years (60-78 years). Open reduction and internal fixation were performed in 20 cases. Seven elbows were treated nonoperatively. Patients were followed up at 3, 6, and 12 weeks, the clinical and radiologic assessments were graded to evaluate the function of the elbow, articular step and the angle of distal humeral tilt. The outcomes were compared with those from the young patient treated with internal fixation. RESULTS AND CONCLUSION: All the cases were followed up for 7 to 28 months. Bony union occurred in 26 cases, 1 case suffered aseptic nonunion. The patient refused the additional treatment for poor whole body condition. No implants broke. Though the screws of 2 cases and the k-wires of 3 cases were loosing, it was not necessary for further operation. The function of the elbow, articular step and the angle of distal humeral tilt of the surgically treated group were obviously superior to the non-surgically group (P < 0.01). Rates of complications of the elder treated surgically were observed to be comparable to those described in the literature for younger patients. There was no difference about the rates of the nonunion (including fracture site and olecranon osteotomy site), infection, heterotopic ossification nerve injury and the symptoms related with implants. Similar to the other intra-articular fracture, the internal fixation is beneficial for the distal humerus fracture in elderly patients as the angle the humerus tilt and integrity of the articuli were restored with the basic principle of surgery and inter fixation. Related Articles | Metrics

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Internal fixation of fractured ribs with rib plates in 39 patients: A review of 2-year data in the same institution Li Zhi-cheng, Wang Chang-tao, Xue Bing, Lü Yi-feng, Xiong Jian, Wang Dong-dong 2010, 14 (22):  4155-4159.  doi: 10.3969/j.issn.1673-8225.2010.22.041 Abstract ( 156 )   PDF (272KB) ( 447 )   Save BACKGROUND: The management of rib fracture varies greatly due to lack of consensus regarding if internal fixation of fractured ribs is needed, who and which methods to achieve stability. OBJECTIVE: To retrospectively analyze the necessity and feasibility of internal fixation of rib plate implanted into 39 patients with blunt chest trauma last two years. METHODS: A total of 39 patients suffering from sustained blunt chest trauma, including 32 males and 7 females, averagely aging (47.8±13.8) years, were treated with operative chest wall fixation. There were 4 patients with flail chest without pulmonary contusion, 10 patients with flail chest and pulmonary contusion, 15 patients without flail chest and pulmonary contusion, and 10 patients without flail chest but with pulmonary contusion. According to different clinical statuses, patients were either treated with conservative therapy at admission and secondary operative stabilization or need urgent surgery to manage intrathoracic injuries and underwent surgical stabilization of chest wall with rib plates. RESULTS AND CONCLUSION: Satisfactory effects were aquired in all patients with rib fracture using rib plates, including stabilization in chest wall, rectification of collapsed chest walls and thoracic deformity. However, a 68-year-old patient died for pneumonia, sepsis, and then septic shock at 26 days after operation. Clinical results in other patients were excellent after surgical stabilization of chest wall. Postoperative chest X-rays or chest CT demonstrated favorable reduction, no migration or dislocation, general symmetry in two side thorax. Compared with preoperation, collapsed chest walls and thoracic deformity were vanished and retrieved to normal on the whole. Patients with rib fractures, no matter with or without flail chest or pulmonary contusion, treated with operative chest wall fixation with rib plates are practicable, and will have a satisfactory effect.   Related Articles | Metrics

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Trabecular metal rod implantation combined with traditional Chinese medicine application in treating early avascular necrosis of the femoral head in 26 cases Wang Shang-zeng, Sun Yong-qiang 2010, 14 (22):  4160-4164.  doi: 10.3969/j.issn.1673-8225.2010.22.042 Abstract ( 140 )   PDF (415KB) ( 511 )   Save BACKGROUND: Trabecular metal rod AVN, a kind of porous tantalum metal prosthesis, is first designed by Michael Christie and has received good effects since it was used in Europe from November 2001. Traditional Chinese medicine (TCM) has advantage in treating avascular necrosis of the femoral head (AVN), especially for those in the early and middle stages. Early diagnosis and treatment play a key role in receiving good therapeutic effect.  OBJECTIVE: To explore clinical efficacy of trabecular metal rod implantation with TCM in treating early AVN. METHODS: A total of 26 patients with AVN received treatment at the Department of Orthopaedics, Henan Hospital of Traditional Chinese Medicine, from February 2005 to June 2007, were collected, including 16 males and 10 females, aged 18-56 years (mean 40.0±2.2 years). There were 21 cases with unilateral AVN, 5 cases with bilateral AVN; according to Ficat system, 14 cases were as stage Ⅰ and 12 as stage Ⅱ. All patients suffered from hip pain and hip activity limitation, including 15 cases walking with the single crutch, 8 cases walking with the support of bilateral crutches, and 3 patients unable to walk. Average value of Harris evaluation was (61.5±1.0) preoperatively. All patients were treated by trabecular metal rod implantation combined with TCM. RESULTS AND CONCLUSION: All cases were followed up for 1-2 years. All 26 patients of AVN were treated by trabecular metal rod implantation successfully during 10-18 minutes (mean 15 minutes). All wounds healed by first intention. The average value of Harris evaluation was (87.3±1.3) points postoperatively, which has significant difference compared to preoperatively (P < 0.05). The results were excellent in 21cases, good in 3 cases, fair in 2 case, with the excellent and good rate of 92%. In addition, there was no syndrome of infection, bedsore, or deep venous thrombosis in all cases. Trabecular metal rod implantation combined with TCM is a simple and effective means for treating early AVN. Related Articles | Metrics

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Endotoxin detection in multi-enzyme cleaner after cleaning implantation instruments of orthopedics  Li Xiao-yan, Yu Ni, Jiang Li-hua, Wei Bing, Ding Shu-zhen 2010, 14 (22):  4165-4167.  doi: 10.3969/j.issn.1673-8225.2010.22.043 Abstract ( 107 )   PDF (196KB) ( 493 )   Save BACKGROUND: Plenty of studies have shown that 3M multi-enzyme cleaner to clean implantation instruments of orthopedics manually is better than that without multi-enzyme cleaner, but there is no widely accepted measures to judge success of cleaning implantation instruments of orthopedics. Endotoxin detection benefits establishing evaluation criteria of cleaning implantation instruments of orthopedics successfully, and reflecting the cleaning effect to a certain extent in order to effectively apply the multi-enzyme cleaner. OBJECTIVE: To detect endotoxin quantitatively in the surface of implantation instruments of orthopedics and the cleaner after using 3M multi-enzyme cleaner to clean implantation instruments of orthopedics manually, so as to evaluate the cleaning effect of implantation instruments of orthopedics. METHODS: A total of 600 implantation instruments of orthopedics were selected randomly and cleaned by 3M multi-enzyme cleaner. The samples of the surface of instruments (before and after clean medical instruments) and in multi-enzyme cleaner were collected. Using Ltoy Lalt method, 8 EU/mL endotoxin was obtained and diluted to eight different concentrations. The reaction time was measured, standard curve equation was established, and the endotoxin in the sample was quantified according to the equation. RESULTS AND CONCLUSION: In the maximum cleaning effectiveness of the multi-enzyme cleaner, the endotoxin content in the multi-enzyme cleaner was less than 6.0 EU/mL after cleaning. Results show that endotoxin quantification in the multi-enzyme cleaner can be used to judge success of cleaning implantation instruments of orthopedics. Related Articles | Metrics

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Construction of a three-dimensional bionic knee joint model based on reverse engineering Zou Ren-ling, Xu Xiu-lin, Chen Bao-xue 2010, 14 (22):  4168-4172.  doi: 10.3969/j.issn.1673-8225.2010.22.044 Abstract ( 109 )   PDF (423KB) ( 355 )   Save BACKGROUND: How to design and manufacture sophisticated artificial knee joint that meets the needs of patients after knee joint replacement rely on the precise design and manufacturing technology, which ensure the prosthesis match the body and make a coordinated movement with maintained soft tissues.  OBJECTIVE: To design personalized knee joint utilize of computer-aided design technology. METHODS: The human knee joint was scanned by three-dimensional laser scanning and output of the point cloud data were processed by computer-aided design technology. After that, the three-dimensional solid model of the knee was reconstructed by Geomagic and UG software. RESULTS AND CONCLUSION: A very precise three-dimensional knee model was constructed. It provides an accurate model basis for the digital manufacture of biomimetic artificial knee, virtual assembly, stress analysis, motion analysis, and surgical simulation. Related Articles | Metrics

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Computer-assisted design and rapid prototyping technology for the underlay of hemifacial atrophy Gong Zhen-yu, Li Guo-hua, Liu Yan-pu, He Li-sheng, Zhou Shu-xia 2010, 14 (22):  4172-4175.  doi: 10.3969/j.issn.1673-8225.2010.22.045 Abstract ( 114 )   PDF (302KB) ( 367 )   Save BACKGROUND: There are many methods for repairing the hemifacial atrophy, the most common is preparing plaster facial mold of the patient, with wax piled on the surface to restore the patient's facial shape, and wax pattern serves as a reference of surgical pad. However, the therapeutic effect for the correction and treatment is not satisfactory due to varied abnormality and difficult plans. OBJECTIVE: To discuss the feasibility of manufacturing underlay for the treatment of hemifacial atrophy using computer-assisted design and rapid prototyping technology. METHODS: Skull of the hemifacial atrophy patient was scanned with Picker 6000 SCT, and the data obtained were processed in Voxel Q image workstation for 3-D reconstruction with volume rendering technique. After the interval lamination, the images were downloaded at 0.4-mm interval in a BMP format using CuteFTP 4.0 software. Then the transaxial 2-D image data were converted into digitized 2-D contour data by using image processing software developed by experimental team through a series of processes, including filtering, screening, noise reduction, and distortion correction. The edges and contour of the images was extracted to obtain a vector diagram of facial cranial cortical bone contour line. The digitized data were inputted into image processing software of Surfacer 9.0 for vector superposing, thus the 3­D wire frame and solid images of skull could be reconstructed. According to mirror-image symmetry relation, the point-cloud data of facial bone on the normal side was duplicated to the atrophied side. Thus a 3-D model of the underlay was produced between the atrophied bone and the mirror image of normal side. In order to compensate the atrophy of soft tissues, the model was designed 1.5 mm thicker. After the three-dimensional Surfacer data on the CAD were re-stratified, the contour editing of the underlay and the supporting set of prototype were completed in RpDataRepare, forming RP files and creating underlay template through rapidly output of the processing file for rapid prototyping required, as a reference of surgical procedures. RESULTS AND CONCLUSION: The 3­D solid model of the patient skull bone surface contour was obtained and simulacrum of the underlay was prepared with computer assistance and rapid prototyping. According to the simulacrum, the operation was carried out and got a satisfactory result. The manufacture of underlay for the treatment of hemifacial atrophy could be accomplished by computer assisted design and rapid prototyping in a highly precise and rapid manner. It is a promising technique in the field of individualized underlay making in craniofacial surgery. Related Articles | Metrics

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Osteoporotic hip fracture: Comparison on various treatments of metal implants Zhang Shou, Kong Chang-geng, Chen Wen-yuan, Ding Xiao-li 2010, 14 (22):  4176-4180.  doi: 10.3969/j.issn.1673-8225.2010.22.046 Abstract ( 110 )   PDF (225KB) ( 357 )   Save BACKGROUND: The metal implant internal fixation exhibits good effect for femoral neck fractures of young patients, but few studies report the metal implant treatment for femoral neck fracture in the aged patients. OBJECTIVE: To compare different implant treatments for osteoporotic hip fractures in senile patients. METHODS: A total of 237 aged patients with osteoporotic hip fracture, aged from 60 to 96 years old, were recruited from the hospital between January 1998 and December 2008. There were 32 cases treated by cannulated screw internal fixation, 23 cases by anatomical plate internal fixation, 41 cases by dynamic hip screw internal fixation, 111 cases by bipolar femoral head replacement, and 30 cases by total hip replacement. Comparison of the incidence of complications and the recovery of hip function were performed in each group. RESULTS AND CONCLUSION: Cannulated screws, anatomical plates, dynamic hip screw internal fixation showed a higher complication rate significantly than bipolar femoral head replacement and total hip arthroplasty (P < 0.01); the good and excellent effect rate in cannulated screw, femoral end plate, and dynamic hip screw fixation was significantly lower than that in bipolar femoral head replacement and total hip arthroplasty (P < 0.001, P < 0.01). The results suggested that artificial joint replacement (bipolar femoral head replacement or total hip replacement) is the optimal choice for aged osteoporotic femoral neck fracture, cannulated screw fixation is suitable for Garden I, dynamic hip screw fixation and proximal femoral anatomical plate fixation fit for intertrochanteric fractures of Jensen-Evans I-Ⅱ; Jensen-Evans Ⅱ-Ⅲ osteoporotic intertrochanteric fractures joint replacement is the ideal choice.  Related Articles | Metrics