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    22 October 2011, Volume 15 Issue 43 Previous Issue    Next Issue
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    Construction of a canine model of total hip arthroplasty
    Li Zhi-chang, Xiao Chong, Li Ru-jun, Gao Hong, Lin Jian-hao
    2011, 15 (43):  7981-7986.  doi: 10.3969/j.issn.1673-8225.2011.43.001
    Abstract ( 374 )   PDF (1821KB) ( 312 )   Save

    BACKGROUND: Total hip arthroplasty (THA) has become the major treatment of late stage of hip disease. Among lots of THA animal models, the canine is popular because of its similarity to human and being easy to manage.
    OBJECTIVE: To build up an animal model of metal-on-metal THA based on German Shepherd dogs.
    METHODS: 33 German Shepherd dogs were divided into four groups: pilot group (n=7), blank control (n=4), cemented group (n=11) and cementless group (n=11). The blank control group only received the approach and suture, while the two experimental groups received cemented and cementless THA. The prosthesis was designed for this project. Animals of these three groups were sacrificed 1 year after surgery, and X-ray films of the hip were taken at the time of 3 months, 6 months and 1 year after surgery for observation of hip morphology.
    RESULTS AND CONCLUSION: Animals of the blank control group recovered well. In the cemented group, femoral fracture and secondary wound infection occurred in two animals, infection surrounding the prosthesis occurred in two animals, and herniation of cement into the pelvis occurred in one animal. In the cementless group, wound and deep infection occurred in three animals, and repetitive dislocation of the hip joint occurred in one animal. All infected animals were scarified unless the infection was controlled after 1 week of cefuroxime administration. All the other animals recovered well, the gait was nearly normal, and the X-ray films taken immediately, 3, 6, 9 and 12 months after surgery showed that the implants were in a good position. The total complication rate in the arthroplasty operation was 9% (2/22), and the total infection rate was 32% (7/22). These findings suggest that the canine model of THA is a stable, repetitive animal model with high successful rate.

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    Virtual operation planning in orthopedic surgery for acetabular fractures based on real CT data
    Wang Guang-ye, Zhang Chun-cai, Xu Shuo-gui, Xue Shuang-tao, Lin Qing-gao
    2011, 15 (43):  7987-7990.  doi: 10.3969/j.issn.1673-8225.2011.43.002
    Abstract ( 311 )   PDF (522KB) ( 392 )   Save

    BACKGROUND: Virtual operation planning can help surgeons to improve the accuracy of orthopedic operations.
    OBJECTIVE:To test the feasibility and clinical value of preoperative virtual surgical planning in pelvis and acetabular fractures using Mimics software based on an interactive virtual reality-style environment.
    METHODS: Thirteen patients with pelvis and acetabular fractures were scanned with spiral CT preoperatively. The real data from CT in DICOM format were transformed into Mimics software. With segmentation process, each fracture segment became a separate object. Bone fragments could be moved and rotated in all three planes and reduction was performed. Then we performed all the steps of the surgical procedure.
    RESULTS AND CONCLUSION: The median time needed to segment the osseous parts of an entire pelvis and to extract a surface model was 45 minutes (ranging 30 to 70 minutes), and the median time for fracture reduction was 28 minutes (ranging 16 to 45 minutes). The planned approach was followed in 12 of the 13 cases, the planned fixation was followed completely in 12 cases and partially in 1 cases. The screw count was identical to the planned operation in 10 cases, the screw length was identical in 8 cases, and fixation plate count was identical in 11 cases. Postoperative congruence of the acetabular joint surface as determined according to Matta in the follow-up CT was anatomic in 6 cases (46%) and satisfactory in 7 cases (54%). There was no case with inadvertent penetration of the hip joint. Virtual operation planning in orthopedic surgery is helpful for enacting accurate operation program and providing data reference for actual operation, which brings significant value and new opportunities in clinical practice.

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    Measuring the displacement of the steel plate for humeral fractures under 100 N and 400 N by the digital speckle method
    Zhao Yun-wei, Zhou Yi-ping, Chen Ying-jie, Li Zhong-ming, Ye Hong, Kong Wei-yun
    2011, 15 (43):  7991-7993.  doi: 10.3969/j.issn.1673-8225.2011.43.003
    Abstract ( 250 )   PDF (551KB) ( 290 )   Save

    BACKGROUND: The digital speckle method used in biomedicine is more accurate to analyze the characteristics of screw breakage.
    OBJECTIVE: To measure the displacement of the humeral steel screw by the digital speckle method.
    METHEDS: A total of 4 root humeri were used, and humeral middle segment fracture was made by sawing at 1/2 of the humerus. The fracture sample was reduced, and fixed using 8-well plate with 4 screws at each end. Five conditions (before and after the fracture) were designed to compare the displacement of the screws. The displacement was calculated under 100 and 400 N tensile force. Condition A was a strengthened plate fixation (no sawed, no fracture); Condition B was to remove a screw at the proximal end after fracture; Condition C was to remove a screw at the distal based on B; Condition D is to remove a screw at the proximal based on C; Condition E was to remove a screw at the distal based on D. Two MEDAL screws displacement at both ends were calculated by using relevant softwares.
    RESULTS AND CONCLUSION: Under 100 N and 400 N tension, there were significant different displacement of the two screws symmetrically distributed at both fracture lines as other screws decreased (P < 0.01). Stress difference of the two screws symmetrically distributed beside fracture line ends had no remarkable significance by further binary comparison (P > 0.05). The two screws which were just located near the two fringes of the fracture line undertaken more stress and collapsed easily. It would be better to choose the screw with the screw pore of diameter 100-2.5 mm longer than the present one, in order to increase its stability to avoid the breakage.

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    Establishment of a three-dimensional finite element model of mandible surrounding solely or splinted implant-borne fixed partial denture
    Ma Li-sha, Tang Liang, Pan Yan-huan
    2011, 15 (43):  7994-7997.  doi: 10.3969/j.issn.1673-8225.2011.43.004
    Abstract ( 282 )   PDF (530KB) ( 344 )   Save

    BACKGROUND: Three-dimensional finite element model has been widely used in previous studies, accurate construction of which provides research support for the optimization of implant bridge design.
    OBJECTIVE: To establish a three-dimensional finite element model of solely and splinted implants in the mandible, as the mathematical foundation of biomechanical research.
    METHODS: Three-dimensional finite element models were created of a 765 section of the mandible with solely and splinted implants embedded in, by using CT scanning technology, the Pro/Engineer software and the ANSYS software.
    RESULTS AND CONCLUSION: The three-dimensional finite element model was good in geometry, which could serve for the needs of the three-dimensional stress analysis. CT scanning aided finite element model building, used with Pro/Engineer software and ANSYS software, is a convenient and credible method.

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    Construction of a three-dimensional finite element model of human cranial-maxillary complex with Mimics
    Guan Zhen-qun, Shi Jun, Li Ai-qun, Li Min, Wang Ming-hua, Liu Tao, Huang Di-yan
    2011, 15 (43):  7998-8001.  doi: 10.3969/j.issn.1673-8225.2011.43.005
    Abstract ( 292 )   PDF (491KB) ( 476 )   Save

    BACKGROUND: Cranial-maxillary complex is one of the most complex and versatile structure in the skeletal system. For the biomechanical analysis of cranial maxillary complex, it is necessary to establish a precise three-dimensional finite element model
    OBJECTIVE: To develop an effective and feasible method to construct the three-dimensional finite element model of cranial-maxillary complex. 
    METHODS: A voluntary healthy adult with normal relationship, healthy periodontal tissues and temporomandibular joint was chosen for model establishment. Multi-slice CT scan in combination with Mimics software and MSC.Patran software were used to prepare the three-dimensional finite element model of cranial-maxillary complex.
    RESULTS AND CONCLUSION: We had explored out a new quick construction method of maxillary complex. A 3D FEM of normal maxillary complex was constructed. It included 76 035 nodes and 373 819 elements. It could be observed at any dimension. The finite element model had better biomechanical characters.

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    Femoral neck anteversion CT measuring method in diagnosis and treatment of hip lesions
    Hu Rong-hui, He Bin, Wu Bei-hai, Liu Li, Yan Rui, Liu Jia-kai, Huang Xiao-bo, Zhang Jian, Ding Wei
    2011, 15 (43):  8002-8005.  doi: 10.3969/j.issn.1673-8225.2011.43.006
    Abstract ( 426 )   PDF (527KB) ( 309 )   Save

    BACKGROUND: Femoral neck anteversion is an angle between the posterior edge connection of the femoral condyle and the femur neck axis, involving the two ends of the femur. The measurement is more difficult, and many measurement methods lead to different results.
    OBJECTIVE: To provide the anteversion of the femoral neck criterion for imaging diagnosis of hip joint through CT measurement research.
    METHODS: Eighty adults who had performed CT scan were selected. The hip joints had no structural disease. In conventional position, the same side hip joint and knee joint were scanned and the anteversion of the femoral neck was calculated, called as definition value. In neutral position, the hip joint was scanned, and the anteversion of the femoral neck was measured, called as experiment value.
    RESULTS AND CONCLUSION: The mean and standard deviation of the definition value of anteversion of the femoral neck was (10.48±2.40)°. The mean and standard deviation of the experiment value of anteversion of the femoral neck was (10.29±2.10)°. There were no significant differences between definition value and experiment value (P > 0.05). The method to measure experiment value was simple that was just to scan hip joint. Experiment value showed anteversion of the femoral neck exactly. It provided quantificat index for the diagnosis and treatment of hip disease.

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    The anatomy research on three-dimensional digital intercondylar notch model based on MRI images: Comparison of three-dimensional data and measurement data
    Xu Peng, Li Yan-lin, Chen Wen-dong, Yang Guang, Wang Guo-liang, Tong Lu, Hu Meng
    2011, 15 (43):  8006-8009.  doi: 10.3969/j.issn.1673-8225.2011.43.007
    Abstract ( 326 )   PDF (605KB) ( 523 )   Save

    BACKGROUND: X-ray, CT, and MRI two-dimensional images for measurement of the intercondylar notch are limited by the projection position and selection of measurement level and the measurement accuracy is poor.
    OBJECTIVE: To explore the accuracy of three-dimensional digital model based on MRI images and to compare the difference of three-dimensional digital intercondylar notch model with cadaver.
    METHODS: There were 18 male cadaveric knees and 14 female cadaveric knees scanned by MRI two-dimensional images. The MRI images were imported into Mimics Software for intercondylar notch three-dimensional reconstruction, the related anatomical data which were gotten from the three-dimensional digital model named as three-dimensional reconstruction group, while the cadavers were dissected to measure anatomical data named as entity group.
    RESULTS AND CONCLUSION: The measuring values had no differences between the three-dimensional reconstruction group and entity group (P > 0.05). The three-dimensional digital model based on MRI images could accurately show the entity specimens information. It could be used for anatomy research of the normal femoral intercondylar notch.

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    Three-dimensional vascular magnetic resonance assessment of the blood supply following femoral neck fracture
    Fu Yu, Fu Yun-gen, Xu Wen-hua, Li Jun-ning, Yuan Xiao-jun
    2011, 15 (43):  8010-8013.  doi: 10.3969/j.issn.1673-8225.2011.43.008
    Abstract ( 316 )   PDF (574KB) ( 458 )   Save

    BACKGROUND: Clinical judgments of local blood supply after femoral neck fracture are many; however, the disadvantages of these methods are also a lot. Especially, it cannot accurately judge the blood supply of 2-3 grade blood vessels around femoral neck fracture.
    OBJECTIVE: Using three-dimensional magnetic resonance angiography to study the blood circulation of the femoral head after femoral neck fracture, providing a basis for the choice of surgical approaches.
    METHODS: Sixteen patients with femoral neck fracture admitted at 2008-07/12 did not receive three-dimensional magnetic resonance angiography and were treated with closed reduction and double-headed pressurizing hollow screw as control group. Thirty-three patients with femoral neck fracture admitted at 2009-01/2011-02 underwent MRI and three-dimensional magnetic resonance angiography, closed reduction and two-headed compression screw fixation was performed in 30 cases as experimental group and hip replacement in 3 cases.
    RESULTS AND CONCLUSION: In the control group, 11 cases had osteal healing and 5 cases needed other treatment; in the experimental group, 29 cases had osteal healing and 1 case needed other treatment. The three-dimensional magnetic resonance angiography can show the arteries and ramus around femoral neck clearly, and provide reference for selection of surgical approaches and reducing the incidence of secondary surgery.

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    Condyle volume and surface area in young Chinese people with Angle's class Ⅰ malocclusion: A cone-beam CT study
    Feng Gang, Zhou Jian-ping, Wu Yang, Zhou Xiao-feng, Dai Hong-wei
    2011, 15 (43):  8014-8018.  doi: 10.3969/j.issn.1673-8225.2011.43.009
    Abstract ( 325 )   PDF (697KB) ( 321 )   Save

    BACKGROUND: Condyle is the growth center of the mandible, and the size of the condyle is closely associated with the mandibular shape; while a variety of joint diseases can lead to changes in condylar shape.
    OBJECTIVE: To measure the condyle volume and surface area in young Chinese people with Angle’s class Ⅰ malocclusion by cone-beam CT (CBCT), and to provide a quantitative standards for volumetric and surface measurements of the mandibular condyle in Chinese population.
    METHODS: Seventy young patients with Angle’s class Ⅰ malocclusion were chosen from the Affiliated Hospital of Stomatology, Chongqing Medical University (age range: 18-28 years; 34 males and 36 females). Inclusive criteria were as follows: patients with symmetrical faces, “↓” open type, opening was normal, no joint snapping, pain and other symptoms. All patients received CBCT examination, the CT slice used through the Mimics 10.0 for three-dimensional reconstruction of the condyle to measure the condyle volume, surface area and shape index (ratio of volume and surface area).
    RESULTS AND CONCLUSION: The condyle volume and surface area in male patients were greater significantly than those in female patients (P < 0.01). There were no difference between the left and right condyle in the volume and surface area ( > 0.05). The shape index had no difference between male and female patients as well as between the left and right condyle. It is found that patients with symmetrical faces and no joint symptoms of malocclusion Angle's class Ⅰmalocclusion have symmetrical condyle.

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    Application of carotid artery MR images segmentation and three-dimensional reconstruction in locating carotid atherosclerotic lesions
    Shao Hui-yan, Qin Hai-qiang, Hou Yuan-yuan, Zhou Ping, Xia Hong
    2011, 15 (43):  8019-8022.  doi: 10.3969/j.issn.1673-8225.2011.43.010
    Abstract ( 351 )   PDF (669KB) ( 475 )   Save

    BACKGROUND: The technology of three-dimensional (3D) reconstruction of medical images has been playing an increasingly important role in clinical diagnosis and research. The 3D reconstruction technique is rather complex, with the image segmentation being the first and most important step.
    OBJECTIVE: To explore the carotid artery MR image segmentation and 3D reconstruction methods for its application in locating carotid atherosclerotic lesions.
    METHODS: The 3D TOF sequence images were chosen and segmented by the threshold segmentation based on maximum entropy, which was followed by the mathematical morphological method to take the carotid artery blood from the background successfully. Finally, the 3D model of the carotid blood was produced with the aid of the Mimics software and the location of carotid atherosclerotic lesions was identified easily.
    RESULTS AND CONCLUSION: For the 3D TOF sequence images segmentation, the threshold segmentation based on maximum entropy is better and suitable. Besides, the mathematical morphological method takes responsibility for the following segmentation. The 3D model of carotid blood is of great help in locating carotid atherosclerotic lesions. 

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    Comparison of early gait parameters following total knee arthroplasty with fixed platform and rotating platform high-flexion prostheses
    Zhou Xin, Wei Min, Wang Wei
    2011, 15 (43):  8023-8026.  doi: 10.3969/j.issn.1673-8225.2011.43.011
    Abstract ( 305 )   PDF (535KB) ( 445 )   Save

    BACKGROUND: Because of different design mechanisms in fixed platform and rotating platform prosthesis, there are different opinions.
    OBJECTIVE: To compare the early gait parameters and HSS scores following total knee arthroplasty with fixed platform and rotating platform high-flexion prosthesis and to find the difference between two treatment methods.
    METHODS: Thirty-four knees in 34 patients with osteoarthritis undergoing total knee arthroplasty were evaluated by using HSS and gait analysis technique. The effects of total knee arthroplasty with fixed platform and rotating platform high-flexion prosthesis were compared.
    RESULTS AND CONCLUSION: By using HSS and gait analysis, we found no difference in two kinds of prostheses within 12 months following total knee arthroplasty. Through HSS and gait analysis technique, we can get more accurate and more comprehensive information.

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    Application of continuous femoral nerve block for perioperative management of pain in total knee arthroplasty
    Fang Rui, Deng Ying-jie, Meng Qing-cai, Song Yu-cheng
    2011, 15 (43):  8027-8030.  doi: 10.3969/j.issn.1673-8225.2011.43.012
    Abstract ( 270 )   PDF (545KB) ( 247 )   Save

    BACKGROUND: Femoral nerve block as a new pain control after total knee arthroplasty has not been widely carried out.
    OBJECTIVE: To observe the clinical efficacy of continuous femoral nerve block for perioperative management of pain in total knee arthroplasty.
    METHODS: A total of 77 patients were randomized into study group (32 cases) and control group (35 cases). All patients received a basic analgesic regimen: oral administration of celecoxib preoperatively and injection of cocktail therapy intraoperatively. In addition, the study group received continuous femoral nerve block postoperatively. A morphine patient-controlled analgesia pump was also available as a rescue analgesic to all the patients.
    RESULTS AND CONCLUSION: The study group had less pain (P < 0.05) within the first postoperative 48 hours, was more satisfied with the analgesia (P < 0.05) and used less morphine (P < 0.05) compared with the control group. Fewer patients were nauseated, vomited or were drowsy in the study group (P < 0.05). Also, the study group achieved better knee flexion at 1 week after surgery (P < 0.05). However, after 3 months, there were no significant functional differences between the groups (P > 0.05). A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after total knee arthroplasty. Early functional recovery is improved. Therefore, the method is a safe and effective analgesia with satisfactory results.

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    Expression of serum interleukin-6, 8, 10, C-reactive protein and deep vein thrombosis after joint replacement
    Yang Feng, Sui Fu-ge, Zhang Yong, Li Heng, Ma Dong-sheng, Li Qiang, Tian Fei-peng
    2011, 15 (43):  8031-8033.  doi: 10.3969/j.issn.1673-8225.2011.43.013
    Abstract ( 311 )   PDF (408KB) ( 272 )   Save

    BACKGROUND: Vascular endothelial cell injury, slow blood flow, hypercoagulability, and abnormal white blood cell rheology are the important factors for deep vein thrombosis after joint replacement.
    OBJECTIVE: To analyze the association of serum interleukin 6, 8, 10, C-reactive protein expression with deep vein thrombosis after joint replacement.
    METHODS: Serum interleukin 6, 8, 10, C-reactive protein expression were detected 68 cases of joint replacement patients before and after replacement, and ultrasonic testing was used to determine whether deep vein thrombosis occurred.
    RESULTS AND CONCLUSION: The expression of serum interleukin 6, 8, 10, C-reactive protein in thrombosis patients after joint replacement was higher than that of patients without thrombosis after joint replacement at 1 and 3 days (P < 0.05), indicating inflammatory factors participated in thrombosis formation. Real-time monitoring of changes in these indicators could help to prevent thrombosis. In the patients with thrombosis, the levels of serum interleukin 6, 8, 10, C-reactive protein were higher at 1 and 3 days after joint replacement than before joint replacement (P < 0.05); however, at 5 days after joint replacement, the levels of these indicators were close to those before joint replacement (P> 0.05). After joint replacement, the blood hypercoagulability had a gradual reduction process, especially at 3 days after joint replacement that was a key to anti-inflammatory anticoagulant treatment.

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    Short-term outcome of metal-on-metal total hip arthroplasty with large diameter head
    Yuan Dong-tang, Zuo wen-shan, Liu Kai-Xiang, Dai Zhi-Tang, Xu Yong-yi
    2011, 15 (43):  8034-8037.  doi: 10.3969/j.issn.1673-8225.2011.43.014
    Abstract ( 209 )   PDF (506KB) ( 244 )   Save

    BACKGROUND: Dislocation after total hip replacement is still one of the main complications of traditional metal-on-polyethylene total hip replacement. Metal-on-metal total hip arthroplasty with large diameter head has a good stability, suitable for young and active patients with higher requirement of movement.
    OBJECTIVE: To evaluate the short-term therapeutic effect of total hip arthroplasty with metal-on-metal bearings and large diameter head hip prosthesis.
    METHODS: A retrospective analysis was done in 48 patients (54 hips) with advanced stage hip disease treated by primary total hip arthroplasty with metal-on-metal bearings and large diameter head hip prosthesis. The mean diameter of femoral head prosthesis was 44 mm (38 to 48 mm). The postoperative short-term effect was evaluated with Harris scores and X-ray plain.
    RESULTS AND CONCLUSION: All patients received the follow-up of 18 to 36 months. The mean Harris hip score was 93.6 (91 to 96) at the last follow-up. The mean range of hip motion was 232.6° (182° to 257°) at the last follow-up. There were no infection, no hip and thigh pain, no vessel and nerve complications, no dislocation. Post-opretive X-ray plain revealed fine position of the prostheses without any loosening. Short-term results show that large diameter metal-on-metal total hip arthroplasty has advantages of lower wearing, large range of motion and few dislocations.

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    Application of artificial total knee prosthesis replacement in limb salvage surgery for osteosarcoma with pathological fracture located in the distal femur
    Liu Yi, Cui Zhi-ming, Cui Sheng-yu, Yang Jian, Yan Jian-jun
    2011, 15 (43):  8038-8041.  doi: 10.3969/j.issn.1673-8225.2011.43.015
    Abstract ( 310 )   PDF (495KB) ( 319 )   Save

    BACKGROUND: Amputation surgery as a traditional treatment for osteosarcoma is preferred. With the continuous improvement of chemotherapy, prosthesis manufacturing process and materials science advances, it is possible to keep body functions
    OBJECTIVE: To evaluate the effect of artificial total knee prosthesis replacement in the treatment of patients with osteosarcoma and pathological fracture located in the distal femur.
    METHODS: Limb salvage surgery with prosthetic knee replacement was performed in 9 patients with osteosarcoma and pathological fracture in the distal femur. The reconstruction of limb function was done using total knee replacement with individualized prosthesis. Neoadjuvant chemotherapy was used in all the cases pre- and postoperatively.
    RESULTS AND CONCLUSION: The nine patients were followed up for 6-72 months. Eight cases survived without tumor in 3 years and 6 in 5 years. The 5 years survive rate was 66.7%. The range of extension and flexion of the knee was 0°-100° in 6 cases, and 3 in 0°-70°. The function of the knee was assessed by Enneking system. The results were graded as excellent in 6 patients, good in 2 cases, and fair in 1 case. Material-related inflammation and rejection reactions were not found. It is effective for the treatment of osteosarcoma and pathological fracture in the distal femur through extensive or radical resection and reconstruction by using prosthetic knee replacement.

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    Clinical application of un-cemented distal femoral prosthesis in elderly patients undergoing total hip revision
    Jiang Lin, Li Jian, Jian Xiao-fei, Zhang Shi-zhan
    2011, 15 (43):  8042-8045.  doi: 10.3969/j.issn.1673-8225.2011.43.016
    Abstract ( 244 )   PDF (491KB) ( 313 )   Save

    BACKGROUND: It is still a thorny problem faced by orthopedic surgeons how to select the right femoral prosthesis fixation in total hip revision in elderly patients at present. Application of revision surgery with modular femoral prosthesis can effectively deal with such problems.
    OBJECTIVE: To evaluate the clinical outcomes of the application of un-cemented distal fixation stem in the total hip revision of elderly patients.
    METHODS: Eleven patients aged over 75 years with aseptic loosening femoral stem were revised. According to Paprosky classification system, type Ⅰ was 2 cases, type Ⅱ was 2 cases, type ⅢA was 7 cases.
    RESULTS AND CONCLUSION: All cases were followed up for over 16 months. The average Harris hip score increased from 37 to 89. The excellent or good rate post-surgery was above 90%. No loosening occurred again after revision. The radiographs after surgery showed increased bone density and thickness around the prosthesis. Reliable axial and anti-rotational stability can be achieved with the application of un-cemented distal fixation stem. It is especially appropriate for the revision surgery in elderly patients.

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    Biomechanical characteristics of medial collateral ligaments in animal models of knee osteoarthritis
    Jin Xiao-fei, Guo Chang-qing, Jiang Zhao-xia, Liu Fu-shui
    2011, 15 (43):  8046-8049.  doi: 10.3969/j.issn.1673-8225.2011.43.017
    Abstract ( 264 )   PDF (749KB) ( 538 )   Save

    BACKGROUND: Factors of mechanics and physical chemistry lead to degeneration of cartilage matrix which may cause knee osteoarthritis (KOA). There are lot of studies on factors of physical chemistry and degeneration of cartilage matrix and few studies on factors of mechanics.
    OBJECTIVE: To explore the change of tension for medial collateral ligament (MCL) of rabbit KOA models.
    METHODS: Rabbits in the model group were copied into KOA models, after which test on tension was performed to each of the 6 rabbits in the two groups at the speed of 5 mm/min on Bose Electro Force 3300 protracted test machine. Data obtained from the test every 0.1 s were recorded as far as the sample was pulled and broken.
    RESULTS AND CONCLUSION: Maximum displacement, maximum stress, maximum strain and modulus of elasticity of MCL were (2.76±0.37) mm, (17.92±3.18) MPa, (10.7±2.07)%, (316.19±74.55) MPa in the normal control group and (2.08±0.31) mm, (11.34±1.05) MPa, (7.97±1.65)%, (279.77±33.91) MPa in the model group. We could see that each index in the normal control group was greater than that in the model group obviously (P < 0.05). It indicates that KOA has a certain effect on the biomechanics of MCL.

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    Establishment of a femoral head model of low dose steroid-induced osteonecrosis
    Liu Wei, Zhao Jin-min, Su Wei, Li Xiao-feng, Qin Yi-wu
    2011, 15 (43):  8050-8054.  doi: 10.3969/j.issn.1673-8225.2011.43.018
    Abstract ( 348 )   PDF (1560KB) ( 304 )   Save

    BACKGROUND: With the widespread use of steroid hormone, the incidence of steroid-induced osteonecrosis remained high, but the pathological mechanism of human femoral head avascular necrosis is unclear.
    OBJECTIVE: To establish a model of steroid-induced osteonecrosis of femoral head and to discuss the effects of low dose of steroid in New Zealand white rabbits.
    METHODS: Thirty rabbits were randomly divided into two groups. The experimental group rabbits received intramuscular injection of 4 mg/kg methylprednisolone sodium succinate; the control group rabbits were injected with the same amount of physiological saline at the same time. The venous blood reticulocytes were extracted for serological testing before and at 4, 6 and 8 weeks after exsangquinations. At 4, 6 and 8 weeks after steroid administration, histopathology of femoral head was performed and these rabbits were euthanized in batch.
    RESULTS AND CONCLUSION: During the experimental process, one rabbit in the experimental group died. A total of 29 rabbits were involved in the analysis of results. During experimental course, the experimental group rabbits exhibited depressed consciousness and reduced activities and decreased weight loss (P < 0.05) after steroid administration. During the 4th week after administration, cells in the marrow cavity expanded and multiplied in number, which could be observed through the use of light microscope, and the percentage of fat cell size was higher compared with the control group (P < 0.05). At the 6th week, bone empty lacunae percentage was increased compared with the control group (P < 0.05). At the 8th week, the bone trabeculae of the experimental group were reduced and disordered, and disconnected, bone trabecular area percentage was decreased compared with the control group (P < 0.05), and there were parts of sequestrum and collapse in the area of cartilage. At the 8th week, total cholesterol level in the experimental group was significantly higher than that in the control group ( < 0.05). At the 4th week, total triglycerides and low density lipoprotein level in the experimental group was significantly higher than that in the control group ( < 0.05); high density lipoprotein level was significantly higher than that in the control group ( < 0 .05). At the 6th week, serum level of alkaline phosphate was significantly increased compared with the control group ( < 0.05). Osteobecrosis of femoral head can be induced by low dose of steroid in rabbits.

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    Reconstruction of a metal on metal hip surface replacement prosthesis based on reverse engineering/ forward design
    Liu Deng-jun, Li Jian-yi, He Xiao-bing, Yin Hao, Ran Guang-wen, Li Zheng-yan, Li Qi, Lin Li-jun
    2011, 15 (43):  8055-8058.  doi: 10.3969/j.issn.1673-8225.2011.43.019
    Abstract ( 234 )   PDF (1168KB) ( 299 )   Save

    BACKGROUND: During the prosthesis assembly, an absolutely matched three-dimensional model is required.
    OBJECTIVE: Through the exploration of reverse engineering/forward design technique to find a fast and accurate method for reconstruction of a three-dimensional model of hip surface replacement prosthesis.
    METHODS: Based on point cloud file from the three-dimensional laser scanner, proximal femur component, acetabular component were reconstructed by the Geomagic and 3ds max software.
    RESULTS AND CONCLUSION: The three-dimensional reconstruction distinctly displayed the structures of acetabulum and proximal femur component. Geomagic and 3ds max software according to the original three-dimensional laser scanner point cloud file can accurately perform reconstruction of hip surface replacement prosthesis, and provide a technical support for virtual surgery and personalized prosthesis design.

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    Establishment of a three-dimensional finite element model of the lower limb artery and computational fluid dynamics simulation
    Ma Yan-shan, Xie Ying-hua, Ren Guo-shan, Zhao Chang-yi, Li Wei, Cao Lei
    2011, 15 (43):  8059-8062.  doi: 10.3969/j.issn.1673-8225.2011.43.020
    Abstract ( 315 )   PDF (1160KB) ( 404 )   Save

    BACKGROUND: With the development of computer technology, blood vessels virtual reality becomes possible.
    OBJECTIVE: To construct a digital finite element model of the lower limb artery based on the CT sectional images for fluid dynamics simulation.
    METHODS: DICOM images were harvested from patients with narrow artery CTA to build a three-dimensional model in MIMICS14.0. Then, the finite element model was obtained in ANSYS11.0, for analysis of the real conditions of fluid flow.
    RESULTS AND CONCLUSION: A three-dimensional model of local stenosis vessel in MIMICS14.0 software. Then, the finite element model of blood vessels was obtained in ANSYS workbench, with 7 335 model nodes and 43 415 units. Finite element analysis was applied to obtain a series of visualized computational fluid data. We could the visual graphic of the flow velocity variations, pressure variations, blood flow path and Wall shear, and establish the required three-dimensional finite element model.

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    Anatomic characteristics of thoracic pedicle-rib complex for internal fixation
    Xing Wen-hua, Jia Lian-shun, Huo Hong-jun, Yang Xue-jun
    2011, 15 (43):  8063-8067.  doi: 10.3969/j.issn.1673-8225.2011.43.021
    Abstract ( 318 )   PDF (2012KB) ( 376 )   Save

    BACKGROUND: The surrounding structures of the thoracic vertebra are complicated, and the thoracic pedicle is thinner than lumbar pedicle anatomically, particularly in some cases of scoliosis or other spine deformity, resulting in impossible implantation of pedicle screws or post-implantation injury. Therefore, the safety and efficacy of pedicle screw fixation cannot be guaranteed.
    OBJECTIVE: To study the applied anatomy of the pedicle-rib complex and to perform the biomechanical test for screw insertion through the pedicle-rib complex in the thoracic spine.
    METHODS: Six specimens of adult cadaveric thoracic spine (T1-12) were used to observe modality of pedicle and pedicle-rib complex. The following parameters were measured: pedicle width (P-W), pedicle height (P-H), pedicle length (P-L), pedicle transverse angle (P-TA), pedicle sagittal angle (PSA), pedicle-rib complex transverse distance (PRC-W), longitudinal distance (PRC-H), screw length (PRC-L), angle in transverse plane (PRC-TA) and angle in sagittal plane (PRC-SA).
    RESULTS AND CONCLUSION: The measurement results of the above-mentioned parameters were as follows: PRC-W: 13.0-17.3 mm, PRC-H: 5.8-8.0 mm, PRC-L: 43.4-60.5 mm, PRC-TA: 15.4°-36.7°, PRC-SA: 76.2°-85.4°. Screw implantation through the pedicle-rib complex in the thoracic spine is safer and has better mechanical stability than that of pedicle screw. The former one may be just regarded as a supplementary of the latter in some instance that the transversal width of thoracic pedicle is too small to implant screw.

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    Expression and significance of CXCR4 in rat bone tissue around implants during early implantation
    Jia Ting-ting, Hou Yu-dong
    2011, 15 (43):  8068-8070.  doi: 10.3969/j.issn.1673-8225.2011.43.022
    Abstract ( 263 )   PDF (513KB) ( 275 )   Save

    BACKGROUND: The SDF-1/CXCR4 axis system is consisted of CXCR4 and stromal cell-derived factor -1 (SDF-1). The SDF-1/CXCR4 axis system plays an important role in regeneration and repair of tissue and bone injury.
    OBJECTIVE: To investigate expression and significance of CXCR4 in rat bone tissue around implants during early implantation.
    METHODS: Twenty Wistar rats of 4 months old were selected and randomly divided into implantation 6-, 12- and 24-hour groups and blank control group with 5 mice in each group. All rats except blank control group received anodically oxidized implants in the left tibia. Rats were killed 6, 12, 24 hours after implantation, the implants were unscrewed, and bone tissues around implants were prepared, 2 cm in diameter. For blank control group, 2 cm proximal epiphysis bone tissues were prepared. Then protein samples were then prepared.
    RESULTS AND CONCLUSION: a large number of fibers could be seen on the anodized implant surface in each group. the grey values of CXCR4/β-actin were significantly higher in the implantation 6-, 12- and 24-hour groups than the blank control group (P > 0.01). The expression of CXCR4 during the first 24 hours of implantation was obviously higher than that of the blank control group, indicating that CXCR4 positive cells take part in the regeneration of bone tissue during early osseointegration.

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    Horizontal and vertical stress relaxation characteristics of the distal femoral cancellous bone
    Zhao Yan-jun, Jiao Jian-xia, Piao Cheng-dong
    2011, 15 (43):  8071-8074.  doi: 10.3969/j.issn.1673-8225.2011.43.023
    Abstract ( 279 )   PDF (635KB) ( 286 )   Save

    BACKGROUND: Previous studies mostly have two or more samples for experiments, and the longitudinal stress relaxation experiments are preferred.
    OBJECTIVE: To compare the horizontal and vertical tensile stress relaxation of the distal femoral cancellous bone, and to provide the biomechanical parameters of the distal femoral cancellous bone.
    METHODS: Ten femur samples from normal male corpses, aged 20-30 years, were selected, 5 for each side. The femoral samples were taken out from the corpses within 1 hour after autopsy. The right femoral samples were covered with saline-soaked gauze, saved in -20 ℃ refrigerator. Before experiment, the samples were taken to be thawed in room temperature and made into specimens of 20 mm×20 mm×20 mm. Firstly, longitudinal stress relaxation experiments were performed in 10 specimens, and 24 hours later, horizontal stress relaxation experiments were performed in these 10 specimens. Strain acceleration was 0.5%/s, experimental time was set to 7 200 s, and 100 experimental data were collected.
    RESULTS AND CONCLUSION: The longitudinal and horizontal stress relaxation was 0.58 MPa and 0.72 MPa at 7 200 s, respectively. The stress relaxation curve changed based on the relation of logarithm. The longitudinal creep strain at 7 200 s was lower than the horizontal one. The stress relaxation equation of the distal femur cancellous bone based on the three-parameter model can well reflect the stress relaxation properties of the distal femur cancellous bone.

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    Reconstructed thoracolumbar height following posterior transpedicular pedicle screw fixation and bone graft
    Fu Yu, Huo Hong-jun, Yang Xue-jun, Xiao Yu-long, Xing Wen-hua, Zhao Yan
    2011, 15 (43):  8075-8078.  doi: 10.3969/j.issn.1673-8225.2011.43.024
    Abstract ( 258 )   PDF (569KB) ( 346 )   Save

    BACKGROUND: Posterior short segment pedicle screw fixation devices can achieve similar anatomic fracture reduction effect and significantly improve the outcome, but the loss of orthopedic degree during long-term follow-ups, fixation failure and other complications are commonly seen.
    OBJECTIVE: To study the feasibility and curative effect of posterior transpedicular pedicle screw fixation and bone graft for thoracolumbar fractures.
    METHODS: Seventy-three thoracolumbar vertebra fracture patients treated by unilateral pedicle screw fixation and contralateral autologous and allogeneic bone graft.
    RESULTS AND CONCLUSION: All the patients achieved bone union within 6 months, and the fusion rate was 100%. No screw loosening and breaking occurred. One case of Frankel grade C had no change, and 1 case of Frankel grade D had no change. The remaining patients had an improvement in neurologic function and low back pain; The Cobb angle of the injured segment, the height of anterior border of the injured vertebral body and the vestigial degree of canalis spinalis anteroposterior diameter were significantly restored with 6 months after treatment. Vertebral pedicle screw fixation with transpedicular bone graft cannot only reduce verbebral fracture satisfactorily, reconstruct thoracolumbar height, increase the stability of the spine, but also decrease the possibility of nail breaking and correction loss.

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    Knee function comparison and histological evaluation of the tibial shaft after intramedullary nail fixation
    Zhu Long-zhang, Xue Feng, Han Ben-song
    2011, 15 (43):  8079-8082.  doi: 10.3969/j.issn.1673-8225.2011.43.025
    Abstract ( 297 )   PDF (578KB) ( 328 )   Save

    BACKGROUND: Biological changes of the knee after intramedullary nail fixation is an important factor influencing knee function.
    OBJECTIVE: To analyze and compare the knee function following tibial fractures treated with intramedullary nail fixation by different approaches, and to make histological comparisons and evaluation for patellar tendon and fat pad damage.
    METHODS: In a retrospective case study, we evaluated 45 patients with history of closed tibial shaft fracture who had been treated by intramedullary nail fixation. The 45 patients were divided into transpatellar, medial parapatellar and lateral parapatellar groups.
    RESULTS AND CONCLUSION: There was no difference in the scores of knee function among the three groups after implantation (P > 0.05). Scar formation degree in the surgical incision, knee dysfunction and pain degree were more significant in the transpatellar group than the medial parapatellar and lateral parapatellar groups. These findings indicate that intramedullary nail fixation via the medial parapatellar and lateral parapatellar approaches leads to a better knee function and a lower incidence rate of patellar tendon and fat pad damage.

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    Cluster analysis and principal component analysis in traditional medical syndrome types and standardization of cervical spondylosis
    Wang Chun-xiao, Xie Xing-wen, Li Ning
    2011, 15 (43):  8083-8088.  doi: 10.3969/j.issn.1673-8225.2011.43.026
    Abstract ( 357 )   PDF (646KB) ( 365 )   Save

    BACKGROUND: Recently, the classification of cervical spondylosis is relatively single, lacking the features of Chinese medicine syndrome types in dialectically treating the disease. The previous methods of classifying cervical spondylosis are the summaries of personal experiences without objective base. Therefore, it is significant to investigate syndrome classification using cluster analysis and principal component analysis.
    OBJECTIVE: To investigate the distribution traits in cervical spondylosis according to different symptom types of traditional Chinese medicine using cluster analysis and principal analysis.
    METHODS: The questionnaire was designed according to the clinical manifestations in cervical spondylosis patients. Symptoms, clinical signs, tongue, pulse and other diagnostic messages of 575 patients were collected, to analyze 98 common symptoms using cluster analysis and principal component analysis.
    RESULTS AND CONCLUSION: According to the results of cluster analysis, the disease could be divided into eight categories: dampness-heat energizer, phlegm and wet resistance channels and collaterals, deficiency of qi and blood, deficiency of liver-kidney yin, deficiency of the spleen and kidney-yang, blood stasis and qi stagnation, cold dampness resistance channels and collaterals, deficiency of liver and spleen. We found that most of their disease mechanisms were “state of evil domination”, which was caused by qi stagnation, dampness-heat, cold dampness, phlegm-dampness, blood stasis. Meanwhile, because of the existence of asthenia of healthy qi, the main representation was deficiency of yin, deficiency of yang, deficiency of qi and deficiency of blood. Cluster analysis and principle component analysis are scientific to some extent used in the research of traditional Chinese medical syndrome types.

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    Focal target controlling during high intensity focused ultrasound therapy based on respiratory gating
    Zhang Jie, Zhao Chun-liang, Tan Jian-wen, Zhong Ling, Wang Hua
    2011, 15 (43):  8089-8092.  doi: 10.3969/j.issn.1673-8225.2011.43.027
    Abstract ( 326 )   PDF (582KB) ( 363 )   Save

    BACKGROUND: It is an urgent problem to be solved that the organ of displacement caused by breathing could affect the precision of the target of orientation and also the safety of the therapy during the routine treatment.
    OBJECTIVE: To study the feasibility that using the respiratory gating to improve the accuracy of focal point positioning during high intensity focused ultrasound (HIFU) therapy.
    METHODS: HIFU ablation based on breathing gated control using piezoresistive micro-breathing sensor was applied to the rabbit liver in vivo, which was compared with the normal HIFU ablation procesure for the difference in coagulative necrosis produced under the same ultrasound intensity and ablation duration.
    RESULTS AND CONCLUSION: The rabbits were executed immediately after HIFU ablation to investigate lesions inside the liver. Results showed that the biological focal region using breathing gated HIFU ablation was 4.5 mm×2 mm at the largest sectional plane, while that using normal HIFU ablation procesure was 9 mm×2.5 mm. The respiratory gating could eliminate the influence of the accuracy of focal point positioning during HIFU therapy.

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    Signal processing and simulation analysis of mapping catheter positioning signals in respiration and heartbeat interference
    Liu Yan-tao, Su Zhi-jian, Chen Zhong-zhong, Liu Xin-xu
    2011, 15 (43):  8093-8096.  doi: 10.3969/j.issn.1673-8225.2011.43.028
    Abstract ( 339 )   PDF (676KB) ( 321 )   Save

    BACKGROUND: In the three-dimensional (3D) endocardial mapping system with electric filed positioning principle, the respiration and heartbeat movements influence the positioning signals of mapping catheter in the chest, which greatly affect the positioning accuracy. 
    OBJECTIVE: To find a simulation analysis and signal processing method of artificially adding and detecting the respiration and heartbeat interference terms.
    METHODS: First, the positioning signals’ mathematical model was proposed according to the mapping principle to determine the signal conditioning, detection and extraction methods. Then, the signal processing was simulated and calculated by Matlab to check if the mathematical model was right. Finally, to meet the requirements of high-speed and real-time during the operation, we designed the corresponding hardware circuit to theoreti-cal model, and used Multisim (circuit design software) to simulate the hardware circuit to check the feasibility of implementing the proposed method in the actual work.
    RESULTS AND CONCLUSION: It showed that either numerical simulation or circuit simulation could emulate catheter positioning signals with respiration and heartbeat interference, the theoretical analysis method and actual circuit system could extract the respira-tion and heartbeat interference terms successfully.

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    Systematic evaluation of patellar replacement in total knee arthroplasty
    Cheng Shi-gao, Wang Wan-chun, Xiao Yang, Wu Xu-hui, Li Jian
    2011, 15 (43):  8097-8103.  doi: 10.3969/j.issn.1673-8225.2011.43.029
    Abstract ( 353 )   PDF (774KB) ( 349 )   Save

    BACKGROUND: Whether patellar displacement is performed during total knee replacement or not has been controversial.
    OBJECTIVE: To evaluate the efficacy of patellar replacement during total knee arthroplasty systematically, and to provide references for further clinical research and medical practice.
    METHODS: In accordance with strict inclusion and exclusion criteria and the pre-developed search strategy, the following databases and journals were searched for relavant articles: Cochrane Central Register of Controlled Trials, MEDLINE-, PubMed-, EMBASE-, CBM, CNKI and VIP. Meta analysis used the Revman 5.0.25 software provided by Cochrane collaboration.
    RESULTS AND CONCLUSION: 1788 knees were included in the 14 published trials, including 886 knees in the patellar resurfacing group and 902 in the patellar nonresurfacing group. The result of the meta-analysis indicated that the risk of postoperative anterior knee pain was lower in patellar resurfacing group than in patellar nonresurfacing group between 5 years and 7.5 years. The combined RR was 0.19, 95%CI (0.11, 0.31). But the difference did not exist within 5 years or after 7.5 years. The risk of reoperation had no significant difference between the patellar resurfacing group and patellar nonresurfacing group within 5 years. But 5 years later, the risk of reoperation was lower in the patellar resurfacing group than in the patellar nonresurfacing group. The combined RR was 0.49, 95%CI (0.33, 0.75). Whatever using sub-group analysis or using general analysis, there was no difference in the mean postoperative knee scores. Weighted mean difference for the results of the general analysis was 0.26, 95%CI (-1.39, 1.90). Whatever using sub-group analysis or using general analysis, there was no difference in patient satisfaction. The combined RR for patient satisfaction was 1.01, 95%CI (0.97, 1.05). The efficacy of resurfacing the patella in total knee arthroplasty is better than nonresurfacing the patella in total knee arthroplasty.

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    Unilateral versus bilateral kyphoplasty for osteoporotic vertebral compression fractures: A Meta-analysis
    Li Da-gang, Su Pei-ji, Chen Gan-feng, Chen Shi-zhong, Gao Heng
    2011, 15 (43):  8104-8107.  doi: 10.3969/j.issn.1673-8225.2011.43.030
    Abstract ( 331 )   PDF (636KB) ( 333 )   Save

    BACKGROUND: Kyphoplasty has been shown to significantly improve the treatment of osteoporotic vertebral compression fractures; however, it is still a controversy as to whether the procedure should be done by unilateral or bilateral approach.
    OBJECTIVE: To compare the efficacy and safety of unilateral or bilateral kyphoplasty for the treatment of osteoporotic vertebral compression fractures.
    METHODS: All controlled studies of unilateral or bilateral kyphoplasty for the treatment of OVCF were identified. Two reviewers assessed the trials and extracted data independently.
    RESULTS AND CONCLUSION: Five studies including 241 patients met the inclusion criteria. There was no significant difference between the two groups with regard to improvement in pain and cement leakage (P=0.99, P=0.56, respectively). Compared with unilateral kyphoplasty, kyphotic wedge angle reduction was more significant in the bilateral group (P=0.05). The mean operation time for the unilateral group was significantly shorter than the bilateral group (P < 0.000 01). The results showed that both unilateral kyphoplasty and bilateral kyphoplasty can achieve satisfactory clinical and radiographic outcomes in treating osteoporotic vertebral compression fractures. Although the bilateral kyphoplasty is more efficacious in kyphotic wedge angle reduction, the operation time is longer. There is no significant difference between the two groups in the cement leakage. High-quality randomized trials are needed to confirm these.

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    Gamma nail versus dynamic hip screw in the treatment of intertrochanteric fractures: A Meta-anlyisis
    Peng Wei-bo, Nong Lin, Wei Shi-zhan, Luo Qun-qiang, Mo Xiong-ge, Ban Hua-deng
    2011, 15 (43):  8108-8111.  doi: 10.3969/j.issn.1673-8225.2011.43.031
    Abstract ( 268 )   PDF (620KB) ( 394 )   Save

    BACKGROUND: Early fixation for intertrochanteric fractures is positive and effective, and the clinical therapies for intertrochanteric fractures in the elderly are different and each has its advantages and disadvantages.
    OBJECTIVE: To explore the clinical effect of Gamma nail versus dynamic hip screw in the treatment of intertrochanteric fractures.
    METHODS: By searching CENTRAL (the Cochrane central register of controlled trials), Medline EMBSE, WANFANG, CBM and CNKI, we collected randomized controlled trials about the Gamma nail versus dynamic hip screw for intertrochanteric fractures. The methodological quality was assessed by using Cochrane Handbook. The data was analyzed by using statistic software Stata 11.0.
    RESULTS AND CONCLUSION: Twelve trials were analyzed in the final analysis. Totally 888 patients were in the gamma nail group and 981 patients were in the dynamic hip screw group. A higher rate of postoperative femoral shaft fracture, shorter operation time and less blood loss were observed in the Gamma nail group compared with DHS group (P < 0.05); But no statistical difference was found in wound infection, operation good rate and hospital stay between the two groups. Gamma nail can shorten the operation time and reduce the amount of blood loss, but increase the risk of postoperative femoral shaft fracture.

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    Meta analysis of conservative or surgical treatment of floating shoulder injury
    Liu Zhen-dong, Wang Jing-cheng, Gu Jia-xiang, Feng Xin-min, Yan Lian-qi, Yang Jian-dong, Hu Han-sheng, Wang Qiang, Tao Yu-ping
    2011, 15 (43):  8112-8115.  doi: 10.3969/j.issn.1673-8225.2011.43.032
    Abstract ( 283 )   PDF (612KB) ( 385 )   Save

    BACKGROUND: Floating shoulder injury is a rare trauma disease, and the treatments of this disease are controversial. There are no authoritative clinical instructions for scholars to reach a consensus at present.   
    OBJECTIVE: To assess the conservative or surgical treatments of floating shoulder injury.    
    METHODS: The databases of China National Knowledge Infrastructure (CNKI) and Web of Science were searched online with computer. The key words were “floating shoulder, floating shoulder injury”. The data collected about all relevant controlled trials were extracted and evaluated, analyzed with RevMan4.2 software, and followed by observation of the analyzing features and results indicated by forest plots. 
    RESULTS AND CONCLUSION: Whether conservative or surgical treatments can achieve satisfied clinical outcomes. The surgical treatment, compared with conservative methods, is dominant in getting excellent effect. There is no difference between two methods in getting good effects of the overall quality.

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    Process concerning the periprosthetic infection after total hip replacement
    Li Fei-long, Zeng Yi-rong
    2011, 15 (43):  8118-8123.  doi: 10.3969/j.issn.1673-8225.2011.43.034
    Abstract ( 290 )   PDF (391KB) ( 292 )   Save

    BACKGROUND: Periprosthetic infection after total hip replacement usually results in surgery failure and needs a second operation.
    OBJECTIVE: To explore the pathogenesis, diagnosis and treatment of periprosthetic infection after total hip replacement by reviewing and summarizing articles published in recent years.
    METHODS: A computed-based online search of Pubmed database was performed by using the key words of “total hip arthroplasty, infection” for manuscripts published from January 1990 to December 2010 and of those in SpringerLink database between January 1, 1970 and December 31, 2010. A total of 2 109 manuscripts were retrieved. Moreover, related book or manuscripts that published by high-impact journals were included. Totally, 29 manuscripts were included.
    RESULTS AND CONCLUSION: The formation of biofilms on the surface of prosthesis is the main cause for hardly eradicated. Resistant bacteria and polymicrobial infection seems to be an increasing tendency. A correct diagnosis as soon as possible is very important to prognosis. However, without a gold-standard way, each mean has advantages and shortages, and comprehensive considerations are necessary. Interleukin-6 seems a good choice for its inexpensive, non-invasive and a high sensitivity and specificity, which has aroused increasing attention. The antibiotics only, debridement with retention, one-stage replacement, two-stage replacement, joint arthrodesis, even amputation, are used to treat infection after total hip replacement. Prophylactic antibiotics are important to prevent infection. Antibiotic-loaded acrylic cement seems to be reliable and accept for more and more patients. However, each option must be selected according to the presence of infection individually.

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    Repair of osteonecrosis of the femoral head with statins
    Gao Ji-jian, Li Biao, Gong Yue-kun
    2011, 15 (43):  8124-8127.  doi: 10.3969/j.issn.1673-8225.2011.43.035
    Abstract ( 316 )   PDF (612KB) ( 419 )   Save

    BACKGROUND: In recent years, with the development of organ transplant technology in clini, osteonecrosis of the femoral head caused by corticosteroids accounts for the first place that has an increased trend year after year.
    OBJECTIVE: To review the mechanism of statins drugs in the treatment of osteonecrosis of the femoral head providing the foundation for further experimental research and clinical application.
    METHODS: The first author searched CNKI, PubMed, Wanfang and VIP databases in 1980-01/2010-12 to retrieve articles about the mechanism of statins used in the treatment of avascular necrosis of the femoral head. The keywords were “avascular necrosis of the femoral head; statins; glucocorticoids; osteoblast” or “ONFH; corticosteroids; statins; osteoblasts” in Chinese and English, respectively. Articles published recently or in authorized journals were preferred. Old and repetitive experimental articles were eliminated, 169 articles were checked; and according to inclusion criteria, 34 articles were reviewed.
    RESULTS AND CONCLUSION: Osteonecrosis of the femoral head is a common and multiple diseases in the field of orthopedics, and its treatment is a difficult task facing the world. Research shows that statins can effectively correct lipid metabolism disorders, reduce bone cell damage in the femoral head, and slow or stop the pathological process of osteonecrosis, deformation and collapse.

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    Clinical application of Ilizarov transfixation wires and circular external fixation system in treating lower limb fractures
    Fang Guang-wen, Lü Ting-zhuo, Shu Heng-sheng
    2011, 15 (43):  8128-8132.  doi: 10.3969/j.issn.1673-8225.2011.43.036
    Abstract ( 237 )   PDF (652KB) ( 474 )   Save

    BACKGROUND: Ilizarov transfixation wires and circular external fixation system can be used in orthopedic domain such as limb lengthening, deformity correction and management difficult therapeutic problems of bone and soft tissues.
    OBJECTIVE: To review the application progress of Ilizarov transfixation wires and circular external fixation system in treating lower limb fractures.
    METHODS: The first author retrieved the literature about the application of Ilizarov transfixation wires and circular external fixation system in treating lower limb fractures in the PubMed and Wanfang database from 1997 to 2011.
    RESULTS AND CONCLUSION: Ilizarov transfixion wires and circular external fixation system is an available method in treating various kinds of lower limb fractures, and has obtained more and more orthopedic surgeons favor for its many significant advantages such as biological fixation, minimal concomitant injury, decreased incidence of soft tissue complications, early mobilization, early weight-bearing, rapid union, no need second operation to get rid of internal fixation implants.

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    Aseptic loosening after prosthetic replacement
    Tan Wei-qin, Yang Shi-jun, Cui Jian-he
    2011, 15 (43):  8133-8136.  doi: 10.3969/j.issn.1673-8225.2011.43.037
    Abstract ( 349 )   PDF (622KB) ( 439 )   Save

    BACKGROUND: Aseptic loosening after total hip replacement has been a trouble for the surgeons.
    OBJECTIVE: To investigate the mechanism, influential factors and prevention measures of prosthetic loosening.
    METHODS: A computer based search of CNKI and PubMed (1993-01/2010-11) was performed for articles about the mechanism, influential factors and prevention measures of prosthetic loosening using the keywords of “Prosthetic loosening, Mechanism, Factors, Treatment” in Chinese and English. Repetitive and Meta analysis articles were excluded.
    RESULTS AND CONCLUSION: Finally, 21 articles were included in the result analysis. After artificial joint replacement, the wear debris particles on the implant-bone interface and surrounding bone tissues can induce a series of biological reactions through the interaction. It is the key to cause aseptic loosening. However, the aseptic loosening can be improved by the improvement of prosthesis design and materials as well as promotion of implanting skill and reasonable prevention.

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    Prophylaxis and treatment for infection following total knee replacement
    He Sheng, Zeng Yi-rong
    2011, 15 (43):  8137-8141.  doi: 10.3969/j.issn.1673-8225.2011.43.038
    Abstract ( 276 )   PDF (293KB) ( 238 )   Save

    BACKGROUND: It is difficult to revise replacement due to infection-induced osteodeficiency, osteoporosis, soft tissue lost or cicatrization.
    OBJECTIVE: To establish the standardized clinical prevention and treatment methods by summarizing the new progress to prevent, diagnosis of the infection, and its effective treatment, as well as rehabilitation evaluation after total knee replacement.
    METHODS: A computer-based online search of CNKI and PUBMED database between January 1990 and December 2010 was performed to search related articles with the key words of “total knee arthroplasty, infection”. A total of 2 346 articles were retrieved. Moreover, related works were manually searched. Totally, 30 articles were included.
    RESULTS AND CONCLUSION: It is better to prevent infection rather than treatment after total knee replacement. Currently, there is lack of a clear diagnosis standard on the infection. In treatment aspect, debridement, revision surgery, and choosing effective antibiotics can effectively control the infection. Meantime, new methods are expected to improve the success rate of infection after total knee replacement. Exercise is a continuation of rehabilitation therapy and an important step in treatment. Therefore, on the basis of total knee replacement, it is important to establish the early prevention of postoperative infection, early diagnosis, effective treatment and rehabilitation evaluation system, in order to minimize the incidence of infection and treat infections timely and effectively.

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    Characteristics and choice of interbody fusion implants in lumbar pedicle screw fixation surgery under endoscopy
    Zhang Jun, He Hong-sheng, Yuan Fang-jun, Zhou Wen-bo, Liu Wei
    2011, 15 (43):  8142-8146.  doi: 10.3969/j.issn.1673-8225.2011.43.039
    Abstract ( 478 )   PDF (560KB) ( 315 )   Save

    BACKGROUND: Currently, interbody fusion implants in lumbar pedicle screw fixation surgery under endoscopy include natural biomaterials, synthetic materials and composite materials, which have their own advantages and disadvantages.
    OBJECTIVE: To explore how to choose the most suitable implants by analyzing and discussing the characteristics of the interbody fusion implants in lumbar pedicle screw fixation surgery under endoscopy.
    METHODS: We searched the Wanfang and Medline databases (1999-01/2010-12) with the keywords of “endoscopic, screw-rod fixation, interbody implant” for the articles regarding the interbody fusion implants in lumbar pedicle screw fixation surgery under endoscopy.
    RESULTS AND CONCLUSION: As the size of interbody fusion implants matches the request of the endoscopic pathway, it is widely used in lumbar pedicle screw fixation surgery under endoscopy nowadays. The materials of cages have evolved from the first initial materials such as titanium alloy to biodegradable and absorbable biomaterials. The allograft cortical bone fusion materials have also emerged, which are most close to the so-called “gold standard”. Each intervertebral fusion device has its own advantages and disadvantages. The choice of the most suitable interbody fusion implants should be made according to the patient’s imaging and the characteristics of lumbar spine internal fixation.

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    Screw-rod fixation system for lumbar fractures: A mechanical analysis
    Liu Gang
    2011, 15 (43):  8147-8150.  doi: 10.3969/j.issn.1673-8225.2011.43.040
    Abstract ( 282 )   PDF (493KB) ( 322 )   Save

    BACKGROUND: Posterior pedicle screw fixation system is the most common treatment for lumbar fractures, characterized as easy operation, short time, small damage and little bleeding.
    OBJECTIVE: To analyze the mechanical properties of pedicle screw-rod fixation system under different conditions.
    METHODS: The author retrieved PubMed and Wanfang databases (1990/2010) for articles about lumbar fracture treatment, clinical application, mechanical parameters, intensity, fatigue and safety of pedicle screw-rod fixation system as well as relevant finite element studies.
    RESULTS AND CONCLUSION: Pedicle screw-rod fixation system can effectively restore vertebral body height and curvature to correct deformity and maintain the three-dimensional position of the spine. The design, implant angle, and implant depth of the different implants as well as the number of fixed segments result in different mechanical properties. We can get the best fixation effect based on the understanding of these properties, proper implanting method and fixation of appropriate units.

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    Locking compression plate combined with Osteoset bone graft substitute in the treatment of proximal humeral fracture: A follow-up of 22 cases
    Wang Guo-dong, Yuan Tong-zhou, Xu Nuo, He Bin, Fan Lei, Huang Ye, Wang Yun-hua
    2011, 15 (43):  8151-8154.  doi: 10.3969/j.issn.1673-8225.2011.43.041
    Abstract ( 279 )   PDF (547KB) ( 349 )   Save

    BACKGROUND: Screw, Kirschner’s tension-band wire, intramedullary nail and clover plate are ineffective in the treatment of proximal humeral fractures and often lead to loosening, rotator cuff injury, blood supply destruction to affect humeral head blood supply and shoulder abduction.
    OBJECTIVE: To observe the curative effect of locking compression plate combined with Osteoset bone graft substitute in the treatment of proximal humeral fracture.
    METHODS: Twenty-two cases of proximal humeral fracture were treated with locking compression plate combined with Osteoset bone graft substitute and the curative effect was evaluated.
    RESULTS AND CONCLUSION: All cases were followed up for 12-24 months. According to Neer evaluation system, 13 cases were excellent, 7 cases were good, 2 cases were fine, 0 case was poor, and the fineness rate was 91%. After treatment, X-ray showed that proximal humeral fracture and shoulder dislocation received a satisfactory reduction. It is indicated that the curative effect of locking compression plate combined with Osteoset bone graft substitute in the treatment of proximal humeral fracture is affirmative.

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    Y-type locking plate for intercondylar fractures of the adult hunmerus in 36 cases
    Cheng Yu-fang, Wei Zhong-min, Huang Fang-min, Zhang Ke-liang, Li Zi-xi
    2011, 15 (43):  8155-8158.  doi: 10.3969/j.issn.1673-8225.2011.43.042
    Abstract ( 269 )   PDF (497KB) ( 338 )   Save

    BACKGROUND: Intercondylar fracture of the humerus is a kind of complex intra-articular fractures. Fracture exposure and fixation are difficult.
    OBJECTIVE: To explore the surgical effect of Y-type locking plate through the approach of olecranon osterotomy on intercondylar fracture of the adult humerus.
    METHODS: Thirty-six adult patients with intercondylar fractures of the hunmerus were treated with Y-type locking plate through the approach of olecranon osterotomy, including 22 males and 14 females, aged 19-76 years, averagely 47 year. According to the AO/OTA classificaiton, type C1 fracture was found in 8 cases, type C2 in 15, and type C3 in 13.
    RESULTS AND CONCLUSION: Thirty-two cases received a follow-up of 10-26 months. According to Cassebaum scale, the function of the elbow showed excellent in 15 cases, good in 13 cases, fair in 3 cases and poor in 1 case, and the excellent-good rate was 89.6%. No infection occurred. The mean time for fracture healing was 2.4 to 4.5 months, averagely 3.5 months. The technique of Y-type locking plate for intercondylar fracture of the adult humerus is effective against bone nonunion. Early rehabilitation for patients on the CPM machine is better for elbow joint function. It is an effective method for intercondylar fracture of the humerus.

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    Efficacy of gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone for non-traumatic osteonecrosis of the femoral head in 69 cases with 83 hips
    Wang Yi-jin, Luan Jian, Cui Xue-fen, Ren Yue-bing
    2011, 15 (43):  8159-8162.  doi: 10.3969/j.issn.1673-8225.2011.43.043
    Abstract ( 245 )   PDF (561KB) ( 383 )   Save

    BACKGROUND: Currently, there are many methods for treatment of adult non-invasive femoral head necrosis, but their long-term efficacy is not sure.
    OBJECTIVE: To evaluate the clinical efficacy of gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone for non-traumatic osteonecrosis of the femoral head. 
    METHODS: Sixty-nine patients (83 hips) with non-traumatic osteonecrosis of the femoral head underwent thorough curettage and gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone. Defects in the femoral neck were implanted with gluteal muscle flap from the greater trochanter without fixation. After treatment, anteroposterior X-ray films of the hip were regularly reviewed.
    RESULTS AND CONCLUSION: All the patients were followed up successfully for 12-120 months (average 48 months). The pain of the hip in all patients disappeared or mostly relieved after the operation. The motion of hip joint became better. According to the score of 100 points recommended by Chinese Medical Association, the surgical outcomes were excellent in 48 hips (58%), good in 27 hips (33%), fair in 6 hips (7%), and poor in 2 hips (2%). The good rate was 90%. The gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone for non-traumatic osteonecrosis of the femoral head can obtain mini-trauma, better recovery of necrotic bone and excellent clinical results. However, the long-term effects need further studies.

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    Clinical efficacy analysis and experience in 73 cases of diabetics undergoing hip joint replacement
    Yu Shi-ming, Zhang Yang-chun, Sheng Pu-yi, Hu Jun-yong, Li Yong-biao
    2011, 15 (43):  8163-8166.  doi: 10.3969/j.issn.1673-8225.2011.43.044
    Abstract ( 373 )   PDF (574KB) ( 333 )   Save

    BACKGROUND: With the growth in the incidence of diabetes, the number of diabetic patients accompanied with joint disease is increasing, but diabetic patients undergoing hip joint replacement are rarely reported.
    OBJECTIVE: To analyze the clinical effect of diabetic patients undergoing hip joint replacement and to sum up the experience.
    METHODS: Seventy-three diabetic patients (80 hips) received arthroplasty, including 50 males and 23 females, aged 49-81 years, averagely (62.6±5.4) years. Fifty-five patients were treated by diet and oral antidiabetic drugs before admission, and 18 by the insulin. Of the 73 patients, 57 cases (62 hips) underwent biomedical hip prosthesis, and 16 (18 hips) received bone cement + hip prosthesis.
    RESULTS AND CONCLUSION: Harris score was increased from preoperative 55.4 points to 84.2 points, and the good rate good was 96.5%. After a mean 4.5 years follow-up (ranging 3 months-9 years), the mean Harris score was 77.6 points and the good rate was 80.2%. No delayed infection and prosthesis loosening occurred after operation. The prostheses of 40 cases had no changes, and the prostheses had a slight sinking in 11 cases (average sinking to 2 mm), 7 patients had mild hip pain, and 5 cases presented with acetabular rim hyperostosis. Prosthesis renovation was not performed in all the cases. The author thought that diabetics without serious complications, by proper perioperative management, good blood glucose control and so on, can obtain a good effect on hip arthroplasty.  

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    Posterior spinal osteotomy, three-dimensional orthopedic treatment and third-generation pedicle screw fixation system for treatment of Scheuermann's disease: A data review of 9 cases in the same organization within 7 years
    Li Ye, Wang Yi-peng, Zhang Jian-guo, Shen Jian-xiong, Zhao Hong, Zhao Yu
    2011, 15 (43):  8167-8170.  doi: 10.3969/j.issn.1673-8225.2011.43.045
    Abstract ( 346 )   PDF (463KB) ( 268 )   Save

    BACKGROUND: Currently, there are few reports about Scheuermann’s disease, and relevant clinical experiences are lack.
    OBJECTIVE: To evaluate the clinical diagnosis, manifestation and operative treatment of Scheuermann’s kyphosis and analyze its clinical outcomes.
    METHODS: Nine patients with Scheuermann’s disease were selected in the Department of Orthopedics, Peking Union Medical College Hospital, from January 2002 to December 2009. All the patients received posterior spinal osteotomy and three-dimensional orthopedic treatment. The kyphosis Cobb’s angle in the sagittal plane, clinical manifestation were evaluated both before and after operation.
    RESULTS AND CONCLUSION: The median follow-up was 27 months (3-88months), and two cases were lost. The mean kyphosis Cobb’s angle in the sagittal plane changed from 68° (30°-86°) to 29° (0°-56°). The correction rate was about 55% (35%-100%). The kyphosis Cobb’s angle on the final follow-up was 30° (5°-58°), and the mean lost angle was 1°. The sagittal balance was good (from 4.5 cm to 1.5 cm). All patients, who had chronic back pain, fatiguability refractory to conservative treatment, improved considerably after surgery. One-stage posterior spinal osteotomy with three-dimensional orthopedic treatment can be used effectively for the correction of Scheuermann’s kyphosis.

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