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26 November 2011, Volume 15 Issue 48 Previous Issue    Next Issue

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Construction of a rabbit intervertebral disc degeneration model induced by puncture under fluoroscopic guidance characterized by imaging and pathology Jiang Xin-hua, Zhang Ling, Chen Jian-yu, Cai Zhao-xi, Zhang Ya, Liu Zhen-zhen, Xie Chuan-miao, Wu Yao-pan, Wu Pei-hong 2011, 15 (48):  8931-8934.  doi: 10.3969/j.issn.1673-8225.2011.48.001 Abstract ( 308 )   PDF (1077KB) ( 374 )   Save BACKGROUND: Most animal models of disc degeneration are prepared under direct vision during surgery, and surgical incision leads to a larger damage in animals. OBJECTIVE: To prepare a rabbit intervertebral disc degeneration model by annulus puncture under fluoroscopic guidance, and to investigate the radiology and pathogenesis of intervertebral disc degeneration. METHODS: Rabbit annulus was punctured under fluoroscopic guidance at L2/3, L3/4, L4/5, the process of disc degeneration was observed in different time intervals after the puncture of the intervertebral disc by X-ray, MRI and histopathology. RESULTS AND CONCLUSION: After the puncture of the intervertebral disc, there was a progressive degeneration of the disc with decreased signal intensity on T2WI, the disc showed necrosis of nucleus pulposus cells and annulus, and cracks and fissures were evident in the annulus at last. Annulus puncture can induce a progressive, reproducible intervertebral disc degeneration in a rabbit model. Related Articles | Metrics

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Construction of a three-dimensional finite element model of “lumber-pelvic-hip” to simulate lumbar massage technique Hu Hua, Xiong Chang-yuan, Han Guo-wu 2011, 15 (48):  8935-8938.  doi: 10.3969/j.issn.1673-8225.2011.48.002 Abstract ( 420 )   PDF (1164KB) ( 529 )   Save BACKGROUND: The finite element analysis of partial vertebral or entire vertebral massage technique has its limitation. OBJECTIVE: To build an infinite element model of “lumber-pelvic-hip” to research the biomechanical mechanism of lumbar massage. METHODS: Surface models of the lumbar, pelvis and proximal femur bone complex with high geometric similarity were constructed by Mimics 10.01 through importing subject-specific spiral CT data. Then, the models were modified though geomagic9 software, and solid modeling was converted from triangular based surface model by hypermesh10.0 software to add intervertebral disc and ligaments. According to the relevant literature on the finite element model, material properties were assigned for each component. Three loading conditions were used to simulate lumbar massage technique in finite element analysis software Abaqus6.5 software. Finally, the displacement, von-Misses stress and strains of specific location in the “lumber-pelvic-hip” infinite models were calculated by computer. RESULTS AND CONCLUSION: The displacement, von Misses stress and strains of specific location in the model under the three conditions could reflect the biomechanical characteristics of the lumber-pelvic-hip, implying the accuracy of the finite element model. Geometric similarity is essential for a finite element model, and subject-specific material assignment according to reported biomechanical data can ensure the accuracy of the model. Both loads and boundary conditions approximation to physiologically environment in the finite element models ensure the accuracy of results. Related Articles | Metrics

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Digital model and three-dimensional visualization of lumbar disk bulging segment Li Xiao-lin, Ren Bo-xu 2011, 15 (48):  8939-8942.  doi: 10.3969/j.issn.1673-8225.2011.48.003 Abstract ( 399 )   PDF (538KB) ( 355 )   Save BACKGROUND: The biomechanical study of lumbar disk bulging is significant. OBJECTIVE: To investigate the digital model and three-dimensional visualization of lumbar disk bulging segment. METHODS: Bone structure and various soft tissues of the lumbar spine were reconstructed by Mimics software based on 16-slice spiral CT continuous two-dimensional 114 images of L3-4 segments. The models were verified by introduced finite element analysis software. RESULTS AND CONCLUSION: The established three-dimensional digital model of lumbar disk bulding segment included two vertebral bodies, endplate, annulus fibrosus, nucleus pulposus and six types of ligaments. The digital model could be used for research of three-dimensional measurement, reduction, surgical simulation, output as computer aided design, rapid prototyping, and finite element analysis based on its natural appearance and strong entity. It is indicated that thin-layer CT and Mimics software ensure more accurate and rapid establishment of digital model in order to facilitate further research. Related Articles | Metrics

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Image fusion of three dimensional knee joint from virtual human project based on Mimics software Wu Hui-qun, Yan Pei-pei, Geng Xing-yun, Zhang Yuan-peng, Lü Guang-ming, Han Xiao, Ji Da-feng, Jiang Kui, Dong Jian-cheng 2011, 15 (48):  8943-8946.  doi: 10.3969/j.issn.1673-8225.2011.48.004 Abstract ( 394 )   PDF (626KB) ( 747 )   Save BACKGROUND: Scholars in home and abroad have been used different methods for three-dimensional (3D) modeling of the human knee joint, according to their different focuses, the ultimate effect and methods were different. OBJECTIVE: To make registration and fusion of reconstructed knee joint according to the characteristics from different modality images, which provides a convenient method for further biomechanics research. METHODS: Different segmentation algorithms were implemented to different knee joint tissues according to the characteristics of image from CT and MR modalities using Mimics V 10.0. 3D reconstructions of different segmented images were performed, and the results were registered and fused. RESULTS AND CONCLUSION: Based on reverse engineering principle, the bony structures such as femur, tibia, fibula, patella were reconstructed from CT serial sections, and meniscus, patellar ligament, medial collateral ligament, anterior cruciate ligament, posterior cruciate ligament were reconstructed from MR serial images. The reconstructed structures were successfully fused, and could be observed at any angle or observed individually, and could be measured. It is indicated that 3D models of knee joint based on image fusion from different modality images, which provides basis for research on computer-aided knee joint injury rehabilitation. Related Articles | Metrics

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Comparison of walking parameters before and after proprioception training by three-dimensional gait analysis after reconstruction of anterior cruciate ligament Shen Mei, Jin Ke-xin, Mao Shi-gang, Zhang Su-rui, Che Shi-qin, Lin Fang-kun 2011, 15 (48):  8947-8950.  doi: 10.3969/j.issn.1673-8225.2011.48.005 Abstract ( 344 )   PDF (646KB) ( 508 )   Save BACKGROUND: There are many studies on the effects of training on static proprioception or balance after reconstruction of anterior cruciate ligament, but few on the stability of walking. OBJECTIVE: To study the effects of proprioception enhancement training on walking stability after reconstruction of anterior cruciate ligament by three-dimensional gait analysis. METHODS: Thirty-two patients underwent unilateral anterior cruciate ligament reconstruction. At 3-6 months after operation, patients could walk themselves, and no significant swelling and pain of knee occurred. Gait analysis was examined in all patients before and after 2 months proprioception training. RESULTS AND CONCLUSION: The gait velocity (P < 0.05), stride length (P < 0.01), cadence (P < 0.01) and the maximum clearance distance of the affected foot (P < 0.001) in patients were significantly improved after training compared with those before training. Three-dimensional gait analysis showed that the sway of the trunk and pelvis was more symmetric and coordinated when walking. The three-dimensional gait analysis system is very important to evaluate the effect of proprioception training on unconscious stability of joint and maintenance of posture and balance.  Related Articles | Metrics

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Three-dimensional finite element modeling method of medical organs in simulation environment Hu Zhi-gang, Li Hong-bo 2011, 15 (48):  8951-8954.  doi: 10.3969/j.issn.1673-8225.2011.48.006 Abstract ( 399 )   PDF (649KB) ( 514 )   Save BACKGROUND: The three-dimensional reconstructed model by medical images data is mainly applied to clinical analysis, while the reverse reconstructed model by laser-scanning is usually used in biomechanical analysis. The accuracy of biomechanical model establishment directly affects the analysis results. OBJECTIVE: To analyze the reconstruction methods and significance of medical organ model by medical images data and three-dimensional laser-scanning. METHODS: ①The three-dimensional reconstruction was performed by medical reconstruction software based on human CT scanned images. ②Point cloud data of medical models analyzed by three-dimensional laser scanner were used to reverse reconstructing medical organ model with reverse treatment software. RESULTS AND CONCLUSION: Both the two methods can build geometric model and finite element model accorded with human anatomy structure for biomechanical simulation calculation. The three-dimensional model reconstructed by CT/MRI images truly reproduced the surface characteristics and internal structure of cases being scanned, which could be used as a reliable model in clinical diagnosis, surgical planning, shaping, prosthetic design, and anatomy teaching. The reverse reconstructed model by point cloud data analyzes with laser-scanning could show the case surfaces. It could be used in computer simulation analysis of human organs blunt impact by transportation and military. References | Related Articles | Metrics

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Clinical observations of flapless implant operation with implant navigation in the areas of maxillary premolar Sun Zhen-yu, Zhang Ming-rui, Chen Guang, Wang Dao-fu, Feng Jie, Hu Bin 2011, 15 (48):  8955-8959.  doi: 10.3969/j.issn.1673-8225.2011.48.007 Abstract ( 353 )   PDF (658KB) ( 637 )   Save BACKGROUND: CAD-CAM template-guided flapless implantation can ensure reliable transfer of preoperative computer-assisted planning into surgical practice. A new type of template-guided flapless implant placement using a CAM model-based planning procedure can also be used in sites with insufficient bone volume． OBJECTIVE: By observing the clinical results of flapless implant operation with implant navigation in the areas of maxillary premolar, which have relatively insufficient bone width, to evaluate the clinical feasibility of this method. METHODS: A total of eight patients who had lost 10 maxillary premolars were treated with the operations. The average height of premolar alveolar bone was (13.45±1.67) mm. By using craniofacial CT scan, three-dimensional reconstruction analysis and sham-operated analysis of rapid prototyping models, we obtained the accurate datum of the length, width, height and angle of the alveolar bone.  RESULTS AND CONCLUSION: The surgical guides had sufficient retention which was easy to place and remove on the teeth. Compared with the sham-operated analysis of models, all the implants of the 10 teeth had been implanted accurately. The average operation time was (17.0 ± 5.8) minutes. Except for one patient who had a residual root under the mucosa of maxillary sinus, the length of the implants in the alveolar bone was all more than 13 mm, without the occurrence of penetration of mucosa of maxillary sinus, perforation of bone lamella and other complications. And all the patients only had mild swelling and pain. Ten porcelain crowns were placed 3 to 6 months later. With the guidance of guide plates, the implants can be accurately implanted into the insufficient bone by application of flapless implant operation. This method may have great technical advantages and broad prospects in curing the patients with alveolar bone atrophy and insufficient available bone. Related Articles | Metrics

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Structural optimization and three-dimensional finite element analysis of functionally graded dental implants Sun Jian, Xiong Yao-yang, Li Yuan-chao, Sun Fang, Zhang Fu-qiang 2011, 15 (48):  8960-8963.  doi: 10.3969/j.issn.1673-8225.2011.48.008 Abstract ( 313 )   PDF (583KB) ( 544 )   Save BACKGROUND: The graded design of the titanium and bioceramics will enhance the early osseointegration and maintain the long-term stability. OBJECTIVE: To investigate the biomechanical behavior of functionally graded dental implant by using three-dimensional finite element method. METHODS: Three-dimensional elemental models of functionally graded dental implant and partial mandible were established. Three different elastic modulus graded change of functionally graded dental implant were designed: linear, exponential function, logarithmic function, with titanium implant as the control group. Three-dimensional element stress analysis was done by Abaqus software. RESULTS AND CONCLUSION: Compare to the control group, the stresses were reduced on every level of the implant and bone in the design of the functionally graded dental implant. From the top o the bottom of the implant, the stress on the surface of the implant was reduced by 3% to 50%, while the stress on the implant/bone interface was reduced by 10% to 30%. Among the three graded deigns, the most significant stress reduce was found in the exponential function design. The design of functionally graded dental implant reduce the stresses in the implant/bone interface, the most significant difference is exponential function design. Related Articles | Metrics

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Initial stress distribution of the maxillary anterior teeth, periodontal ligament and alveolar bone by different intruding loadings:A three-dimensional finite element analysis Lu Hong-fei, Mai Zhi-hui, Chen Qi, Chen Yue, Ai Hong 2011, 15 (48):  8964-8967.  doi: 10.3969/j.issn.1673-8225.2011.48.009 Abstract ( 361 )   PDF (282KB) ( 526 )   Save BACKGROUND: It is very important to explore an optimal loading force that can both allow effective intrusion and cause no damage to the teeth. OBJECTIVE: To investigate the optimal loading conditions, including loading force values and directions, in the intruding mechanics of maxillary anterior teeth. METHODS: A three-dimensional finite element model (3D FEM) of the maxillary anterior teeth was constructed to include the periodontal ligament (PDL), alveolar bone, and appliance (brackets and wire). The initial stress distribution and force of the maxillary anterior teeth were analyzed when the 3D FEM was loaded with different intruding force values and directions. RESULTS AND CONCLUSION: The optimal value of the intruding force for 6 anterior teeth fell within the range from 0.5 N to 1.0 N. The maximum stress was detected at the distal cervical level of the lateral incisor, and a relatively even distribution of initial stress was observed at 20° palatal deviation to the Y axis. The results suggest that using mini-screw implants at the labial region between the canine and lateral incisor and a combined 0.5-1.0 N intruding force with a distal force could be an optimal intrusion force system by which patients with normal occlusion could obtain a pure intrusion of anterior teeth. Related Articles | Metrics

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Dynamic three-dimensional CT-processing software OsiriX in the individual reconstruction of maxillofacial fractures Li Zhang-yi, Chen Gang 2011, 15 (48):  8968-8972.  doi: 10.3969/j.issn.1673-8225.2011.48.010 Abstract ( 399 )   PDF (1796KB) ( 896 )   Save BACKGROUND: Full understanding of imaging data is important to improve clinical diagnosis treatment efficiency, reduce radiation exposure and increase the cost-effective radio. OBJECTIVE: To use the OsiriX software for individual reconstruction and clinical analysis of maxillofacial fractures based on the spiral CT scan volume data, and by means of contrast with the traditional image interpretation to evaluate the application performance of new image processing platform in the clinical diagnosis and treatment of oral maxillofacial surgery. METHODS: The cases of oral and maxillofacial fractures were examined with spiral CT, the data were used in the OsiriX software platform to reconstruct three-dimensional visualization model for preoperative damage assessment, reconstruction program design, and postoperative reduction assessment, in comparison with the results of traditional interpretation. RESULTS AND CONCLUSION: Based on the OsiriX platform, we can quickly build a dynamic three-dimensional visualization model to have an intuitive understanding of trauma severity, perform the real-time measurement and make pointed reference to develop the reconstruction program. During the reconstruction process, the surgical approach and scope of the operative field are compared to improve the efficiency of reconstruction. Post-reconstruction review is effective to evaluate treatment efficiency. It is indicated that this software has unique advantages in the pre-reconstruction analysis and reconstruction program design, characterized as friendly interface and easy operation, which improves the doctor-patient communication results. Related Articles | Metrics

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Parameter measurement of the lumbar disc related to artificial disc replacement in Chinese Wang Zi-xuan, Shan Tao 2011, 15 (48):  8973-8976.  doi: 10.3969/j.issn.1673-8225.2011.48.011 Abstract ( 322 )   PDF (479KB) ( 483 )   Save BACKGROUND: The application of total disc replacement (TDR) is common for decade years. However, there are few systematic studies with large samples addressing lumbar disc measurement related to TDR in Chinese. OBJECTIVE: To provide a reference and theoretical principle for prosthesis design and replacement procedure of the lumbar disc in Chinese. METHODS: Forty-one intact lumbar spines were anatomized in adult cadavers (male 22, female 19), and cartilage cross-section thickness of the vertebral body was measured. Totally 157 standard lumbar spine X-ray films of normal adult (anterior-posterior and lateral views, male 89, female 68) were randomly selected. Lower/upper transverse diameter, lower/upper anteroposterior diameter and lumbar intervertebral space height were measured. RESULTS AND CONCLUSION: X-ray films of adult cadavers and normal adult with standard lumbar spine showed that there were no gender differences in cartilage cross-section thickness of the vertebral body, lower/upper transverse diameter, lower/upper anteroposterior diameter and lumbar intervertebral space height (P > 0.05). There was significant difference in adjacent vertebral body transverse diameters or adjacent antero-posterior diameters except L1/2, L4/5 antero-posterior diameter and L3/4 transverse diameter (P < 0.05). However, the differences were all slight in measurement outcomes. Lumbar intervertebral space widened gradually, and anterior height was larger than posterior height. The angle between endplates adjacent to L5/S1 intervertebral space was larger in evidence. Related Articles | Metrics

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Treatment of unstable femoral intertrochanteric fractures in elderly patients with total hip replacement: A follow-up of 53 cases in the same institution Peng Hao, Ma Jin 2011, 15 (48):  8977-8980.  doi: 10.3969/j.issn.1673-8225.2011.48.012 Abstract ( 326 )   PDF (533KB) ( 465 )   Save BACKGROUND: The success rate of internal fixation for treatment of unstable femoral intertrochanteric fractures in elderly patients is not high. OBJECTIVE: To observe the treatment effect of total hip replacement on unstable interochanteric fractures in elderly patients. METHODS: Sixty-nine patients over 70 years old with unstable femoral intertrochanteric fracture were involved. Total hip replacement was performed as the primary treatment in all patients. The postoperative complications, mortality rate, Harris hip score, time to return to normal activities of the patients were taken after replacement.  RESULTS AND CONCLUSION: Sixteen patients were out of follow-up. Over seven patients died one year after replacement. The Harris hip score was (66±7) at 1 month, (72±6) at 3 months, (74±5) at 1 year, and (76±6) at 3 years. The Harris hip score of 27 patients was (76±8) at 5 years after replacement. Average time to return to normal daily activities of the patients was 28 days. No loosening or infection of the implants was observed. Total hip replacement is a valid treatment option for unstable femoral intertrochanteric fractures in elderly patients. This procedure can offer quick recovery through the reduction of mechanical risk, avoid the risk associated with internal fixation, and enable the patients a good level of functions immediately after surgery. Related Articles | Metrics

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Metal-on-metal large diameter total hip prosthesis replacement for 5 years: 21 cases follow-up and evaluation Han Ya-fang 2011, 15 (48):  8981-8984.  doi: 10.3969/j.issn.1673-8225.2011.48.013 Abstract ( 339 )   PDF (709KB) ( 380 )   Save BACKGROUND: Due to the excellent activity, metal-on-metal total hip prosthesis has been widely used in artificial total hip replacement. OBJECTIVE: To investigate the medium and long term effect of metal-on-metal large diameter total hip replacement． METHODS: From April 2004 to June 2005, 21 hips of middle-aged and young patients were underwent the metal-on-metal large diameter total hip replacement under combined spinal-epidural anesthesia, and followed-up by the same surgeon through outpatient reexamination, telephone, mail letter, and statistics ipsilateral hip Harris score, range of motion and the occurrence of complications at 5 years postoperative. RESULTS AND CONCLUSION: The average Harris hip score is (94.3±1.6), the flexion angle was(111.2±14.3)°, abduction angle was (40.3±3.4)°,adduction angles was (23.5±2.4)°, external rotation angle was (54.8±3.7)°, Internal rotation angle was (20.9±2.1)°, no dislocation was observed, 1 hip showed mild osteolysis (4.8%), 2 hips appear implant loosening, 2 hips appear painful around the hip joint at 5 years follow-up postoperative. And all these complications appeared at the 6th month after replacement and maintained for 5 years. Metal-on-metal large diameter total hip replacement showed good medium-term stability and joint function recovery, and low pain incidence. Especially for young patients, it has good clinical application value. Related Articles | Metrics

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Biomechanical comparison of bilateral pedicle screw and unilateral pedicle screw fixation Chen Li-ye, Xia Hong, Wang Jian-hua, Yin Qing-shui 2011, 15 (48):  8985-8988.  doi: 10.3969/j.issn.1673-8225.2011.48.014 Abstract ( 314 )   PDF (517KB) ( 525 )   Save BACKGROUND: Most of lumbar degenerative diseases, such as lumbar instability and lumbar spondylolisthesis, need lumbar spinal fusion for the spine stability, but the choice of internal fixation approaches is an argument. OBJECTIVE: To investigate the biomechanical difference of unilateral and bilateral minimally invasive transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative diseases. METHODS: Minimally invasive TLIF with different internal fixations were performed on L4-5 segments from six fresh frozen human lumbar cadaveric specimens. Then, the specimens were divided into two groups according to different internal fixation methods: bilateral pedicle screw group and unilateral pedicle screw group. Range of motion (ROM) for the lumbar function unit was measured on the biomechanical machine and compared between the two groups. RESULTS AND CONCLUSION: Compared with the compact lumbar function unit, the ROM of the two fixation groups were significantly lower (P < 0.05). The ROM value of the bilateral pedicle screw group was significantly lower than that of the unilateral pedicle screw group in all working states (P < 0.05). Biomechanical experiments show that unilateral TLIF provides favorable biomechanical effect and stiffness, which offers the dependable stability of the lumbar vertebrae. However, compared with the bilateral pedicle screw fixation, there are still gaps in the unilateral pedicle screw fixation. Related Articles | Metrics

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In vitro effects of a new shape-memory alloy interspinous process device on zygapophyseal joints pressures distribution Liu Chang-zheng, Ma Xue-hai, Zheng Jin, Zheng Sheng-nai, Yao Qing-qiang, Tang Cheng, Huang Hao, Xu Yan 2011, 15 (48):  8989-8992.  doi: 10.3969/j.issn.1673-8225.2011.48.015 Abstract ( 290 )   PDF (506KB) ( 406 )   Save BACKGROUND: Spinous process and interspinous internal fixation can share the pressure between the disc and zygapophyseal joints and retain physical activity, but the specific biomechanical mechanism need further research. OBJECTIVE: To measure load sharing and stress distribution of zygapophyseal joints with different distractions. METHODS: Six cadaver intact lumbar specimens (L2–5) were loaded in flexion, neutral, and extension using ZWICK-Z010/BIXI electronic universal testing machine to exert 700 N•m. Pressure measuring films measured the zygapophyseal joints load during each of the three positions. Inter-spinous process stabilization device (IPD) with different spacer heights (10, 12, 14, 16, 18, 20 mm) was placed. RESULTS AND CONCLUSION: The IPD with 10 mm spacer height could not share the zygapophyseal joints load significantly. The 12 mm implant could share zygapophyseal joints load only in extension. The 14 mm implant could significant decrease the zygapophyseal joints load. The 16 mm and 20 mm implants could basically eliminate the zygapophyseal joints load. Spacer height of IPD is equal to or slightly greater than the neutral position of interspinous height can share the load of zygapophyseal joints reasonable. Related Articles | Metrics

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Biomechanical effects of kyphoplasty-assisted versus traditional bone cement augmentation on the loosened sacral screws Zhou Dong-chang, Wang Li-bing, Zeng Li-wen, Huang Yang-liang, Yu Bin-sheng 2011, 15 (48):  8993-8997.  doi: 10.3969/j.issn.1673-8225.2011.48.016 Abstract ( 255 )   PDF (407KB) ( 456 )   Save BACKGROUND: Kyphoplasty-assisted bone cement augmentation can be used in lumbar pedicle screw fixation of osteoporotic patients. OBJECTIVE: To assess the fixation strengths of loosened sacral screws augmented with kyphoplasty-assisted and traditional bone cement techniques. METHODS: Fresh sacra were harvested from nine osteoporotic cadavers. After testing bilaterally placed unicortical and bicortical pedicle screws, two unicortical pedicle screws with the traditional and kyphoplasty-assisted cement augmentations were established on the same sacrum. Following 2000 cyclic compression loading to screw head on a MTS machine, their maximum pull-out forces were recorded and compared. RESULTS AND CONCLUSION: The bone mineral densities of nine specimens were ranged from 0.61 to 0.77 g/cm2 (0.71 g/cm2 in average). The mean maximum pull-out forces of unicortical and bicortical screws, and traditional and kyphoplasty-assisted cement screws were 203, 325, 437, and 565 N, respectively. The pull-out force was significantly higher in bicortical screw compared with unicortical (P < 0.05); however, these two fixations exhibited markedly lower pull-out strength compared with two cement augmentation techniques (P < 0.05). The pull-out strength was significantly higher in kyphoplasty-assisted cement augmentation group compared with traditional bone cement technique (P < 0.05). In addition, a significant positive correlation was exhibited between bone mineral density and pull-out force for the four fixations (P < 0.05). Results demonstrated that traditional and kyphoplasty-assisted cement augmentations can serve as the salvage technique for loosening sacral screw. However, kyphoplasty-assisted augmentation can provide higher stability.  Related Articles | Metrics

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Resting state-functional magnetic resonance imaging technology applied to a balancing acupuncture treatment for central mechanisms Ye Yong-song, Liu Bo, Chen Zhi-guang 2011, 15 (48):  8998-9002.  doi: 10.3969/j.issn.1673-8225.2011.48.017 Abstract ( 394 )   PDF (754KB) ( 678 )   Save BACKGROUND: Balanced acupuncture treatment for the disease has a significant effect, but lack of modern scientific theories relate to the mechanism. OBJECTIVE: To investigate the central mechanism of balancing technique acupuncture by using resting-state functional magnetic resonance imaging (fMRI). METHODS: Ten healthy volunteers and 10 backleg pain patients with lumbar disc protrusion were examined by fMRI before and after balancing technique acupuncture. The encephalic regions which remarkably related to bilateral amygdala were analyzed by AFNI software, and the differences in brain functional connectivity of healthy volunteers and the lumbar disc protrusion patients were investigated after balancing acupuncture.  RESULTS AND CONCLUSION: After balancing acupuncture treatment, the pain of 10 lumbar disc protrusion patients has been improved. The brain region of increased functional connectivity included thalamus, brain stem, ventral anterior nucleus, ventral lateral nucleus, medial frontal gyrus, superior frontal gyrus, frontal supraorbital gyrus, inferior frontal gyrus, superior temporal gyrus, middle temporal gyrus, hippocampus, cingulate gyrus and insula. Bilateral middle temporal gyrus，supraorbital gyrus，head of caudate nucleus, insula and left dorsal thalamus，bilateral superior frontal gyrus，left middle frontal gyrus, anterior cingulate gyrus and right inferior parietal lobule of the healthy volunteers cenhanced their connection with amygdala after balancing acupuncture. And bilateral dentate body of cerebellum, vermis, left cerebellum slope, bilateral lingual gyrus, left middle occipital gyrus, right superior frontal gyrus, right precentral gyrus, bilateral inferior parietal lobule, right superior parietal lobule, and right postcentral gyrus decreased their connection with amygdale. The research on amygdale through resting state fMRI is helpful to deeply comprehend the central mechanism of balancing technique acupuncture on backleg pain. Related Articles | Metrics

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Classification of four-class imaginary movements in electroencephalogram Li Li-jun, Xiong Dong-sheng, Wu Xiao-ming 2011, 15 (48):  9003-9006.  doi: 10.3969/j.issn.1673-8225.2011.48.018 Abstract ( 404 )   PDF (675KB) ( 496 )   Save BACKGROUND: Brain-computer interface (BCI) has provided a direct communication pathway between brain and external devices. The BCI based on motor imagery research has developed from classification of the two types to classification of multi-class. OBJECTIVE: To investigate accurate and effective method for extracting and classifying electroencephalogram (EEG) for multi-class imagery movement. METHODS: First, the common average reference method was used to reduce the correlation among leads and improve the signal to noise ratio of EEG signal. The one versus the rest common spatial patterns (OVR-CSP) was used to extract the feature of EEG data, then use support vector machine of decision tree to classify the feature data. For the insufficient sample, combined with support vector machines and Bayesian classifier, expanded to the training set form the test set with a high probability of classification results, and finally re-classified by using support vector machines. RESULTS AND CONCLUSION: The best accuracy was 92.78%. The OVR-CSP and the decision tree based on support vector machine could effectively identify multi-class EEG signal, and the expansion of the sample could improve classification accuracy. Related Articles | Metrics

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Features extraction of brain-computer interface based on adaptive autoregressive models Wang Jiang, Xu Gui-zhi, Wang Lei, Zhang Hui-yuan 2011, 15 (48):  9007-9010.  doi: 10.3969/j.issn.1673-8225.2011.48.019 Abstract ( 395 )   PDF (649KB) ( 924 )   Save BACKGROUND: Due to the non-stationary nature of electroencephalograms (EEG) signals, brain-computer interface (BCI) cannot walk out of the laboratory. Due to dynamical changes of the EEG signals under the disturbance of physical or psychological conditions, it is difficult to obtain stable classified features, which is one of the main reasons for the practical utility of BCI. OBJECTIVE: To observe the classified features of EEG signals base on left hand, right hand and foot movement in order to improve the reaction rate and accuracy of classification in BCI METHODS: Three subjects were selected for the BCI experiment. Three mental tasks with the imagination of left hand, right hand and foot movement were followed according to the screen instructions. The disturbance of electro-oculogram in EEG signal was removed by using band-pass and Laplace filter. Model parameter of many variables adaptive autoregressive models (MVAAR) was extracted as the classified features. The comparison between MVAAR and traditional adaptive autoregressive models was made. RESULTS AND CONCLUSION: The result showed that classified features of left hand, right hand and foot movement could be extracted stably in MVAAR, which is beneficial to improve the adaptive ability of online BCI and the application of BCI system. Related Articles | Metrics

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Preliminary study of intelligent artificial intestinal content sensory nerve Li Jian-guo, Shi Fu-jun, Xu Shuai, Chen Fei, Huang Zong-hai, Zheng Xi-jun 2011, 15 (48):  9011-9014.  doi: 10.3969/j.issn.1673-8225.2011.48.020 Abstract ( 322 )   PDF (698KB) ( 383 )   Save BACKGROUND: Present artificial anal sphincter lacks awareness of the stool, and patients control their defecation mainly through their habits rather than the existence of the stool in the gut. OBJECTIVE: To research whether artificial intestinal content sensory nerve could distinguish different status of intestinal contents, so as to lay the basis for the research and development of intelligent artificial anal sphincter (IAAS). METHODS: Twenty healthy New Zealand rabbits were used, and the experiments were performed on the distal part of proximal colon of the rabbits. Five positions were randomly chosen on each proximal colon as the measuring points, and an intelligent artificial intestinal content sensory nerve was used to judge the solid, liquid, gaseous, and vacant status of the contents inside the colon lumen. RESULTS AND CONCLUSION: The rate of the right judgment about the solid, liquid, gaseous, and vacant status of the contents were 96%, 99%, 100%, 100% respectively. This “intelligent artificial intestinal content sensory nerve” could be used to judge whether or not the feces exists and to distinguish various status of contents inside the intestinal lumen. Using ultrasound to detect the information of different status of intestinal lumen may be an effective method. Related Articles | Metrics

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Atlantoaxial pedicle screw internal fixation for the treatment of atlantoaxial instability under three-dimensional CT reconstruction Peng Ke, Hu You-wei, Tan Yi-yun, Zhang Jian, Zeng Kai-bin 2011, 15 (48):  9015-9018.  doi: 10.3969/j.issn.1673-8225.2011.48.021 Abstract ( 278 )   PDF (528KB) ( 564 )   Save BACKGROUND: Compared with traditional methods, atlantoaxial pedicle screw internal fixation by three-dimensional (3D) CT reconstruction can improve the accuracy rate and decrease the complication of the pedicle screw internal fixation. OBJECTIVE: To investigate the treatment method of atlantoaxial instability with the atlantoaxial pedicle screw fixation, with the reference of 3D CT reconstruction of atlas and epistropheus, and to identify its operational directive significance and clinical treatment effects. METHODS: A total of 30 patients with atlantoaxial instability caused by trauma were recruited, 3D CT reconstructions of atlas and epistropheus were performed before atlantoaxial pedicle screw internal fixation. RESULTS AND CONCLUTION: No statistical significance was found between actual and designed inclination angle of entrance path and distance between midline and the entrance point for C1 and C2 pedicle screw. The intraoperative anatomical morphology of C1 posterior arch and C2 vertebral arch was consistent with pre-operative CT volume reconstruction images. Pedicle screw internal fixation based on pre-operative CT reconstruction is safe, accurate and effective with few complications and lower X-ray radiation. Related Articles | Metrics

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MRI diagnostic value for articular cartilage injuries complicated with bone bruise of the distal femur Wang Qi, Liu Xian-min, Liu Song-bo, Du Ming-chang, Liu Bing, Bai Ye, Liu Guo-qiang 2011, 15 (48):  9019-9022.  doi: 10.3969/j.issn.1673-8225.2011.48.022 Abstract ( 420 )   PDF (534KB) ( 370 )   Save BACKGROUND: Magnetic resonance imaging (MRI) makes up for a deficiency of X-ray plain films and CT images in cartilage imaging, and can be involved in early diagnosis of bone bruise and cartilage injury. OBJECTIVE: To explore the value of MRI in diagnosis of articular cartilage injuries complicated with bone bruise of the distal femur. METHODS: Thirty-five cases of articular cartilage injuries complicated with bone bruise of the distal femur diagnosed by MRI were examined under arthroscopy. RESULTS AND CONCLUSION: The site of articular cartilage injuries complicated with bone bruise of the distal femur examined under arthroscopy corresponded to MRI findings. The injuries showed by arthroscopy were in direct proportion to MRI. MRI plays an important role in evaluating articular cartilage injuries complicated with bone bruises, and bone bruises are considered as an indication of articular cartilage injuries. While sometimes MRI cannot deliver the severity of cartilage injuries because of instrumental factors. Related Articles | Metrics

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Clinical application of virtual technology based on 64-slice CT angiography images and CT virtual colonoscopy Yu Jin-long, Cui Chun-hui, Huang Zong-hai, Huang Shu-xin, Zou Zhao-wei 2011, 15 (48):  9023-9026.  doi: 10.3969/j.issn.1673-8225.2011.48.023 Abstract ( 460 )   PDF (547KB) ( 538 )   Save BACKGROUND: Virtual endoscopy can fully display the anatomy form and pathological changes of the colon at both ends of stenosis and obstruction sites. Combined with three-dimensional (3D) images, we can also understand the conditions of the bowel wall and external cavity, which is more advantageous to the qualitative and stage diagnosis of tumors. OBJECTIVE: To investigate the application value of virtual technology based on 64-slice CT angiography (CTA) images, 64-slice CT 3D imaging and virtual endoscopy in the diagnosis of colon tumors. METHODS: Philips/Brilliance 64 CT volumetric scanning was performed in 10 patients with colonic diseases confirmed based on postoperative pathological specimens, including 8 cases of colon tumors and 2 of colonic polypi. Mimics software was used for the surface rendering of the intestine with the Marching Cubes algorithm followed by virtual endoscope 3D reconstruction, and 3D reconstruction of the large intestine and surrounding tissues was done using the Mimics software based on the CTA two-dimensional images. The reconstructed 3D models were compared with 3D images and virtual endoscopy results obtained in the Brilliance workspace. RESULTS AND CONCLUSION: Satisfied results were achieved from 3D images of 10 patients, and there were no significant differences between the findings of virtual endoscopy and CT virtual endoscopy. Virtual colonoscopy combined with multi-structure digital model reconstruction could provide more information, which was helpful to accurately locate the lesion position and could precisely show complex anatomical structures and spatial adjacent relations. Virtual technologies based on 64-slice CTA images nearly have the same sensitivity and specificity as CT virtual endoscopy combined with 3D images. The former one combined with 3D reconstruction techniques in various tissues can provide  more information than CT virtual endoscopy. Related Articles | Metrics

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Assessment of 18F-fluorodeoxyglucose uptake in different organs detected with positron emission tomography/CT in healthy adults during fasting Xu Yu, Li Ai-mei, Guo Wan-hua, Hu Yun 2011, 15 (48):  9027-9030.  doi: 10.3969/j.issn.1673-8225.2011.48.024 Abstract ( 237 )   PDF (563KB) ( 386 )   Save BACKGROUND: Previous studies in home and aborad were mainly focus on glucose uptake of cancer patient in vivo, but few studies for glucose intake in different organs of normal people under fasting. OBJECTIVE: To observe 18F-fluorodeoxyglucose (FDG) uptake of different organs in healthy adults under fasting by using positron emission tomography (PET)/CT and to analysis the correlation of glycometabolism and healthy adults with brain, liver, kidney, heart and skeletal muscle tissue. METHODS: Totally 31 healthy adults were treated with liver and kidney functions, blood glucose and triglyceride conventionally test under fasting. Mean and maximum standardized uptake value (SUV) of 18F-FDG with brain, heart, liver, kidney and skeletal muscle were detected by combined PET/CT scanner. RESULTS AND CONCLUSION: Under fasting, SUV mean of 18F-FDG in brain was two or three times larger than that in heart and kidney, about four times larger than that in liver and 15 times larger than that in skeletal muscle. There were significant positive interrelationships of SUV mean among skeletal muscle, kidney and liver (r=0.406, 0.391, P=0.023, 0.030), but the SUV mean in kidney was no correlation with the heart and brain. It is indicated that under fasting, the quantity of glucose uptake of brain is greater, while of skeletal muscle is fewer, and of heart, liver, kidney is between the brain and the skeletal muscle tissue. There is a significant correlation of glycometabolism among liver, kidney and skeletal muscle under fasting. Related Articles | Metrics

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Ultrasound image enhancement based on homomorphic filter and histogram equalization Liu Yan-jun, Liu Qi 2011, 15 (48):  9031-9034.  doi: 10.3969/j.issn.1673-8225.2011.48.025 Abstract ( 475 )   PDF (791KB) ( 1064 )   Save BACKGROUND: Homomorphic filter and histogram equalization can enhance the image, but they still have many disadvantages. OBJECTIVE: To observe the effects of homomorphic filtering and histogram equalization on image enhancement in order to reduce the shortcomings of the two methods individually. METHOS: In frequency domain, firstly, ultrasound images were processed separately by using high pass homomorphic filter and low pass homomorphic filter. Two filtered images after linear combination were processed with global histogram equalization. Then the final enhancement supersonic images were obtained. RESULTS AND CONCLUTION: The boundary of ultrasound images was very prominent and evident, and the overall visual effect was more bright and clear. Root mean square error and signal to noise ratio data were obtained by analysis and comparison, which confirmed the methods of ultrasound image enhancement in this article are very effective. Related Articles | Metrics

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Anterior screw metal implant fixation of the upper thoracic spine: An anatomic study He Ju-liang, Zhan Xin-li, Xiao Zeng-ming, Huang Shao-ming, Shen Chong, Zhou Qi, Luo Ju-li 2011, 15 (48):  9035-9039.  doi: 10.3969/j.issn.1673-8225.2011.48.026 Abstract ( 319 )   PDF (654KB) ( 527 )   Save BACKGROUND: There are few reports about anatomic study addressing the anterior screw fixation of the upper thoracic spine. OBJECTIVE: To measure the anatomy data of T1-4 segments in order to analyze the depth to insert the screw, screw length and the bending angle of the steel plate or rob for upper thoracic anterior screw fixation. METHODS: Fifty dry specimens of T1-4 segments were used to measure the relative anatomic data, including the anterior and posterior height, upper and lower radius vector, upper and lower transverse diameter, and the smallest transverse diameter. Fifty center anteroposterior axial MRI photographs of the upper thoracic spine of normal native adults were used to measure the Cobb’s angle by electronic conimeter, and T1 and T4 was considered as the vertebral end. RESULTS AND CONCLUSION: All of the posterior height of the upper thoracic vertebral body was higher than the anterior height of the vertebral body. So the physiological concave bending of the upper thoracic spine was maintained. Because of the inclination, the depth and the length of the screw should be bigger than the upper and lower antero-posterior diameter of the right vertebral body. We should refer to the smallest transverse diameter of vertebral body to select the suitable length and depth screw in latero-anterior fixation of the upper thoracic spine. The Cobb’s angle on the anteroposterior axial MRI photographs of the upper thoracic spine was (7.20±2.04)°. We should bend the steel plate or rob to a suitable concave angle before the fixation in the surgery. Related Articles | Metrics

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Effects of fatigue load on lumbar stability after simulated lumbar diskectomy Song Sheng, Rui Yong-jun, Sun Zhen-zhong, Hua Guo-jun, Fan Rong 2011, 15 (48):  9040-9043.  doi: 10.3969/j.issn.1673-8225.2011.48.027 Abstract ( 402 )   PDF (485KB) ( 447 )   Save BACKGROUND: At present, there is not a unified standard about when to start ambulation after lumbar diskectomy. In the present experiment, we guided functional exercises of patients after lumbar diskectomy based on early biomechanical changes. OBJECTIVE: To explore the effects of fatigue load on lumbar stability after lumbar diskectomy. METHODS: Twelve functional spinal units were taken from 3 fresh porcine spines and divided into A group, B group and C group randomly. Fatigue load test was performed in all cases with different cycle load pressures (500-1 000 N, 500-2 000 N, 500- 3 000 N) after unilateral lumbar diskectomy. RESULTS AND CONCLUSION: There was no significant difference between A group and B group in disc height and stiffness (P > 0.05), but the increased strain showed significant difference (P < 0.05); Disc height and stiffness in B group and C group was reduced, strain was increased, and all these differences were significant (P < 0.01). Change ranges of disc height, strain and stiffness in the three groups were increased with the increase of the load pressure after cyclic tensile test (P < 0.05). The results showed that a bigger fatigue load can damage lumbar stability after lumbar diskectomy.  Related Articles | Metrics

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Relationship of lumbar facet joint tropism with degeneration of the intervertebral disc and the facet joint Duan Wen, Zhang Jian-xiang, Liu Jin-rui, Bo Ran, Song Wen 2011, 15 (48):  9044-9047.  doi: 10.3969/j.issn.1673-8225.2011.48.028 Abstract ( 338 )   PDF (541KB) ( 545 )   Save BACKGROUND: The relationship between lumbar facet joint tropism and degeneration degree of the intervertebral disc and the facet joint is in dispute, and there are few studies about this in China. OBJECTIVE: To investigate the role of lumbar facet joint tropism in the degeneration of the intervertebral disc and the facet joint. METHODS: The differences of facet joint angles of 936 functional spinal units from 312 patients with low back pain were measured, which were < 7° defined as lumbar facet symmetry ≥ 7° as tropism. The degeneration degrees of the intervertebral disc and the facet joint were classified. RESULTS AND CONCLUSION: ①There were no significant differences in facet tropism between different ages and genders (P > 0.05). ②No significant relation was found between intervertebral disc degeneration and facet tropism (P > 0.05). ③Facet tropism was associated with a higher incidence of facet joint degeneration at L4-5 when compared with facet symmetry (P < 0.01). There was no significant correlation between lumbar facet tropism and disc degeneration. But at L4-L5, the active sites of segmental motion, facet tropism may result in facet joint degeneration. Related Articles | Metrics

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Applied anatomy of the sacroiliac ligaments Sun Zhi-feng, Zhang Feng 2011, 15 (48):  9048-9050.  doi: 10.3969/j.issn.1673-8225.2011.48.029 Abstract ( 550 )   PDF (440KB) ( 635 )   Save BACKGROUND: Complete structure of the sacroiliac complex, the sacrotuberous ligament and the sacrospinous ligament in the back of the pelvis is important to the stability of the pelvis. OBJECTIVE: To observe the structure of the sacroiliac joint ligaments and study the functions of the ligaments on the stability of the sacroiliac joint. METHODS: The sacrospinous ligament, sacrotuberous ligament, and pubic symphysis and the ligaments of the sacroiliac joint from 20 embalmed pelvis specimens were observed via the anterioposterior approach to study their anatomical structure. RESULTS AND CONCLUSION: The sacroiliac joint ligaments can be divided into three groups: the anterior sacroiliac ligaments, the interosseous sacroiliac ligaments and the posterior sacroiliac ligaments; the symphysis pubis ligaments; the sacrospinous and sacrotuberous ligaments. These ligaments have two main functions. They can connect the vertebral column with the pelvic, and maintain the stability of the pelvic ring. Related Articles | Metrics

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Pulmonary function changes in scoliosis children evaluated by bodyplethysmography Ding Jing, Wu Mei-si, Zhao De-yu, Liu Na 2011, 15 (48):  9051-9054.  doi: 10.3969/j.issn.1673-8225.2011.48.030 Abstract ( 503 )   PDF (569KB) ( 621 )   Save BACKGROUND: Pulmonary function test is the important method of evaluating the risk before scoliosis correction. In search of a convenient and effective method to estimate pulmonary function is the urgent demand of choosing surgical time and evaluating the therapeutic efficacy for scoliosis in children. OBJECTIVE: To estimate the pulmonary function changes of scoliosis children with bodyplethysmography. METHODS: Thirty-one children with scoliosis and fifty healthy children were enrolled in the study. The parameters included tidal volume (VT), minute volume (MV), ratio of volume to peak expiratory flow (PEF) to total expiratory volume (VPTEF/VE), ratio of time to PEF to total expiratory time (tPTEF/tE), tidal PEF, as well as tidal expiratory flow (TEF) at 25%, 50% and 75% VT, respiratory rate (RR), function capacity (FRCp), and effective resistance (Reff). RESULTS AND CONCLUSION: In comparison with the healthy group, FRCp was obviously decreased in scoliosis children (P < 0.01), Reff was increased significantly (P < 0.01), MV, tidal PEF and TEF at 75% VT were increased. FRCp and Reff were classical indexes of bodyplethysmography. Reff was significantly increased and FRCp was significantly decreased in scoliosis children. Bodyplethysmography can be used as an important method in measuring pulmonary function of underage children with scoliosis. References | Related Articles | Metrics

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Effects of rotating platform prosthesis and fixed platform prosthesis applied in total knee replacement: A Meta analysis Chen Yue-ping, Chen Liang, Luo Dong-fang, Gao Hui 2011, 15 (48):  9055-9058.  doi: 10.3969/j.issn.1673-8225.2011.48.031 Abstract ( 351 )   PDF (472KB) ( 470 )   Save BACKGROUND: Currently, whether rotating prosthesis is superior to fixed prosthesis is still unclear. OBJECTIVE: To compare the clinical outcomes of rotating platform prosthesis and fixed platform prosthesis applied in total knee replacement in order to analyze their different curative effects. METHODS: Relative articles were obtained from Medline database, Embase database, and China Biology Medicine disc. Randomized controlled trials (RCTs) about rotating and fixed platform prosthesis in total knee replacement were selected and compared. The quality of the included studies was assessed by the Cochrane’s random methodology. RevMan 5.1.2 software was used for data analysis, and GRADEpro version 3.2.2 software was used for evidence rating of the included studies. RESULTS AND CONCLUSION: Totally 764 cases form 10 RCTs were involved. Of which 381 cases with rotating prosthesis replacement were taken as experimental group and 383 cases with platform prosthesis replacement were control group. The methodological bias involved in the study was lower, and the curative effect was improved. The Meta-analysis results compared between the two groups showed that there was no significant difference in the knee scores, ranges of motion and postoperative complications, as well as overhaul rates. The results show that the evidence cannot prove that rotating platform prosthesis is better than fixed platform prosthesis. More high-quality RCTs are needed to verify this. However, no matter which type of prosthesis can achieve satisfactory clinical effect. Related Articles | Metrics

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Systematic review the effects of four operative techniques in treating cervical spondylotic myelopathy Chen Ke, Chen Zhong, Jin An-min, Zhang Hui, Min Shao-xiong, Duan Yang, Zhang Xi-bing, Ye Wen-ming 2011, 15 (48):  9059-9063.  doi: 10.3969/j.issn.1673-8225.2011.48.032 Abstract ( 301 )   PDF (525KB) ( 569 )   Save BACKGROUND: There is still a controversy about the surgery in treating multilevel cervical spondylotic myelopathy (CSM). OBJECTIVE: To review 4 operative techniques which were used for the CSM treatment. METHODS: From 1980 to December 2010, a systematic review of retrospective cohort studies with multilevel anterior multilevel corpectomyand fusion (AMCF), anterior cervical discectomy and fusion(ACDF), expensive laminoplasty (EXLP) and decompressive laminectomy and fusion (DLEF) was performed to systematic evaluate the optimum treatment for CSM with over 10-year follow-up. RESULTS AND CONCLUSION: A total of 1 718 articles were retrieved, finally 591 abstracts, 36 articles in full were included. Retrospective cohort studies were compared in all studies. Four studies compared AMCF+EXLP, one study compared DLEF+EXLP, and two studies compared ACDF+EXLP. There were 3 case studies with over 10 years follow-up. neurological recovery rates in all approaches showed no difference. EXLP had a significant incidence of neck pain as compared with multilevel AMCF. The rate of adjacent secondary spondylosis in ACDF was increased as compared with EXLP. AMCF＋DLEF had a significantly higher rate of graft, instrumentation, and approach related complications. AMCF+DLEF had a significant decrease in range of motion of neck as compared with EXLP. Related Articles | Metrics

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Individual entrance point location for pedicle screw implantation Han Jin-hua, Ma De-chun, Bai Miao, Chen Li-juan 2011, 15 (48):  9066-9069.  doi: 10.3969/j.issn.1673-8225.2011.48.034 Abstract ( 359 )   PDF (568KB) ( 712 )   Save BACKGROUND: Implanted positioning of pedicle screws is an important factor for successful pedicle screw implantation. OBJECTIVE: To investigate the technique of implanting pedicle screws and the feasibility of popularizing the application of pedicle screw fixation. METHODS: The first author searched PubMed database and CNKI database for articles regarding clinical safety and long-term effect of different methods for entrance point location of pedicle screw implantation. Finally, 24 articles were included in result analysis. RESULTS AND CONCLUSION: There are three steps for pedicle screw implantation: positioning, orientation, and depth setting. Roy-Camille method, Weinstein method, Mager method and Louis method are used for pedicle screw positioning. Orientation of pedicle screws includes sub-horizontal angle and sagittal angle. It has been proved by clinical practice that the pedicle screw occupying 80% of the vertebral body is appropriate. To ensure the individual entrance point positioning of pedicle screw implantation based on the laminar edge is feasible and reliable with small wound and high accuracy. Related Articles | Metrics

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Biomechanical evaluation of screw and plate fixation in pelvic fractures Zhao Yan 2011, 15 (48):  9070-9073.  doi: 10.3969/j.issn.1673-8225.2011.48.035 Abstract ( 329 )   PDF (609KB) ( 628 )   Save BACKGROUND: Pelvic fractures are more common in clinic. There are various internal fixation methods for implantation that are difficult. If not treated properly, it can cause pelvic soft tissue injury, skin necrosis, infection, leading to clinical failure of internal fixation as one important reason. OBJECTIVE: To investigate the optimal internal fixation therapy for pelvic fractures and to evaluate its effect. METHODS: A computer-based online search of VIP database (2004-01/2011) was conducted to retrieve articles regarding screw and plate internal fixation of treatment of pelvic fractures using the keywords of “pelvic fracture, internal fixation, effect evaluation”. RESULTS AND CONCLUSION: Pelvic fracture is a high-energy injury with high morbidity and high mortality, and the incidence is increased year by year in clinic. Relevant biomechanical studies are useful to explain the action mechanism and fracture type of pelvic fractures and play a very important role in the final choice of treatment. Anatomic reduction and solid fixation of pelvic fractures as well as screws and plate internal fixation are very important. To develop an implant with small wound, low infection rate, stable fixation and good compatibility is the current direction in the treatment of unstable pelvic fractures. Related Articles | Metrics

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Prosthesis, bone graft and internal fixation and bone cement filling for treatment of giant cell tumor of bone Guang Dong, Wang Ya-jun, Zhao Fan 2011, 15 (48):  9074-9077.  doi: 10.3969/j.issn.1673-8225.2011.48.036 Abstract ( 363 )   PDF (639KB) ( 427 )   Save BACKGROUND: Artificial joint replacement or allogeneic bone fixation and bone substitute materials filling are common ways to repair bone defects in giant cell tumor of bone after curettage, so which one is more ideal? OBJECTIVE: To understand the staging standard of giant cell tumors through access to Chinese and English literature about treatment for giant cell tumor of bone, and to compare different therapies, bone graft, bone cement filling and prosthesis. METHODS: A computer based search of CNKI using keywords of “tumor-type prosthesis, giant cell tumor of bone, bone graft, bone cement” and Elsevier Science and Pringer-Link using keywords of “giant cell tumor of bone, therapy, tumor-type prosthesis” were performed to retrieve relevant articles. Totally 346 articles were retrieved, and finally 26 were included in result analysis. RESULTS AND CONCLUSION: The traditional treatments for giant cell tumor have a higher recurrence rate. The bone graft may not be able to fill the entire bone cavity, bone cement materials cannot be easy to be fused with the host. Tumor-type prosthesis shows a good effect on giant cell tumor of bone, but it is still inadequate. However, special prosthesis joints can repair bone defects following giant cell tumor of bone according to individualized treatment needs, which is an effective and reliable surgical method as well as the main research direction for the future treatment of giant cell tumor of bone. Related Articles | Metrics

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Hip replacement and sports femoral head injury Li Rui, Chen Tao, Bu Fan-lin, Zhang Li-jie 2011, 15 (48):  9078-9081.  doi: 10.3969/j.issn.1673-8225.2011.48.037 Abstract ( 408 )   PDF (780KB) ( 454 )   Save BACKGROUND: Jumping of explosive force in sports can result in hip joint injury. Sudden force on some sites surrounding the hip joint may lead to avulsion fracture. OBJECTIVE: To summarize advances in hip replacement for sports necrosis of femoral head, replacement materials and complications and evaluate performance and application of biomaterials used in repairing sports femoral head injury. METHODS: A computer-based online search of Pubmed and Wanfang Database was performed for articles regarding biomaterials used in tissue engineered tendon scaffold published between January 1991 and Dember 2010, with key words “necrosis of femoral head, biomaterials, hip replacement, complication” in Chinese and “artificial hip joints, biomaterials, prostheses” in English. Repetitive studies, review articles and Meta analysis were excluded. A total of 21 articles were included and evaluated. RESULTS AND CONCLUSION: Selection of hip replacement techniques for necrosis of femoral head and evaluation of replacement materials performance were analyzed. Hip replacement techniques and replacement materials have advantages and disadvantages. Ceramics femoral head prosthesis and metal-to-metal prosthesis can reduce polymer polyethylenewearing particles induced prosthesis loosening. Total hip replacement is an effective approach for advanced stage of hip joint diseases. Moreover, it has been regarded as gold standard for middle and advanced stage of necrosis of femoral head due to wide indication range and favorable effects. Related Articles | Metrics

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Functional rehabilitation training following hip replacement Ye Xin-ping 2011, 15 (48):  9082-9084.  doi: 10.3969/j.issn.1673-8225.2011.48.038 Abstract ( 347 )   PDF (464KB) ( 728 )   Save BACKGROUND: Functional training following hip replacement can improve prosthesis function, patient rehabilitation, enhance muscle power, enlarge joint range of motion and restore concordant of daily life. OBJECTIVE: To summarize advances in functional rehabilitation training following artificial hip replacement. METHODS: A computer-based online search of PubMed, CNKI, Wanfang Springer Link and Science Direct was performed for related articles published between 1997 and 2011 with key words “artificial hip joints, Replacement, Sports rehabilitation”. RESULTS AND CONCLUSION: Artificial hip replacement can effectively relieve pain, reconstruct joint function and improve quality of patient life. Perioperative functional rehabilitation training of hip replacement should be individualized and progressive. The training plan should be formulated according to patient condition, complication, disease tolerance, expectation of functional restoration, and be performed gradually in aspects of duration, amount and frequency to rapidly restore the function with few complications. Early functional rehabilitation training is very important for patients undergoing hip replacement, which can improve pain and walking, and enhance joint range of motion; later functional rehabilitation training can effectively prevent muscular tension reduction and myatrophy induced by limb immobilization.  Related Articles | Metrics

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The reconstruction principle of bone structure Zhang Wen-xian, Li Sheng-hua 2011, 15 (48):  9085-9087.  doi: 10.3969/j.issn.1673-8225.2011.48.039 Abstract ( 266 )   PDF (543KB) ( 430 )   Save BACKGROUND: In principle, fracture treatment mainly focuses on bone remodeling from the biological and mechanical aspects to combine mechanical fixation with biological fixation as well as combine intramedullary fixation with extramedullary fixation. OBJECTIVE: To introduce the principle development of fracture treatment and bone remodeling. METHODS: A computer-based search of CNKI (2006-01/2011-05) and PubMed (2006-01/2011-05) for bone remodeling articles using the keywords of “bone structure, rebuild, principle” in Chinese and English, respectively. RESULTS AND CONCLUSION: In 30 collected articles, 14 were included in result analysis. The treatment concept of fractures has been gradually changed from mechanical fixation system to biological fixation system. Fracture treatment research focuses on the balance between stable fixation and intact soft tissues, and the design of implants and instruments is significantly improved. In recent years, there are digitized virtual human technology, bio-mechanics finite element theory, trauma-control theory, pharmacological research for osteoporosis, and tissue engineering theory and technique to repair defects. In general, the concept of bone remodeling is to choose a most reasonable patient-centered way to guide and promote bone healing and functional recovery at the macro-and micro-level. Related Articles | Metrics

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Application of rehabilitation equipment in functional rehabilitation of hemiplegia Qin Xiao-yong 2011, 15 (48):  9088-9092.  doi: 10.3969/j.issn.1673-8225.2011.48.040 Abstract ( 384 )   PDF (579KB) ( 1337 )   Save BACKGROUND: Brain plasticity and functional restitution are the theoretical basis of hemiplegia rehabilitation. Rehabilitation instrument is important among approaches for hemiplegia rehabilitation. OBJECTIVE: To investigate how to effectively apply rehabilitation equipment in hemiplegia rehabilitation by discussing application theory, current condition, efficacy and future development. METHODS: A computer-based online search of CNKI and Medline database was performed for related articles published between January 1996 and August 2011 with key words “hemiplegia rehabilitation, hemiplegia rehabilitation equipment, rehabilitation engineering, hemiplegia rehabilitation robot” in English and “hemiplegia, hemiplegia rehabilitation, hemiplegia rehabilitation equipment, orthotics, electrostimulation, electro-acupuncture” in Chinese. Repetitive articles and Meta analysis were excluded, and 28 articles were included. RESULTS AND CONCLUSION: Traditional hemiplegia rehabilitation equipment has been modified in hemiplegia rehabilitation. In addition, multiple functional rehabilitation equipment by combining various approaches, and rehabilitation robot by combining rehabilitation equipment with computer, biofeedback and interest computer game program have been developed. Results showed that hemiplegia rehabilitation equipment can significantly improve recovery speed and quality of affected limb function. Related Articles | Metrics

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Time factor of peri-implant bone resorption Yu Xue-song, Zhao Li, Pan Shi-yuan 2011, 15 (48):  9093-9095.  doi: 10.3969/j.issn.1673-8225.2011.48.041 Abstract ( 368 )   PDF (521KB) ( 517 )   Save BACKGROUND: Currently, there are few clinical data about the speed of peri-implant bone resorption with different times. OBJECTIVE: To observe the bone resorption of alveolar around after transplanting implant, and to evaluate the effect of time factor on peri-implant bone resorption. METHODS: All the direct digital panoramic films of oral implant cases after surgery from 2003 to 2010 were collected. Panoramic films for analysis were divided into immediate pieces, 1, 3, 6, 12 months groups after implantation. All the panoramic films were measured. The speed of peri-implant bone resorption at different post-operation times was compared. RESULTS AND CONCLUSION: There was significant difference of the peri-implant bone resorption rate at different post-operation times from 1 to 6, 3 to 6, 1 to 12, 3 to 12 months (P < 0.01). It is indicated that the maximal peri-implant bone resorption occurs at 1-3 months after implant surgeries. Related Articles | Metrics

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Implantation material selection based on bone densitometry for thoracolumbar vertebral compression fracture treatment Liu Zhen-wu, Yan Ji-ying, Liu Fa-jing, Liu Li 2011, 15 (48):  9096-9099.  doi: 10.3969/j.issn.1673-8225.2011.48.042 Abstract ( 370 )   PDF (588KB) ( 491 )   Save BACKGROUND: During the course of percutaneous kyphoplasty (PKP), polymethyl methacrylate is injected into vertebrae and attaches in the broken ends of fractured bone, which hinders fibrous tissue regeneration and new bone formation besides of instantly stabilized fracture. In the long run, it is adverse to the healing of non-osteoporosis fracture.    OBJECTIVE: To analysis the guidance of bone densitometry for choosing modus operandi and implantation material in the treatment of thoracolumbar vertebral compression fracture METHODS: Totally 65 patients with single-segment of thoracolumbar compression fracture were divided into two groups according to the L2-4 bone mineral density: osteoporosis group were treated with PKP and non-osteoporosis group were treated with pedicle screw implant and fixation treatment. RESULTS AND CONCLUSION: There were 3 cases of paravertebral cement leakage in the osteoporosis group and 1 case of wound infection in the non-osteoporosis group. The postoperative follow-up ranged 20-28 months. Two patients occurred adjacent vertebral fracture in the osteoporosis group, but no one had vertebral height lost and kyphosis angle increased after fixation removed in the non-osteoporosis group. Operation time, blood loss and the visual analogue scale score in the osteoporosis group were lower as compared with non-osteoporosis group (P < 0.05). Compared with preoperation, both groups had statistical significance in vertebral height restoration and kyphosis angle rectification (P < 0.05), but the non-osteoporosis group was more striking in above indexes (P < 0.05). Both PKP and pedicle screw implant fixation treatment are common methods in treating thoracolumbar vertebral compression fracture of mid-aged patients, and a more significant clinical effect will be received if takes an appropriate operation according to the osteoporosis degree. Related Articles | Metrics

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Biocompatibility comparison between different dynamic hip screws for femoral intertrochanteric fractures Chen Yu-fang, Wei Zhong-min, Zhang Ke-liang, Li Zi-xi 2011, 15 (48):  9100-9103.  doi: 10.3969/j.issn.1673-8225.2011.48.043 Abstract ( 337 )   PDF (533KB) ( 645 )   Save BACKGROUND: There has been no clear conclusion about the better selection of materials with good biocompatibility between stainless steel and titanium alloy dynamic hip screw for the treatment of intertrochanteric fracture of the femur. OBJECTIVE: To compare the biocompatibility between stainless steel and titanium alloy dynamic hip screw implantation in the treatment of intertrochanteric fracture of femur. METHODS: A total of 86 patients with femoral intertrochanteric fracture were selected from July 2003 to October 2009, and treated with stainless steel dynamic hip screw (n=43) and titanium alloy dynamic hip screw (n=43). Two groups were matched in terms of gender, age, cause of injury, and fracture type. 00Cr18Ni14Mo3 stainless steel was used in stainless steel dynamic hip screw group and Ti6A14V titanium alloy in the titanium alloy dynamic hip screw group. Differences in postoperative complications and recovery of hip joint function were compared between two groups, and soft tissue inflammatory reaction, hyperplasia and fibrous capsule wall surrounding the implants were observed. RESULTS AND CONCLUSION: There were no significant differences between two groups in the postoperative complications and recovery of hip joint function, but the stainless steel dynamic hip screw group was worse than the titanium alloy dynamic hip screw group in the soft tissue inflammatory reaction, hyperplasia and fibrous capsule wall surrounding the implants when removing the screws (P < 0.01). Results indicated that biocompatibility of titanium alloy dynamic hip screw was better than the stainless steel dynamic hip screw and can be used as a permanent implant material. Related Articles | Metrics

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Transpedicular bone graft combined with short-segment pedicle screw internal fixation for senile thoracolumbar fracture Wang Hong-wei, Wang Yu, Wang Jun-hui, Mu Shang-qiang, Jiang Bo, Pan Feng 2011, 15 (48):  9104-9107.  doi: 10.3969/j.issn.1673-8225.2011.48.044 Abstract ( 307 )   PDF (490KB) ( 482 )   Save BACKGROUND: Traditional pedicle screw internal fixation combined with posterolateral lumbar fusion in the treatment of senile thoracolumbar burst fracture are easily to occur reset angle, high loss, delayed nerve damage and internal fixation loosening. OBJECTIVE: To investigate the method and effect of transpedicular bone graft combined with pedicle screw internal fixation on the treatment of senile thoracolumbar fracture. METHODS: Totally 32 patients who were more than 60 years old with thoracolumbar burst fracture were treated by posterior pedicle fixation combined with grafting through the injured pedicle. Height of fractured vertebrae, Cobb angle, occupying of spinal canal, neuropathic function, lumbar and back pain were measured and analyzed preoperatively, postoperatively and during the follow up period. RESULTS AND CONCLUSION: All the patients were followed-up over 6 months. The internal fixation was not break or loose, the height of fractured vertebrae, the Cobb angle, the occupying of spinal canal, the neuropathic function, lumbar and back pain improved obviously, and the height of fractured vertebrae, the Cobb angle and the occupying of spinal canal were not obviously lose. It is indicated that application of transpedicular bone graft combined with posterior pedicle screw internal fixation is an effective method in treatment of senile thoracolumbar burst fracture, it can restore the height and strength of the vertebral body, and immediately increase vertebral bone content and the stability of the spine, and reduce the possibility of breaking nail, breaking rod, the loss of height and other complications, which are caused by stress. Related Articles | Metrics

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Comparison of clavicle anatomical plates with reconstruction plates in treating midshaft clavicle fracture by MIPO technique Liu Yue, Wu Liang, Zhang Yan, Zheng Shi-wei, Jiang Rui, Yang Tie-yi 2011, 15 (48):  9108-9111.  doi: 10.3969/j.issn.1673-8225.2011.48.045 Abstract ( 421 )   PDF (551KB) ( 664 )   Save BACKGROUND: Which clavicle anatomical plate or reconstruction plate is more suitable for midshaft clavicle fracture is a problem. OBJECTIVE: To compare the effect of clavicle anatomical plates and reconstruction plates in treating midshaft clavicle fracture by MIPO technique. METHODS: Fifty-six patients with midshaft clavicle fracture treated with clavicle anatomical plates or universal reconstruction ribbon plates were retrospectively reviewed. We planned to investigate the operation time, fracture healing, functions and complications. RESULTS AND CONCLUSION: Totally 56 patients had bone healing. Operation time of the anatomical plates group was shorter than that of the reconstruction ribbon plates group. All patients had no complications, such as nonunion and infection. There were two cases of screw loosing separately in the two groups. There was no statistic difference in Neer scores and visual analog scale scores. Closed reduction and internal fixation with clavicle anatomical plates and universal reconstruction ribbon plates have the similar outcome. The easy operation is the advantage of the former, and the latter can be used in irregular or oblique fractures. Related Articles | Metrics

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Kyphoplasty expanded by sacculus proprius for the treatment of thoracolumbar vertebral compression fractures caused by metastatic tumor: A 2-year follow-up Sun Zhi-yong, Qian Zhong-lai, Mei Xin, Yang Yan, Jiang Wei-min, Chen Liang, Bao Zhao-hua, Yang Hui-lin 2011, 15 (48):  9112-9115.  doi: 10.3969/j.issn.1673-8225.2011.48.046 Abstract ( 315 )   PDF (586KB) ( 536 )   Save BACKGROUND: Kyphoplasty expanded by sacculus proprius has achieved good therapeutic efficacy for the treatment of thoracolumbar vertebral compression fractures caused by metastatic tumor, hemangioma and multiple myeloma.  OBJECTIVE: To evaluate the clinical efficacy of kyphoplasty expanded by sacculus proprius on the treatment of thoracolumbar vertebral compression fractures caused by metastatic tumor. METHODS: The patient with thoracolumbar vertebral compression fractures caused by metastatic tumor was treated with kyphoplasty. Outcome data include the anterior and mid-vertebral body height variation, degree of kyphosis, visual analog scale score for pain and Oswestry disability index were collected preoperative, postoperative, and in the two-year follow-up. RESULTS AND CONCLUSION: The anterior and mid-vertebral body height preoperative was higher than that postoperative (P < 0.05), and the mean visual analog scale score, Oswestry disability index and degree of kyphosis of these patients preoperative were decreased postoperative (P < 0.05) and maintained at two years postoperative. Kyphoplasty is an effective, minimally invasive procedure for the treatment of thoracolumbar vertebral compression fractures caused by metastatic tumor, leading to reduction in pain, improvement in quality of life and satisfied with the short-term curative effect. Related Articles | Metrics

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Variation in serum biomarkers of bone turnover in rapidly progressive necrosis of the femoral head Mei Jie, Peng Hao, Yin Dong 2011, 15 (48):  9116-9120.  doi: 10.3969/j.issn.1673-8225.2011.48.047 Abstract ( 296 )   PDF (665KB) ( 470 )   Save BACKGROUND: Foreign studies have suggested that the pathogenesis of rapidly progressive necrosis of the femoral head is associated with abnormal serum metabolism of articular cartilage and osteoclast dysfunction. OBJECTIVE: To determine the expression of TRACP-5b and CTX-Ⅱ in serum of patients with rapidly progressive necrosis of the femoral head. METHODS: Enzyme-linked immunosorbent assay kit was used to detect the expression of TRACP-5b and CTX-Ⅱ in serum of patients with common femoral head necrosis (group A, n=30), patients with rapidly progressive femoral head necrosis (group B, n=30), patients with osteoporosis (group C, n=30), and patients with Soft tissue defect or simply popliteal cyst (group D, n=30). RESULTS AND CONCLUSION: The expressions of TRACP-5b in the groups B and C were higher than those in the groups A and D (P < 0.05); while the expression of TRACP-5b was slightly higher in the group C than the group D without significant difference (P >0.05). The expressions of CTX-Ⅱ was the highest in the group B (P < 0.05), and slightly higher in the groups A, C than group D without significant difference (P > 0.05). It is indicated that one of the possible pathological mechanisms of the rapidly progressive necrosis of the femoral head is the enhance activity of osteoclasts leading to the elevated expression of serum TRACP-5b and rapid articular cartilage degradation leading to the elevated expression of serum CTX-Ⅱ. The candidate diagnostic criteria for the rapidly progressive necrosis of the femoral head may be the TRACP-5b and CTX-Ⅱ in the future. Related Articles | Metrics