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24 December 2011, Volume 15 Issue 52 Previous Issue    Next Issue

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Feasibility of metal-on-metal prostheses for total knee arthroplasty in rabbits Liu Jian-hua, Yu Shi-ming, Hu Jun-yong, Xu Dong-liang 2011, 15 (52):  9691-9695.  doi: 10.3969/j.issn.1673-8225.2011.52.001 Abstract ( 315 )   PDF (1501KB) ( 514 )   Save BACKGROUND: The present studies of the anti-wear are focused on the improvement and choice of the joint surface. The surface of metal-on-metal is the most important direction of reform and investigation. OBJECTIVE: To explore the feasibility and the utilization information after 12 months of metal-on-metal prosthesis of total knee arthroplasty (TKA) in rabbits and evaluate the biomechanical characteristics of the prosthesis. METHODS: The prostheses were designed personally, surfaces of femoral and tibial prostheses were reformed by stainless steel-mesh, friction surfaces were used to match metal-on-metal. Ten adult New Zealand rabbits underwent TKA and non-replacement of the patella were divided randomly into two groups (5 in each group). The experimental prosthesis was fixed biologically and the control group was used with bone cement. RESULTS AND CONCLUSION: At 12 months after replacement, a great amount of bone reconstructions were found in the experimental group. The difference of function of the knee joint between the two groups was not significant. Roentgenograms proved that two groups were fixed well and no dislocation and no loosening. The maximal shear strength of prosthesis bone interface in the experimental group was higher than that in the control group (P < 0.05).There were new bone formation of the thick stereo mesh surface of the prosthesis in the experimental group and no new bone formation of the surface of the cementless prosthesis in the control group under fluorescence microscopy. The metal-on-metal prosthesis of TKA is suitable to be fixed biologically for the rabbits, no matter whether use bone cement or not. The fixation strength of prosthesis by two layer stainless steel-mesh is better than that of the bone cement prosthesis at 12 months after operation. Related Articles | Metrics

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Effect of Uygur medicine Maizhuni on the expression of matrix metalloproteinase 1 and tissue inhibitor of matrix metalloproteinase 1 in the articular cartilage of rat osteoarthritis models Zhang Yao-wu, Fang Rui, Liu Zhen-feng, Ailijiang•Asila, Meng Qing-cai 2011, 15 (52):  9696-9700.  doi: 10.3969/j.issn.1673-8225.2011.52.002 Abstract ( 313 )   PDF (1457KB) ( 512 )   Save BACKGROUND: Articular cartilage damage in osteoarthritis patients is related to the imbalance between matrix metalloproteinase 1 and tissue inhibitors of matrix metalloproteinase. OBJECTIVE: To investigate the expression of matrix metalloproteinase 1 and tissue inhibitor of matrix metalloproteinase 1 in articular cartilage and the intervention effects of Uygur medicine Maizhuni. METHODS: Knee osteoarthritis model was constructed using modified Hulth method. A total of 20 healthy SD rats were randomly divided into Maizhuni group and model group. Rats were treated with Uygur medicine Maizhuni or saline by gavage in the 2nd week after model construction for 4 weeks. RESULTS AND CONCLUSION: Compared with model group, the degree of rat knee joint cartilage degeneration in Maizhuni group was alleviated. The cartilage general score and Mankin score in Maizhuni group was lower than that in the model group (P < 0.05). The expression of matrix metalloproteinase 1 in knee joint chondrocytes of Maizhuni group decreased than that of the control group (P < 0.05); the expression of tissue inhibitor of matrix metalloproteinase 1 in Maizhuni group increased than that in the model group (P < 0.05). These findings indicate that Uyghur medicine Maizhuni may protect articular cartilage by down-regulating the expression of matrix metalloproteinase 1 and up-regulating the expression of tissue inhibitor of matrix metalloproteinase 1. Related Articles | Metrics

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Effect of plate length on the stiffness of plate and screw fixation structure Hang Hai-feng, Liu Pan 2011, 15 (52):  9701-9708.  doi: 10.3969/j.issn.1673-8225.2011.52.003 Abstract ( 349 )   PDF (2349KB) ( 413 )   Save BACKGROUND: Currently in the process of fracture fixation, studies on different plate lengths under a certain number and distribution of screws are few. When plate is too short, fixed plate is not strong, so which usually cause the failure of internal fixation. OBJECTIVE: To detect the stress changes of different plant lengths under the same number and distribution of screws by three point bending test. METHODS: Thirty tibial specimens in adult corpses were divided into six groups (five in each group) at random, each of which was cut transversely in the median for constructing non-defect fracture model. Every group was fixed symmetrically with four-hole, six-hole, eight-hole, ten-hole, twelve-hole, fourteen-hole limited contact dynamic compression plates (LC-DCP) separately and each plate was attached by four screws (two screws were the nearest to fracture and the others were the farthest from fracture). Groups were labeled as A, B, C, D, E, F groups orderly. RESULTS AND CONCLUSION: In three-point bending test, the average strain of fracture site in the group A was maximal and in the group D was minimal. There was significant difference in the average strain of fracture site between the group A and the other five groups (P < 0.05). There was significant difference in the average strain of fracture site between the group B and the C, D, E, F groups (P < 0.05). There was significant difference in the average strain of fracture site between the group C and the D, E groups (P < 0.05). There was also significant difference in the average strain of fracture site between the D and F groups (P < 0.05). It is indicated that during three point bending test, the screw length has significant effect on the stiffness of the plate and screw structure under the same screw number and position. The 8-hole plates and those longer than 8 holes have better elastic deformation ability and stability. Related Articles | Metrics

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A 2 Hz extremely low-frequency pulsed magnetic field promotes the healing of fresh limb fractures following metallic implants internal fixation Liu Ji-tao, Tao Jun 2011, 15 (52):  9709-9712.  doi: 10.3969/j.issn.1673-8225.2011.52.004 Abstract ( 344 )   PDF (1230KB) ( 462 )   Save BACKGROUND: Delayed bone healing and nonunion are prone to occur after fracture treated with internal fixation. OBJECTIVE: To study the clinical effects of the pulsed magnetic fields (PEMFs) of different extremely low-frequency for treatment of fresh fracture of limbs after internal fixation with metallic implants. METHODS: The patients with fresh fractures of the limbs were divided into four groups randomly. The patients of control group were treated with routine therapy and the patients of treatment group were treated with PEMFs of 2 Hz, 16 Hz and 32 Hz at 3 days after fixation. X-ray was performed at 4, 8, 12 weeks after fixation in all patients. The osteocalcin, bone-specific alkaline phosphatase and the carboxy-terminal propeptide of type Ⅰ procollagen were detected before and after fixation followed PEMFs to evaluate the effects of PEMFs on fracture. RESULTS AND CONCLUSION: The callus formation of four groups were significantly higher than before as time going on (P <  0.01). The callus formation and biochemical indexes of bone metabolism of PEMFs groups of 2 Hz, 16 Hz and 32 Hz were significantly higher than that of the control group at the same time point (P < 0. 01), and the callus formation and biochemical indexes of bone metabolism of PEMFs group of 2 Hz were higher than those of the 16 Hz and 32 Hz (P < 0. 05). It is confirmed that PEMFs can promote the growth of callus to accelerate the healing process of bone fracture, and the effective of the extremely low-frequency PEMFs of 2 Hz is better than that of 16 Hz and 32 Hz. Related Articles | Metrics

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Effective restoration of the injured vertebral height due to thoracolumbar fractures implanted with double-incision pedicle screws Huang Yi-fei, Tong Min, Wu Yan-sheng, Zhang Bin, Hu Wei, Dong Zhen-yu, Hu Wei-shan 2011, 15 (52):  9713-9716.  doi: 10.3969/j.issn.1673-8225.2011.52.005 Abstract ( 264 )   PDF (590KB) ( 452 )   Save BACKGROUND: Studies show that the posterior pedicle screw fixation is the preferred treatment for flexion compression fracture. OBJECTIVE: To observe the injured vertebral height and clinical effects of thoracolumbar fractures treated by the two-incision posterior fixation with pedicle screw. METHODS: Thirty-four patients with thoracolumbar flexion compression fracture diagnosed by X-ray and MRI of thoracolumbar were treated by the two-incision posterior fixation with pedicle screw. RESULTS AND CONCLUSION: Thirty-four patients were followed-up for 8.9 months in average. There was no loosening of internal fixation or fracture during the follow-up. Complete remission of 21 cases, partial remission of 1 case, and minor response of 1 case were observed in pain treatment. The loss of injured vertebral height of patients was decreased (P < 0.01), the score of the evaluation of functional independence was increased (P < 0.01), and the score of pain visual analogue was decreased (P < 0.01) after treatment compared with before. The results confirm that the two-incision posterior internal fixation of the lumbar can effectively restore the injured vertebral height and limb function, and achieve pain relief. It is the effective treatment for patients with thoracolumbar flexion compression fractures. Related Articles | Metrics

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Rapid positioning of pedicle screws through lumbar spondylolysis  Fang Guo-fang, Ding Zi-hai, Lei Gao, Luo De-min, Song Zhi-hui 2011, 15 (52):  9717-9720.  doi: 10.3969/j.issn.1673-8225.2011.52.006 Abstract ( 283 )   PDF (732KB) ( 432 )   Save BACKGROUND: It is difficult to locate pedicle in the patient with spondylolisthesis induced by lumbar spondylolysis because of spondylolysis, transposition of lumbar vertebrae and alteration of local anatomy. So it is necessary to find a new located method to locate pedicle. OBJECTIVE: To rapid positioning of pedicle screw position through lumbar spondylolysis in order to reduce exposure of soft tissue, blood loss and operation time. METHODS: Position relationship between the spondylolysis and the center of pedicle was analyzed and measured by anterior-posterior film. The distance of the center of pedicle to lumbar spondylolysis (L4, L5) was measured. Forty patients with spondylolisthesis were treated with rapid positioning of pedicle screw through lumbar spondylolysis. Operation time, blood loss and accuracy rate of locate pedicle were recorded and then a comparison of them was made between the AO method and new method. RESULTS AND CONCLUSION: Distance of the center of pedicle to lumbar spondylolysis was (8.2±3.6) mm. Rapid positioning of pedicle screw position through lumbar spondylolysis can reduce the exposure of soft tissue, blood loss and operation time without nerve lesion during and after pedicle screw implantation. Related Articles | Metrics

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Establishment and verification of a three-dimensional finite element model of Hangman fracture Chen Yu, Xiang Liang-bi, Zu Qi-ming, Liu Jun, Zhou Da-peng, Yu Hai-long, Han Wen-feng 2011, 15 (52):  9721-9724.  doi: 10.3969/j.issn.1673-8225.2011.52.007 Abstract ( 335 )   PDF (479KB) ( 363 )   Save BACKGROUND: Currently, there are few studies on finite element model of multi-segmental cervical and no studies on finite element model of Hangman fracture. OBJECTIVE: To establish three-dimensional finite element models of normal C2-4 segments and Hangman fractures in various degrees, as well as simulate and verify the models. METHODS: CT scanning of the C2-4 segment was performed in an adult male volunteer in order to establish the three-dimensional finite element model of C2-4 segment using three-dimensional finite elements analysis software including ANSYS at computer workstation. The model included the vertebral body, arch of vertebra, intervertebral disc and the ligament. The Hangman fracture model was prepared by cutting off bilateral isthmus of C2, the anterior longitudinal ligament of C2-3 and part of the intervertebral disc based on this model. Range of motion (ROM) at three dimensions in six directions of C2-3 and C3-4 segments under simulated 50 N loading was calculated in normal or Hangman fracture models. RESULTS AND CONCLUSION: C2-3 segment: ROM of the Hangman fracture + ligament intervertebral disc resection model was larger than that of the normal model in all directions, especially in directions of flexion and extension, however, the ROM was the same on rotation and lateral flexion to that of the normal model. C3-4 segment: the ROM of the two groups was similar, and the difference was no larger than 0.16°. The displacement results were basically consistent with those of the stress testing of the three-dimensional finite element models. The three-dimensional finite element models can be used for simulating biomechanics of Hangman fractures. Related Articles | Metrics

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Three-dimensional digital model of the anterior cruciate ligament based on magnetic resonance imaging Chen Wen-dong, Li Yan-lin, Xu Peng, Yang Guang, Wang Guo-liang, Ma Ke, Li Qing, Li Xiao-lin, Cao Bin 2011, 15 (52):  9725-9728.  doi: 10.3969/j.issn.1673-8225.2011.52.008 Abstract ( 343 )   PDF (541KB) ( 682 )   Save BACKGROUND: In recent years, the research about three-dimensional digital models of anterior cruciate ligament has been developed rapidly in abroad. However, there is no basic anatomy report about three-dimensional digital models of the knee joint and anterior cruciate ligament at home. OBJECTIVE: To explore the validity and reliability of two-dimensional MRI image and MIMICS software in building three-dimensional digital models of the knee joint and anterior cruciate ligament. METHODS: Twenty fresh normal adult corpse knee-joint specimens were selected, then they were scanned with MRI, acquired continuous image data of level thick 1.0 mm, and these data were imported into computer with DICOM form and were carried through three-dimensional reconstruction by using MIMICS software. The three-dimensional substance digital models of double knee joints which included femur distal end, tibia proximalis, anterior cruciate ligament, meniscus, patella and fibula were reconstructed. Measurement software was utilized for relevant indexes. Meanwhile, the corpse specimens were dissected to measure relevant data of the anterior cruciate ligament, and the difference of measured indexes between the corpse specimen and the three-dimensional substance model was analyzed. RESULTS AND CONCLUION: There was no difference between the data of corpse specimen and three-dimensional substance digital model (P > 0.05). It indicated that MRI image data of the human knee joint and anterior cruciate ligament could be used to reconstruct the authentic and reliable three-dimensional digital models of the knee joint and anterior cruciate ligament. Related Articles | Metrics

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Three-dimensional finite element analysis of anterior plate fixation for the treatment of sacroiliac joint dislocation Xiao Jin, Yin Qing-shui, Zhang Mei-chao, Zhao Wei-dong, Li Jian-yi 2011, 15 (52):  9729-9733.  doi: 10.3969/j.issn.1673-8225.2011.52.009 Abstract ( 269 )   PDF (355KB) ( 357 )   Save BACKGROUND: Most reported biomechanical studies on sacroiliac joint injury and fixation use cadavers or artificial bone models to simulate the sacroiliac joint injury. OBJECTIVE: To analyze the vertical stability of anterior plate fixation for sacroiliac joint dislocation using three-dimensional finite element method. METHODS: The anterior plate fixation model of unilateral sacroiliac joint dislocation was constructed on the basis of the three-dimensional finite element model of a complete pelvis. An axial load of 500 N was applied on the model; the cloud pictures of stress, strain and displacement were obtained after calculation and compared with that of the complete pelvis under the same conditions. RESULTS AND CONCLUSION: Stress concentration occurred at the internal fixation system; the maximum stress was found at the screws near the injured sacroiliac joint, far greater than the maximum stress of the complete pelvis under the same condition. The maximum strain was found in the healthy sacroiliac joint; the fixed sacroiliac joint had no strain. The maximum displacement was found in the injured sacroiliac joint; it was about twice longer than the complete pelvis. These findings indicate that the vertical stability of pelvis is poor using anterior plate internal fixation treatment for sacroiliac joint dislocation; and stress concentration occurs at the screws and plates. Related Articles | Metrics

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Design and biomechanical characteristics of adjustable multi-plane unilateral external fixator Shen Lu-feng, Li Zhen-su, Dong Xie-ping, Wu Xiao-hui, Wang Jin-cheng 2011, 15 (52):  9734-9737.  doi: 10.3969/j.issn.1673-8225.2011.52.010 Abstract ( 310 )   PDF (610KB) ( 714 )   Save BACKGROUND: Fracture patients after treated with damage control fixation, when needed a secondary fixation under conditions improved, another appropriate nail point for re-fixation is necessary, or complicated components is configured before fixation to adjust the original nail position. OBJECTIVE: To design a adjustable multi-plane unilateral external fixation device for opening extremities comminuted fracture fixation and secondary non-invasive reduction and fixation under abnormal medical conditions, and to detect biomechanics of the device. METHODS: Totally 24 femur specimens of the adult large pigs were prepared to construct 12 comminuted fracture models, then divided into experimental group with self-installing adjustable multi-plane unilateral external fixation and control group with installation of AO external fixation. Biomechanical testing was done separately in axial, shear and rotary conditions. RESULTS AND CONCLUSION: There were no significant difference of anti-stress, anti-bending and anti-rotation in the experimental and control groups. The adjustable multi-plane unilateral external fixation can install nail arbitrary for temporary reduction and fixation within 1/3 perimeter of the injured limb. When secondary fixation, original components can fix firmly without re-set screw. Related Articles | Metrics

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Model establishment and analysis of feeble current coupling signal transmitting through human limb Gao Yue-ming, Pan Sio-hang, Mak Peng-un, Vai Mang-i, Du Min 2011, 15 (52):  9738-9741.  doi: 10.3969/j.issn.1673-8225.2011.52.011 Abstract ( 447 )   PDF (636KB) ( 629 )   Save BACKGROUND: Research the features of feeble coupling current signal transmitting through the human body based on the conductive character of the human tissues is important for the charging and communicating of the implantable medical devices. OBJECTIVE: To analyze the distribution and attenuation when the feeble current coupling signal transmitting within the human limb. METHODS: The human limb was abstracted to a four layers cylinder, including the skin, fat, muscle and bone. The quasi-static model was formed and analyzed via the finite element method. The simulation and the in vivo experiment were carried out to insight the distribution of the current density and compare decay rate of potential on body surface with the simulation results. RESULTS AND CONCLUSION: The simulation results indicated that the muscle was the major path of the coupling current, the part of current in the skin was increasing with the frequency and the conductive current was much more than the displace current. However, the displace current increased while the frequency increasing, yet the conductive current decreased. Moreover, the current density in the wet skin was greater than the dry skin case. The attenuation of the body surface had a high pass filter character with the frequency. And the capacity effect of the tissues had obvious influence on the attenuation. Finally, the in vivo experiment matched well with the simulation results. Related Articles | Metrics

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Effect of two different diameter implants on deformation of maxillary sinus mucosa: A three-dimensional finite element analysis Liu Xiao-fang, Hu Ling-ling, Song Guang-bao, Hou Ya-rong, Liu Da-lie, Zhang Jin-cai 2011, 15 (52):  9742-9745.  doi: 10.3969/j.issn.1673-8225.2011.52.012 Abstract ( 376 )   PDF (562KB) ( 391 )   Save BACKGROUND: Mild and uniform deformation of maxillary sinus mucosa is an important factor that reduces the incidence of mucosal perforation during maxillary sinus elevation by using bone condensing technology. OBJECTIVE: To compare the effects of two diameter implants on the deformation of maxillary sinus mucosa. METHODS: Three-dimensional finite element models of the maxillary sinus mucosa (thickness 0.3 mm) with two diameter implants (4.1 mm, 4.8 mm) were established in the special unit of ANSYS software. Maxillary sinus elevation operation was simulated. Von Mises stress values of mucosa surface with different lifting height was calculated according to the finite deformation theory. RESULTS AND CONCLUSION: The maximum stresses of all models existed in the center of the mucosa and the minimum stresses existed in the edge of the mucosa. There was no significant difference in the stress to the center of the mucosa between the two diameter implants (P > 0.05), but the stress in the edge of mucosa of the larger diameter implant (4.8 mm) was significantly less than that of the stress in the edge of the small diameter implant (4.1 mm). The larger diameter implant (4.8 mm) has less stress for augmentation of the maxillary sinus floor in the case of allowed width. Related Articles | Metrics

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Factors to influence the stability of the prosthesis after total hip replacement: Bone marrow mesenchymal stromal cells, bone morphogenetic protein and osteogenic potential Li Xiao-miao, Shen Yi, Wang Wei-li, Ren Wei-ping 2011, 15 (52):  9746-9749.  doi: 10.3969/j.issn.1673-8225.2011.52.013 Abstract ( 344 )   PDF (627KB) ( 322 )   Save BACKGROUND: The relationship between the osteogenic potential of the bone marrow microenvironment and long term stability after total hip replacement is not clear yet. The author makes a point, the fit intensity of the prosthesis can be predict through the osteogenic potential analysis of the bone marrow. OBJECTIVE: To investigate the relationship between the activities of bone marrow mesenchymal stem cells, expression of osteogenic protein-signaling pathway related genes, osteogenic potential and the stability of the prosthesis. METHODS: Bone marrow mesenchymal stem cells (BMSCs) were prepared from bone marrow aspirate obtained from the proximal femur metaphysis during total hip replacement (THR) surgery. Twelve patients were included in this study (8 men and 4 women, ages 50-84, body mass index 21.5-50). The isolated BMSCs were culture-expanded to passage one; non-confluent, undifferentiated cells were harvested for flow cytometry or for RNA isolation. Linear regression analysis was used to assess the correlation among indicators of osteogenic potential. RESULTS AND CONCLUSION: The number of Stro-1+ cells, activity of alkaline phosphatase and expression of osteoblasts-related genes from BMSCs of these 12 patients varied significantly. There was a positive correlation between cells expressing the Stro-1 surface marker and bone morphogenetic protein receptor 1a, MSX2, Runx2 and the activity of alkaline phosphatase (P < 0.05), there was a significant correlation between the activity of alkaline phosphatase and the expression of Runx2 after the cells was cultured by osteoblats (P < 0.05). There was a highly diverse of the bone marrow microenvironment osteogenic potential among THR patients. The potential impact of the BMSCs profiles on the long term outcome of total joint replacement patients warrants further investigation. Related Articles | Metrics

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Effect of entotrochanter reduction and fixation on hip joint function of elderly intertrochanteric fracture patients with entotrochanter displacement over 2 cm: A prospective randomized controlled study Lü Fa-, Cheng Guo-jie, Chen Ping-bo, Li Wen-fu, Jia Wei-dong, Zhang Bo, Lü Gang, Ai Ke Ba Er,Yang Chun, Rong Kai, Hu Fei 2011, 15 (52):  9750-9755.  doi: 10.3969/j.issn.1673-8225.2011.52.014 Abstract ( 347 )   PDF (771KB) ( 529 )   Save BACKGROUND: It is unclear that whether intertrochanteric fracture accompanied with entotrochanter displacement over 2 cm requires reduction and fixation. OBJECTIVE: To explore the clinical value of entotrochanter reduction and fixation of elderly intertrochanteric fracture patients with entotrochanter displacement over 2 cm. METHODS: Seventy elderly intertrochanteric fracture patients with entotrochanter displacement over 2 cm selected from the Department of Orthopedic Trauma, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, from January 2010 to March 2011 were enrolled. Patients undergoing entotrochanter reduction and fixation served as experiment group (n=35) and those without reduction as control group (n=35). Intertrochanteric fracture was fixed by intramedullary system, while entotrochanter displacement was treated by wire or screw fixation. The patients were followed up at 1, 3, 6, 12 months after surgery. RESULTS AND CONCLUSION: There was no internal fixation loosening, broken nail and infection in both groups during the follow-up. The healing time of the two groups had no significant difference (P > 0.05). The score of hip function in the experiment group was better than that in the control group at 1 month after surgery; however, at 3, 6, 12 months after surgery, the differences were non-significant. The results showed that entotrochanter reduction and fixation was suitable for elderly intertrochanteric fracture patients with entotrochanter displacement over 2 cm based on its obvious short-term effects, but patients with poor general condition were not recommended. Related Articles | Metrics

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Changes of blood clotting in elderly patients prior to and after cemented hip replacement Liu Hong-bing, Yang Liu-cai, Meng Qing-bing 2011, 15 (52):  9756-9759.  doi: 10.3969/j.issn.1673-8225.2011.52.015 Abstract ( 378 )   PDF (506KB) ( 368 )   Save BACKGROUND: As the high blood clotting of the elderly patients, the complications may occur more easily after cemented hip replacement, such as deep venous embolism, disseminated intravascular coagulation, pulmonary embolism and cerebral embolism. OBJECTIVE: To explore the changes of four blood clots index, such as the prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB) after cemented hip replacement in elderly patients. METHODS: The PT, APTT, TT and FIB of 40 elderly patients with artificial hip replacement was detected at 10 minutes before implantation and 30 minutes, 1, 2, 3 hours after implantation, respectively. RESULTS AND CONCLUSION: Compared with 10 minutes before implantation, the PT of 30 minutes after implantation was significantly decreased (P < 0.05), and the FIB was increased obviously (P < 0.05), and restored to the normal state at 3 hours after implantation (P > 0.05). The changes of APTT and TT before and after implantation were not significant (P > 0.05). The results showed that there were high blood clots in a short time after bone cement implantation, and disappeared at 3 hours after implantation. Three hours after bone cement implantation was the best time to detect the blood clots. Related Articles | Metrics

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Celecoxib prevents against heterotopic ossification after total hip arthroplasty  Zhao Wei-guang, Liu Li, Li Xiao-lei, Liu Zhen-wu 2011, 15 (52):  9760-9763.  doi: 10.3969/j.issn.1673-8225.2011.52.016 Abstract ( 331 )   PDF (654KB) ( 617 )   Save BACKGROUND: Currently, indomethacin is commonly used in preventing heterotopic ossification after total hip arthroplasty. However, it has serious adverse gastrointestinal reactions. While celecoxib used as COX-2 specific inhibitor has less gastrointestinal side effects in theory, but its effect on prevention of heterotopic ossification after total hip arthroplasty is still unclear. OBJECTIVE: To explore the effect of celecoxib on preventing heterotopic ossification of total hip arthroplasty patients and provide the basis for clinical medication of patients with gastrointestinal symptoms. METHODS: Fifty patients received total hip arthroplasty from December 2010 to May 2011 were recruited into this study. The mean age was (65.40±3.24) years old, and 19 left hips and 32 right hips were involved. The patients were divided into celecoxib group and indomethacin group randomly, and were treated with celecoxib of 200 mg/d and indomethacin of 75 mg/d for 6 weeks respectively. RESULTS AND CONCLUSION: The incidence of heterotopic ossification was 12.0% in the celecoxib group and 16.0% in the indomethacin group, and there was no significant difference between them (P > 0.05). Harris hip function scores showed the excellent and good rate was 88.0% in the celecoxib group and 76.0% in the indomethacin group, and the difference had no significance (P > 0.05). The incidences of gastrointestinal side effects in the celecoxib group and indomethacin group were 16.0% and 36.0% respectively, and the difference was significant (P=0.039). Chi-square test showed the data about adverse reaction between the two was distinctly different (P=0.039). It is indicated that the celecoxib can be used in preventing heterotopic ossification of total hip arthroplasty patients with less gastrointestinal side effects. Related Articles | Metrics

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Prevention and medical treatment of deep vein thrombosis after hip replacement: A controlled trial Zhang Zhi, Fan Yu-wei, Yang Yi-min, Wang Jian-xin 2011, 15 (52):  9764-9766.  doi: 10.3969/j.issn.1673-8225.2011.52.017 Abstract ( 302 )   PDF (471KB) ( 341 )   Save BACKGROUND: Deep vein thrombosis (DVT) after hip replacement operation is one of risk complications. Drug therapy is an effective way to prevent thrombosis. To achieve the best preventive effect, standardized medication program is used in clinical. OBJECTIVE: To summarize the prevention and treatment experience of DVT in patients after hip replacement operation． METHODS: Totally 110 patients who received hip replacement from Department of Orthopedics, Guyuan City People’s Hospital between January 2010 and May 2011 were analyzed retrospectively. Clinical data of the patients who received low molecular weight heparin, Fondaparinux sodium, Rivaroxaban and warfarin for prevention of DVT were selected according to the requirement of China Orthopedic Surgery Venous Thromboembolism Prevention Guideline (2009 edition). Above-mentioned clinical results were compared with the clinical data from 123 patients who were also received hip replacement but were treated with drug irregularly to prevent DVT postoperatively between January 2007 and December 2009. RESULTS AND CONCLUSION: All the patients had no obviously uncomfortable symptoms after anticoagulant injection. Few patients with DVT in the both groups were found. D-dimer detection of 45 and 29 cases in the irregular group and the regular group were positive respectively. DVT of the two groups occurred at 4 weeks after hip replacement. Incidence of thrombosis was decreasing with the medication time. Patients with thrombosis in the regular group were obviously lower than those in the irregular group at 12 weeks after hip replacement (P < 0.05). It is indicated that to regularly use low molecular weight heparin, Fondaparinux sodium, Rivaroxaban and warfarin can efficiently prevent the occurrence of DVT after hip replacement. Related Articles | Metrics

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Total hip arthroplasty with posterior minimal incision for the treatment of femoral neck fractures Liu Cheng-jun, Xie Zhi-yue, Gu Zu-chao, Yang Li-ming, Zhang Yu 2011, 15 (52):  9767-9769.  doi: 10.3969/j.issn.1673-8225.2011.52.018 Abstract ( 231 )   PDF (452KB) ( 458 )   Save BACKGROUND: Total hip arthroplasty has become one of the common treatment modalities of the traumatic femoral neck fractures in the aged. Total hip arthroplasty with minimal incision not only reduces the surgical trauma and the patients suffering, but also benefits the recovery from operation in the aged. OBJECTIVE: To explore the clinical results of total hip arthroplasty with posterior minimal incision for the treatment of femoral neck fractures. METHODS: A total of 25 cases of traumatic femoral neck fractures (Garden Ⅲ and Ⅳ) underwent total hip arthroplasty with posterior minimal incision were retrospectively analyzed. RESULTS AND CONCLUSION: All 25 cases were followed up for more than 6 months. According to the X-ray examination after operation, the prosthesis was in good position. One case had prosthesis dislocation, and the dislocation didn’t happen after treatment. One case had lower limb discrepancy which did not influence walks. The average Harris score was 85.7 in the 9th month after operation. There was no infection, nerve injury, prosthetic loosening and deep venous thrombosis after operation. The bone condition around the prosthesis was good. These findings indicate that total hip arthroplasty with posterior minimally incision has the advantages of little trauma size, stabilized artificial joints and short recovery time, therefore is a suitable treatment modality for aged femoral neck fractures (Garden Ⅲ and Ⅳ) patients. Related Articles | Metrics

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Etiological composition of patients undergoing total hip replacement for the first time in Guangzhou: A retrospective analysis of 974 cases in the same institute within 8 years Li Jun, Wang Jian, Li Yang, Shi Zhan-jun 2011, 15 (52):  9770-9773.  doi: 10.3969/j.issn.1673-8225.2011.52.019 Abstract ( 272 )   PDF (534KB) ( 360 )   Save BACKGROUND: There are relationships between the causes, gender and age of patients with total hip replacement. The common causes are hip osteoarthritis, aged femoral neck fracture, aseptic necrosis of femoral head and hip local lesion in systemic disease. OBJECTIVE: To study the etiological composition of patients with total hip replacement for the first time and its distribution in ages and genders. METHODS: A retrospective analysis was performed in 974 patients received total hip replacement for the first time in Affiliated Nanfang Hospital of Southern Medical University from January 2003 to December 2010. All the patients were Guangzhou residents. The patients were divided into 9 groups according to discharge diagnosis, and the composition of ages and genders was analyzed. RESULTS AND CONCLUSION: Seventy patients were of primary osteoarthritis (7.19%), 64 of congenital hip dysplasia (6.57%), 78 of ankylosing spondylitis (8.01%), 518 of avascular necrosis of femoral head (53.18%), 220 of femoral neck fracture (22.59%), 10 of tumor of hip (1.03%), 8 of rheumatoid arthritis (0.82%), 4 of infective arthritis (0.42%), and 2 patients were of hematological disease (0.21%). The proportion of patients over 50 years old was obviously higher than that of the patients under age 50 and age 50 (χ2= 104, P < 0.05). The proportion of female patients was higher than that of the male patients, but the difference was not significant (χ2= 1.73, P > 0.05). The results showed that the causes of the patients received total hip replacement for the first time in Affiliated Nanfang Hospital of Southern Medical University in Guangzhou were complex, the major causes were avascular necrosis of femoral head and femoral neck fracture, the main patients were over 50 years old, and the proportions of female and male patients were similar. Related Articles | Metrics

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Artificial femoral head replacement for intertrochanteric fractures versus femoral neck fractures in elderly patients Zuo Jin-bu, Yu Lei, Liang Hong-wei, Wang Wei, Zhao Bin, Qi Jin-ru 2011, 15 (52):  9774-9777.  doi: 10.3969/j.issn.1673-8225.2011.52.020 Abstract ( 272 )   PDF (472KB) ( 579 )   Save BACKGROUND: Using femoral head replacement for femoral neck fractures which shift significantly has become a consensus, but using artificial femoral head replacement for intertrochanteric fractures is controversial. OBJECTIVE: To compare the effects and prognosis of artificial femoral head replacement for unstable intertrochanteric fractures and femoral neck fractures in elderly patients, and to evaluate the curative of unstable intertrochanteric fractures in elderly patients with the artificiall femoral head replacement. METHODS: Totally 112 cases with artificial femoral head replacement for treating unstable intertrochanteric fractures and femoral neck fractures in elderly patients from June 2005 to June 2009 were selected. There were 52 cases in intertrochanteric fractures group, and 60 cases in femoral neck fractures group. Operation time, blood loss, time of post-surgery exercise, and hip function were compared. RESULTS AND CONCLUSION: All the patients were followed-up for 12 to 39 months after replacement. Hip function was evaluated by Harris score which showed that the excellent and good rate was 92.1%, evaluation excellent for 22 cases, good for 25 cases, fair for 3 cases, and poor for 1 case in the intertrochanteric fractures group, but in the femoral neck fractures group, the excellent and good rate was 91.3%, evaluation excellent for 28 cases, good for 25 cases, fair for 4 cases, and poor for 1 case. Operation time (P < 0. 05) and blood loss (P < 0. 05) in the femoral neck fractures group were significantly lower than those in the intertrochanteric fractures group. There was no significant difference of the time of post-surgery exercise and excellent and good rate of efficacy in the two groups. It is indicated that artificial femoral head replacement can be used as the main method for the treatment of unstable intertrochanteric fractures in the elderly. Related Articles | Metrics

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Stabilized or semi-restrictive cemented prosthesis for treatment of stiff knees: Changes in joint function Chu Ya-ming, Zhou Yi-xin, Li Yu-jun 2011, 15 (52):  9778-9781.  doi: 10.3969/j.issn.1673-8225.2011.52.021 Abstract ( 319 )   PDF (492KB) ( 428 )   Save BACKGROUND: There is a contrary in outcome of knee arthroplasty in patients with severe stiff knees. OBJECTIVE: To explore the outcome of artificial total knee arthroplasty in patients with severe stiff knees.  METHODS: 221 patients with severe stiff knees performed total knee arthroplasty in Beijing Jishuitan Hospital, the Forth Clinical College of Peking University from June 2007 to May 2010 were involved. According to the preoperative range of motion (ROM), these patients were divided into two groups. Severe stiff group (ROM < 65°) included 63 patients (99 knees), and partial stiff group (65°≤ROM<90°) included 158 patients (230 knees). 202 patients (300 knees) had normal activity of the knee before arthroplasty at the same time were taken as control. RESULTS AND CONCLUSION: As a result of the arthroplasty, the ROM, knee society score, and Western Ontario and Mcmaster Universitics Osteoarthritis Index score of all patients were improved than before (P < 0.05). The increased ROM and function after arthroplasty of the severe stiff group knees were significant greater than those of the partial stiff group and the control group, and that of the partial stiff group knees were significant greater than in the control group. The patients with severe stiff knees could gain good ROM and function after total knee arthroplasty. Improvements in mobility and function were greater in the cases with severe preoperative stiffness. Related Articles | Metrics

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Follow-up application of imaging evaluation on adjacent lumbar segment after instrumented posterior spinal fusion Wu Chao, Wei Jian, Wang Qing, Tan Lun, Huang Xun, Tang Yu-hu 2011, 15 (52):  9782-9786.  doi: 10.3969/j.issn.1673-8225.2011.52.022 Abstract ( 334 )   PDF (756KB) ( 504 )   Save BACKGROUND: Now, most studies related to adjacent segment degeneration only analyze the changes of motion segments above and below the fusion. There were no controlled studies on adjacent segments to all the other unfused segments after instrumented posterior fusion. OBJECTIVE: To study measurement of adjacent lumbar segments and evaluate long-term radiographic changes in all adjacent lumbar segments after instrumented posterolateral lumbar fusion. METHODS: Totally 42 digitized radiographs of lateral lumbar spine from 6 corpse skeletons were obtain through different projections and specimen postures (every specimen with 7 projection). Fifty-seven patients with posterolateral lumbar fusion were followed-up from 1.5 to 4 years. Digitized radiographs of them were photographed before fusion surgery and final follow-up. Distortion-compensated roentgen analysis (DCRA) method was used to measure sagittal angle, disc height, and dorsoventral displacement in all the above data. RESULTS AND CONCLUSION: There were no statistical significance in sagittal angle, disc height, and dorsoventral displacement under different postures by using DCRA method (P > 0.05). No changes were observed at the segments located below the fusion. All the unfused segments above the fusion showed significant changes of sagittal angle and disc height. It is indicated that the radiographic changes of posterolateral lumbar fusion suggest the disc degeneration of the segments above the fusion. Related Articles | Metrics

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Three-dimensional CT anatomy of the vein behind atlantoaxial complex Chen Yong-jun, Xie Bo-zhen, Chen Li-jun, Sui Tong, Zhao Hui-yi, Duan Shao-yin 2011, 15 (52):  9787-9791.  doi: 10.3969/j.issn.1673-8225.2011.52.023 Abstract ( 412 )   PDF (733KB) ( 495 )   Save BACKGROUND: Anatomy structure of craniocervical junction is complicated, it is necessary to preoperatively observe the vein structure behind the atlantoaxial complex. Three-dimensional CT angiography (CTA) has obvious advantages in showing them. OBJECTIVE: To observe the complex venous plexus structure behind the atlantoaxial complex. METHODS: Sixty subjects who were performed CTA in head and neck without any pathology of craniocervical junction, were selected at random. Three-dimensional CT images of them were analyzed retrospectively to measure the structure of the vein behind atlantoaxial complex and describe the spatial relationship of atlantoaxial complex.  RESULTS AND CONCLUSION: Statistical analysis showed that there were significant differences in the volume of suboccipital cavernous sinus (SCS) and epidural venous plexus (EVP), the distance from SCS to midline on the left and right sides, the diameter of deep cervical vein (DCV) at the level of posterior arch of the atlas, the distance from DCV to the midline and to posterior arch of the atlas on the left and right sides and measurements between male and female (P > 0.05) except the distance from EPV to midline on the left and right sides (P < 0.05). It is indicated that vein and venous plexus behind atlantoaxial complex are rich and complicated in sharp or structure with uncertaion variations. Related Articles | Metrics

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Application of low-dose dual-source CT angiography imaging in the evaluation of postoperative coronary stenting Bao Jian, Chen Hong-wei, Fang Xiang-ming 2011, 15 (52):  9792-9796.  doi: 10.3969/j.issn.1673-8225.2011.52.024 Abstract ( 323 )   PDF (581KB) ( 499 )   Save BACKGROUND: Multi-slice spiral CT coronary angiography is an impartment screening techniques in the evaluation of coronary stent implantation, but patients need receive larger radiation doses of X-ray. OBJECTIVE: To evaluate the clinical value of low-dose dual-source CT angiography (DSCTA) imaging in the evaluation of postoperative stenting of coronary arteries. METHODS: Totally 45 patients with 63 previously implanted coronary stents underwent prospective Electro-Chemical Grindion (ECG) gating (prospective) using DSCTA. Patency of stented and non-stented coronary arteries was observed and compared with digital subtraction angiography (DSA) gold standard. Fifty patients who underwent retrospective ECG gating (retrospective) using CT angiography were randomly selected for the analysis of irradiation dose comparison. RESULTS AND CONCLUSION: Compared with the DSA, DSCTA showed correct rate of the stent patency was 96.8% and of the non-stent patency was 96.5% in the prospective group. The radiation dose in the prospective group was significantly lower than that of the retrospective group (P < 0.01). It is indicated that DSCTA yields not only high quality images but lower radiation dose under the permission of heart rate or rhythm, which suggests that DSCTA could be clinically useful for assessing postoperative coronary stenting. Related Articles | Metrics

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Image reconstruction algorithm for positron emission tomography with Thin Plate prior combined with an anisotropic diffusion filter Zhang Quan, Liu Yi 2011, 15 (52):  9797-9802.  doi: 10.3969/j.issn.1673-8225.2011.52.025 Abstract ( 314 )   PDF (897KB) ( 524 )   Save BACKGROUND: In positron emission tomography imaging, maximun posterior (MAP) reconstruction can greatly improve the quality of reconstructed image by introducing prior distribution constraint. But a improper prior distribution may result in over-smoothess and stepladder edge of reconstructed image. OBJECTIVE: To put forward an algorithm combines with anisotropic diffusion filter and MAP improved by Thin Plate prior according to over-smoothess and stepladder edge of reconstructed image by traditional MAP with local prior information. METHODS: Reconstruction algorithm consists of anisotropic diffusion filter based on equation with forward-and-backward diffusion coefficient and MAP estimation based on Thin Plate prior. Reconstructed images were obtained by the alternate iteration of the above two steps. The quality of reconstructed images was evaluate by normalized rms error (RMSE) and signal-to-noise ratio (SNR). RESULTS AND CONCLUSION: Reconstructed images obtained by MAP with second-order second Thin Plate prior model combined with anisotropic diffusion filter based on forward-and-backward diffusion coefficient partial differential equation were improved in restrain noise, edge-preserving, SNR, RMSE, visual evaluation and so on. Related Articles | Metrics

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Effects of robot-assisted therapy on upper-limb function of acute stroke patients Liu Zhen, Zhang Pan-de, Liu Cui-hua, Rong Xiao-chuan, Deng Hong-yan, Zhang Jin-xin 2011, 15 (52):  9803-9807.  doi: 10.3969/j.issn.1673-8225.2011.52.026 Abstract ( 320 )   PDF (529KB) ( 490 )   Save BACKGROUND: Recently studies showed that robot-assisted therapy can improve recovery of upper-limb in subacute and chronic stroke patients, but the studies on robot-assisted therapy in acute stroke patients are few. OBJECTIVE: To study the effects of robot-assisted therapy on upper-limb in acute stroke patients. METHODS: A total of 30 acute stroke patients were divided into two groups according to the wish. The patients in conventional therapy group received a conventional rehabilitative program including usual facilitation techniques, neuromuscular electrical stimulation, acupuncture therapy and so on. The patients in robot-assisted therapy group received robot-assisted therapy on the basis of conventional rehabilitative program. This kind of robot consists of adaptive upper-limb weight support, intelligence feedback and three-dimension training systems. A single or multiple joint training can be carried out in the virtual reality environment. RESULTS AND CONCLUSION: ①After treatment Fugl-Meyer Score of the upper extremity assessment (FMA) and the functional independence measure (FIM) were better than the scores before treatment both in the two groups significantly. ②At 3 weeks after treatment, there was no statistical difference in the FMA Scores in the two groups (P=0.075), but at 3 months the patients in robot-assisted therapy group gained better scores than conventional therapy group significantly (P < 0.01). ③The differences were not significant in the FIM Scores between the two groups both at 3 weeks or 3 months after treatment (P > 0.05). ④The changes of scores both on FMA and FIM compared with before treatment in robot-assisted therapy group were better than conventional therapy group statistically (P < 0.05). It could be concluded that robot-assisted therapy gained better motor function of upper limb in acute stroke patients on the basis of conventional therapy. Robot-assisted therapy also could change much more motor function and activities of daily living. Related Articles | Metrics

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Application of back propagation neural networks in the prediction of acute hypotension Wu Jian-bo, Lai Li-juan, Li Ning-shan, Wu Xiao-ming 2011, 15 (52):  9808-9812.  doi: 10.3969/j.issn.1673-8225.2011.52.027 Abstract ( 301 )   PDF (611KB) ( 499 )   Save BACKGROUND: The post-operation complications of acute hypotensive episode (AHE) in intensive care units seriously endanger the patient’s lives, and it is depended mainly on the expert experience of doctors to treat. OBJECTIVE: To detect automatically and forecast the occurrence of AHE and to research a model for predicting AHE by medical informatics theory. METHODS: Mean arterial pressure (MAP) signals of those people who experienced AHE and those who did not experienced AHE were both described on different scales by using wavelet transform, and the median and maximum from the wavelet coefficients were extracted as the parameters of MAP signal. Then back propagation (BP) neural networks method for classifying and predicting the parameters was developed and simulated in MATLAB environment. RESULTS AND CONCLUSION: The experiment demonstrates that BP neural networks method was practicable for forecasting the occurrence of AHE. Related Articles | Metrics

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Variations of vascular endothelial dysfunction of the femoral head in diabetic rats Zheng Yu-tao, Chen Hai-ying, Liu Wen-ge, Zhang Peng-fei 2011, 15 (52):  9813-9816.  doi: 10.3969/j.issn.1673-8225.2011.52.028 Abstract ( 285 )   PDF (575KB) ( 344 )   Save BACKGROUND: Onset reason of the complications of diabetic osteopathia is complicated. Endothelial lesions of blood vessel in bone tissue may play an important role in onset reason. OBJECTIVE: To investigate the effects of diabetes on endothelial dysfunction of the femoral head in the rats. METHODS: Totally 60 rats were randomly divided into diabetic group and control group. Diabetic model was constructed by intraperitoneal injection of streptozotocin in the diabetic group. RESULTS AND CONCLUSION: Compared with the control group at 15 weeks after modeling, microstructure of the femoral head in the rats was changed, serum levels of nitric oxide level was significantly decreased, plasma endothelin 1 was significantly increased and expression of blood coagulation factorⅧ was significantly decreased in the diabetic group (P < 0.01). It is indicated that the endothelial dysfunction occurs in the prediabetes. Endothelial dysfunction is induced by micrangium accrementition and diabetes, which are related with the hypofunction of the femoral head in the rats. Related Articles | Metrics

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Bioabsorable interference screws versus metal interference screws in anterior cruciate ligament reconstruction: A systematic review Bei Tao, Zhao Jin-min, Ding Xiao-fei, Wei Qing-jun, Liu Jun-ting 2011, 15 (52):  9817-9822.  doi: 10.3969/j.issn.1673-8225.2011.52.029 Abstract ( 942 )   PDF (553KB) ( 476 )   Save BACKGROUND: Metal screws have even been regarded as the gold standard in anterior cruciate ligament reconstruction, but now it is being challenged by the application of bioabsorable screws. But there is still controversy whether bioabsorable screw is superior to metal screw.  OBJECTIVE: To perform a systematic review of bioabsorable interference screw versus metal interference screw in anterior cruciate ligament reconstruction.                                      METHOD: A literature searching of PubMed, Ovid Medline Cochrane Libarary, Embase, EBSCO, CNKI and CBM about bioabsorable interference screw versus metal interference screw in anterior cruciate ligament reconstruction was done. Hand searching of related journals was carried out. The quality of the eligible studies were assessed according to the Cochrane Handbook 5.0. We used RevMan5.0.23 to do Meta-analysis. The strength of evidence was assessed using GRADE profile. RESULTS AND CONCLUSION: Eleven Randomized controlled trials and one quasi-randomized controlled trial were eligible for our study. Meta-analysis results demonstrated that there were no significant differences in KT-1000/2000 test, Lachman test, Pivot shift test, IKDC score, Lysholm score,and rate of infection. In bioabsorable interference screw group, tunnel enlargement was more common. The rate of knee effusion was slightly higher in bioabsorable interference screw group. GRADE results showed that there were 6 low quality evidences, 2 very low quality evidences and 4 moderate quality evidences. Bioabsorable screws could acquire the same efficiency compared with metal interference screw. Due to the low quality of included studies, low quality of evidence and short follow-up, further, high quality, and large sample trials are required. Related Articles | Metrics

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Meta-analysis of analgesic effect of local injection analgesic drugs around joint after total knee arthroplasty Li Yong, Cai Lin, Gong Tai-fang, Deng Zhou-ming, Zhang Yi, Yang Yong-bo, Hu Chao 2011, 15 (52):  9823-9828.  doi: 10.3969/j.issn.1673-8225.2011.52.030 Abstract ( 306 )   PDF (775KB) ( 404 )   Save BACKGROUND: There are too many traditional analgesia methods of total knee arthroplasty (TKA), but these methods always bring some adverse events. OBJECTIVE: To evaluate the effectiveness and security of local injection of analgesic drugs around joint during TKA by Meta analysis. METHODS: PubMed, Cochrane Library, EMBASE, CNKI, CBM and WANGFANG database were searched for articles related to analgesic of total knee replacement (2000-01-01/2011-04-30). All randomized controlled trials (RCTs) about the analgesic of TKA were adopted; other treatment measures were all the same in both groups except mixed analgesics were local injected around joint during the TKA in the experimental group. Quality of literatures were critically evaluated and extracted by 2 investigators independently. The statistical analysis was conducted using the RevMan 5.1.2. RESULTS AND CONCLUSION: Ten RCTs involving 694 patients were collected. The results of Meta-analyses showed that compared with the traditional analgesia method, visual analogue scales (VAS) for pain during activity in the post-anesthetic-care ([WMD=-1.04, 95%CI (-1.26, -0.82), P < 0.000 01] and the VAS for pain at rest in the post-anesthetic-care [WMD=-0.67, 95%CI(-0.81, -0.54), P < 0.000 01] were lower, the number of patient needed analgesia again [RR=0.26, 95%CI (0.17, 0.40), P < 0.000 01] and morphine consumption [WMD=-6.89, 95%CI (-8.91, -4.86), P < 0.000 01] postoperatively were fewer in the experimental group. There was no significant difference of incidence adverse reactions in the two groups [RR=0.62, 95%CI(0.21，1.84), P=0.39]. The current evidence indicated that local injection of analgesic drugs around joint after TKA is an effective and safe methods, but the effectiveness and security still need to be confirmed by RCTs with large sample. Related Articles | Metrics

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Biomechanics of implanted screws for cervical spine injury Ye Xin-ping 2011, 15 (52):  9831-9834.  doi: 10.3969/j.issn.1673-8225.2011.52.032 Abstract ( 354 )   PDF (613KB) ( 379 )   Save BACKGROUND: Biomechanics showed that cervical spine injury is associated with mechanics. OBJECTIVE: To summarize advances in implanted screw biomechanics in treating cervical spine injury in athletes. METHODS: A computer-based online search of PubMed and CNKI database was performed for related articles with the key words “cervical spine injury; implanted nail; biomechanics” in Chinese and English. Articles that accurately reflected and reported advances in cervical biomechanics were selected, and 28 were included and analyzed. RESULTS AND CONCLUSION: The biomechanics of implanted screws for athletes with cervical spine injury was analyzed from aspects of cervical endogenous stability, exogenous stability and functional exercise to provide theoretical evidence for functional exercise of the athletes. To balance cervical endogenous stability and exogenous stability is very important for treating cervical spine injury and provide new theoretical evidence for understanding occurrence, development, diagnosis and treatment selection for spinal cord injury. Related Articles | Metrics

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Application of tissue engineering repair and computer associated design/computer associated manufacture digital modeling technology in skull defects Song Guang-yuan 2011, 15 (52):  9835-9838.  doi: 10.3969/j.issn.1673-8225.2011.52.033 Abstract ( 290 )   PDF (611KB) ( 471 )   Save BACKGROUND: The surgical reconstruction of extensive skull defect has always been a challenge for neurosurgeon for its complicated anatomical structure and irregular three-dimensional curvature. Choosing the suitable repair material to achieve perfect repairment of skull defect is the hotspot in current research. OBJECTIVE: To summarize the studies on application of concerning tissue engineering and computer associated design/computer associated manufacture (CAD/CAM) digital technology to titanium alloy materials in the repairment of cephalic injury. METHODS: A computer-based online retrieval of Medline database from January 2000 to June 2011 was performed with the key words of “tissue engineering, craniocerebral trauma, CAD/CAM, titanium armor plate” in English, and the retrieval of CNKI database from January 1990 to June 2011 was performed with the key words of “tissue engineering, skull injury, digital three-dimensional modeling, titanium mesh” in Chinese. The highly targeted articles were included. The documents published currently or in the authority journals were preferred in the same field. Studies focused on traditional materials or methods for repairing skull injury and outdated studies were excluded. The latest research and clinical practical studies were summarized in details. RESULTS AND CONCLUSION: A total of 236 documents were obtained in initial retrieval, 27 articles of them were chosen to summarize based on strict inclusion criteria. Traditional methods for repair of skull injury can greatly reduce the effects of restorations because of their poor biocompatibility, lack of materials, and they do not grow with the individual growth. CAD/CAM digital prototyping technology can duplicate the geometrical shape that is highly consistent with the skull and jaw defects to achieve a personalized configuration for repairing skull defects and produce well biocompatible titanium mesh skull prosthesis. Related Articles | Metrics

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Magnetic resonance imaging measurement of the rotational alignment of knee prosthesis Long Teng-he, Lü Guo-shun, Cui Hui-qin 2011, 15 (52):  9839-9842.  doi: 10.3969/j.issn.1673-8225.2011.52.034 Abstract ( 359 )   PDF (527KB) ( 419 )   Save BACKGROUND: Three-dimensional magnetic resonance image (MRI) measurement method can not only observe and measure knee diameters in one direction or a plane, but also measure the multi-directional and multi-plane diameter lines and angles. OBJECTIVE: To assess the application of MRI measurement in the rotational alignment of knee prosthesis during knee replacement. METHODS: A computer-based search was performed for retrieve of articles published 2001-01/2009-10 about the clinical application of MRI measurement in the rotational alignment of knee prosthesis. The key words were “magnetic resonance imaging, replacement” in Chinese and English. RESULTS AND CONCLUSION: Both of MRI and CT are three-dimensional measurement tools, which can measure the distance of the maximal salient point of the external epicondyle of the femur, the lowest point of the medial epicondyle of the femur, the maximal salient point of the medial epicondyle of the femur from the joint line between the back of the knee and distal end of the knee, groove depth and width of the medial epicondyle, the anteroposterior diameter of the femur, and the rotation angle of knee prosthesis. All the measurement data are of clinical significance. The findings show that the role of MRI measurement is superior to CT. As a result, MRI measurement can be considered as an ideal measurement method for the rotational alignment of knee prosthesis during knee replace replacement. Related Articles | Metrics

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Acetabular anteversion effect on the prosthesis in total hip arthroplasty Wu Bing-hua, Dai Min 2011, 15 (52):  9843-9846.  doi: 10.3969/j.issn.1673-8225.2011.52.035 Abstract ( 352 )   PDF (617KB) ( 877 )   Save BACKGROUND: Placement angle of the acetabular cup is a key factor for successful operation. Acetabular abduction and acetabular anteversion are two important parameters to evaluate the reasonableness of the prosthesis placement. OBJECTIVE: To review the measurement methods of the acetabular anteversion as well as the relationship between the acetabular anteversion and the prosthesis providing theoretical guidance for reasonable placement of the prosthesis. METHODS: A computer-based search of Wanfang, VIP and PubMed was performed for articles addressing the acetabular anteversion in total hip arthroplasty published before August 2011. The keywords were “total hip arthroplasty, acetabular anteversion, artificial joint, measurement”. Articles in the same field published recently or in authoritative journals were preferred. Totally 285 articles were retrieved, and finally 25 articles meeting the inclusive criteria were included. RESULTS AND CONCLUSION: The accuracy placement of the acetabular prosthesis is very important for the stability of the joints. Most scholars now believe that the acetabular prosthesis is placed reasonably with the acetabular abduction of 40°-45° and the acetabular anteversion of 15°-20°. Related Articles | Metrics

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Morphological measurements of the proximal tibia and knee replacement Wang Hai-han, Long Teng-he, Cui Hui-qin, Wang Jia 2011, 15 (52):  9847-9850.  doi: 10.3969/j.issn.1673-8225.2011.52.036 Abstract ( 307 )   PDF (554KB) ( 649 )   Save BACKGROUND: The proximal tibia is the upper part of knee prosthesis composition and the bottom part of knee prosthesis position. OBJECTIVE: To evaluate the importance of the proximal tibial morphological measurement in clinical knee replacement. METHODS: With "knee; prosthesis; replacement" in Chinese and English as key words, a computer-based retrieval from January 1995 to October 2011 was performed for papers in terms of magnetic resonance imaging measurements on prosthetic rotational alignment in clinical prosthetic knee replacement. RESULTS AND CONCLUSION: The morphological measurement of proximal tibia includes three-dimensional finite element model, relevant parameters and angle, as well as biomechanics research, which is all closely related with the selection and design of the prosthesis. Morphometry of the proximal tibia can be divided into two-dimensional and three-dimensional measurements, and the later is more accurate to measure tibial plateau width and tilt angle, tibial anteroposterior diameter, these measurement data have great application prospect in the clinical practice. Proximal tibial is the bottom part of knee prosthesis position, while the proximal tibial three-dimensional models can simulate and dock prosthetic model bottom, thus improve the success of the operation. Related Articles | Metrics

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Developmental dysplasia of the hip Li Wei-ping, Wang Hua-ming 2011, 15 (52):  9851-9854.  doi: 10.3969/j.issn.1673-8225.2011.52.037 Abstract ( 426 )   PDF (600KB) ( 1127 )   Save BACKGROUND: Developmental dysplasia of the hip (DDH) has replaced the term congenital dislocation of the hip, because the DDH can more accurately reflect all category of leading to immature hip deformity. OBJECTIVE: To review research progress of characteristics, risk factors and research methods of the DDH. METHODS: The articles related to diagnosis, clinical screening, medical examination, physical examination and treatment of DDH from PubMed and Chinese journal full-text databases between January 2006 and September 2011 were retrieved by the computer with the key words of “developmental dysplasia of the hip, examination and treatment” in English and “the developmentally hip dysplasia, check, treatment” in Chinese. Repetitive researches were excluded, and a total of 27 articles were summarized in this paper. RESULTS AND CONCLUSION: Hip judge risk factors of the DDH includes first exposed and family history, the disease diagnosis is built on the basis of the physical examination. Hip instability, limbs length discrepancy and thigh skin creases asymmetric all can appear in neonatal developmentally dislocation of the hip cases. However unsteady gait and hip outreach are limited in older children becomes more common. Ultrasonic scanning technology inspection exists certain controversial, however, once the diagnosis establishes usually can be used to test and evaluate the development conditions of the hip. Orthosis is the most important means for children under six months. Surgery treatment is suitable for children aged more than 6 months undergoing unsuccessful conservative treatment. Early diagnosis of DDH is very important to improve the treatment, and reduce the risk of complications. Related Articles | Metrics

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Research and development of lower extremity rehabilitation exoskeletons Wan Da-qian, Xu Yi-ming, Bai Yue-hong 2011, 15 (52):  9855-9858.  doi: 10.3969/j.issn.1673-8225.2011.52.038 Abstract ( 558 )   PDF (562KB) ( 1424 )   Save BACKGROUND: How to improve the daily activity of patients with central nervous system injury caused by cerebrovascular diseases is the problem to be solved in rehabilitation medicine. The development of lower extremity rehabilitation exoskeletons may solve it. OBJECTIVE: To review the research and development of lower extremity rehabilitation exoskeletons in order to design and develop them. METHODS: An online search of literatures published between January 1990 to December 2008 of lower extremity rehabilitation exoskeletons was performed in PubMed database (http://www.ncbi.nlm.nih.gov/PubMed) and Wanfang database (http://www.wanfangdata.com.cn) with the key words of “exoskeletons robots, central nerve damage, passive rehabilitation training, the man-machine integration interaction interface” in English and in Chinese. The repetitive studies were excluded. RESULTS AND CONCLUSION: Totally 26 articles were chosen to summarize. There are amount of studies on rehabilitation exoskeletons. However, if small volume, light, low power consumption, high power output can be solved in the rehabilitation exoskeletons, while they also have the abilities of fast response, low inertia, high precision and high security, the maximum response function of lower limb of nerve damage patients may be achieved. Related Articles | Metrics

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Cobb angle changes in hemivertebra malformation patients before and after pedicle screw implantation combined with posterior hemivertebra resection Jiang Yu, Zhu Guo-xing, Yang Yu-sheng 2011, 15 (52):  9859-9862.  doi: 10.3969/j.issn.1673-8225.2011.52.039 Abstract ( 294 )   PDF (497KB) ( 348 )   Save BACKGROUND: Hemivertebra malformation is the most common cause of congenital kyphoscoliosis. Hemivertebra resection can directly remove teratogenic factors, which is an ideal treatment method.                          OBJECTIVE: To observe the Cobb angle changes before and after posterior hemivertebra resection and pedicle screw internal fixation for the treatment of hemivertebra malformation so as to evaluate the treatment effect on kyphoscoliosis malformation. METHODS: Eleven adolescent patients with kyphoscoliosis malformation caused by single hemivertebra selected from the Department of Orthopaedics, the Second People’s Hospital of Wuxi between 2008 and 2011 were treated with posterior hemivertebral resection and pedicle screw internal fixation. RESULTS AND CONCLUTION: During 1-2 years follow-up, posterior-anterior and lateral X-ray images showed that coronal planes Cobb angle in standing position was (49.2±12.8)° before treatment and corrected to (16.5±5.8)° after repairment (average correction rate of 66.5%); sagittal planes Cobb angle was (35.7±6.2)° before treatment and corrected to (14.1±1.9)° (average correction rate of 60.5%). At the final follow-up, the coronal planes Cobb angle was (19.0±5.8)° , and lost 2.8° and sagittal planes Cobb angle was (14.1±1.9)° without significant loss. During the follow-up, no complications of neurological damage, infection and implant failure occurred. It is indicated that the effect of posterior hemivertebra resection and pedicle screw internal fixation for the treatment of kyphoscoliosis malformation caused by hemivertebra malformation is satisfactory with a lower loss probability and successful fusion. Related Articles | Metrics

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Posterior indirect-decompression technique versus posterior direct vision decompression for thoracolumbar burst fractures Liu Chang-zheng, Ma Xue-hai, Zheng Jin, Zheng Sheng-nai, Yao Qing-qiang, Tang Cheng, Huang Hao, Xu Yan 2011, 15 (52):  9863-9868.  doi: 10.3969/j.issn.1673-8225.2011.52.040 Abstract ( 303 )   PDF (778KB) ( 490 )   Save BACKGROUND: Whether thoracic or lumbar vertebral burst fracture with intact posterior longitudinal ligament complex needs decompression and which reduction effect of adopted methods is reliable, now there is little controlled clinical  studies. OBJECTIVE: To investigate and discuss the clinical effect of posterior open-reduction and indirect-decompression technique (POIT) in the treatment of thoracic or lumbar vertebral burst fracture caused by posterior column stretch injury with intact posterior longitudinal ligament complex, and to analyze the two operation methods: POIT and posterior open-reduction and direct vision decompression technique (PODT). METHODS: Totally 48 cases with thoracic or lumbar vertebral burst fracture caused by posterior column stretch injury with intact posterior longitudinal ligament complex were divided into two groups randomly. Twenty-three cases were treated with POIT and twenty-five cases were treated with PODT. Complications rate, kyphosis correction, vertebral tube occupying place and recovery of nerve injury were observed. RESULTS AND CONCLUSION: The patients were all followed up from 20 to 25 months. The incidence of early complications, long-term residual back pain and incidence of activity limitation in the POIT group were lower than those in the PODT group. One week after fixation, anterior and posterior heights of vertebral body and Cobb angle correction in the POIT group were higher than those in the PODT group. There was no statistical difference of the recovery of nerve injury and the loss of reduction in the two groups after 1 year postoperation. It is indicated that using POIT technique to treat the thoracic or lumbar vertebral burst fracture caused by posterior column stretch injury with intact posterior longitudinal ligament complex is an appropriate technique, and the outcomes of the POIT operation is better than the PODT operation. Related Articles | Metrics

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Biomechanical characteristics of dynamic hip screws and anti-rotational screws for intertrochanteric fractures: A data review of 32 cases follow-up Zhao Yan, Huo Jian-jun, Xiaokelaitimaisumu, Abudusaimaiti 2011, 15 (52):  9869-9872.  doi: 10.3969/j.issn.1673-8225.2011.52.041 Abstract ( 232 )   PDF (549KB) ( 400 )   Save BACKGROUND: Anti-rotation ability and fracture stability of using simple dynamic hip screws for femoral intertrochanteric fractures fixation is poor. OBJECTIVE: To observe the biomechanical characteristics of dynamic hip screws and anti-rotational screws for treatment of femoral intertrochanteric fractures. METHODS: Thirty-eight patients who used dynamic hip screws and anti-rotational screws for femoral intertrochanteric fracture were selected. Thirty-two patients who received reduction and fixation with dynamic hip screws and anti-rotational screws for femoral intertrochanteric fracture were retrospective analysed. RESULTS AND CONCLUSION: Totally 32 cases were followed up for average 12.6 months (ranged from 6 to18 months). All the patients obtained bone union in average 18.1 weeks. There were no cases with implant loosening or refracture. According to Harris rating scale, the excellent and good rate was 90.6%, evaluation 21 cases in excellent, 8 cases in good, 3 cases in average and 0 case in poor. Internal fixation of dynamic hip screws and anti-rotational screws are suitable for femoral intertrochanteric fracture and this method have characteristics of large definitive rotational stability and rigid fixation. Related Articles | Metrics

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Characteristics of implantation fixation combined with comprehensive therapy for treatment of intertrochanteric fractures of elderly patients with osteoporosis Wang Jun-hua, Geng De-chun, Yang Hui-lin, Xu Yao-zeng 2011, 15 (52):  9873-9876.  doi: 10.3969/j.issn.1673-8225.2011.52.042 Abstract ( 294 )   PDF (533KB) ( 373 )   Save BACKGROUND: Characteristics of implantation fixation for treatment of intertrochanteric fracture patients is still unclear. OBJECTIVE: To analysis the characteristics of implantation fixation combined with comprehensive therapy for treatment of intertrochanteric fractures of elderly patients with osteoporosis. METHODS: Retrospective analysis of 328 elderly patients with intertrochanteric fracture and osteoporotic was performed to collect the cause of the injuries, combined fractures and medical complications. Surgical approach and treatment outcome were analyzed. RESULTS AND CONCLUSION: The patients ≥65 years old with osteoporotic intertrochanteric fractures accounted for 72.6%, the percentage of cases with combined fractures and medical complications were 9.5% and 46.3% respectively. 84.5% patients accepted surgical treatment. Excellent rates were 85.6% of dynamic hip screw fixation, 90.9% of proximal femoral nail anti-rotation or γ nail fixation, and 86.7% of total hip or artificial femoral head replacement. Intertrochanteric fractures are easy to take place in elderly patients with osteoporosis and intramedullary fixation is the best treatment for intertrochanteric fractures. For osteoporotic intertrochanteric fractures patients, their age, types of fractures, and the severity of osteoporosis and medical complications should be concerned when treatment. Related Articles | Metrics

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Comparison of anatomic plate and locking plates for the treatment of volar Barton’s fractures: One-year follow-up of the changes in volar tilt angle and ulnar inclination angle Zhu Xiao-yu, Chen Kang-wu, Qian Zhong-lai, Wang Gen-lin, Mao Hai-qing, Yang Hui-lin 2011, 15 (52):  9877-9880.  doi: 10.3969/j.issn.1673-8225.2011.52.043 Abstract ( 362 )   PDF (527KB) ( 412 )   Save BACKGROUND: Volar Barton’s fractures are extremely unstable, the treatment remains challenging. Currently, there is no uniform method to treat such fractures. OBJECTIVE: To compare the therapeutic effects of anatomic plate and locking plate for the treatment of volar Barton's fractures. METHODS: The clinical data of 26 patients who were volar Barton’s fractures with fixation by anatomic plates (n=12) and locking plates (n=14) between January 2006 and December 2010 were retrospectively analyzed, and the union rates and function recovery were compared. RESULTS AND CONCLUSION: The mean follow-up period was 27 months (6-58 months). Bone healing was satisfactory in all cases. The mean union time of anatomic plates group was 12.83 weeks while the mean union time of the locking plates group was 11.74 weeks. Evaluated by improved Gartland and Werler method, the excellent rate in the anatomic plates group (75%) was higher than that in the locking plates group (92.8%) (P < 0.05). In conclusion, both the anatomic plate and locking plates got a satisfactory therapeutic outcome for fracture healing of volar Barton’s fractures, but locking plates may provide better wrist function recovery. Related Articles | Metrics