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22 January 2012, Volume 16 Issue 4 Previous Issue    Next Issue

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Evaluation of meniscus injury by magnetic resonance imaging: A documentary analysis based on Science Citation Index from 2001 to 2010 Wang Cheng-wei1, Li Hong-lin1, Zhao Bo1, Li Lu-bing1, Pa Er Ha Ti1, Wang Xue1, Zheng Hui1, A Man1, Yu Jian-hua2 2012, 16 (4):  571-580.  doi: 10.3969/j.issn.1673-8225.2012.04.001 Abstract ( 374 )   PDF (723KB) ( 451 )   Save BACKGROUND: It is well known that magnetic resonance imaging (MRI) is the main imaging test method for the evaluation of meniscus injury as a non-invasive technology. OBJECTIVE: To multivariately analyze the literature on meniscus injury diagnosed by MRI through Science Citation Index Database (SCI) and its analysis tool. DESIGN: Bibliometric analysis. DATA RETRIEVAL: A computer-based online search of related literatures was performed in SCI database from January 2001 to December 2010 using the key words of “meniscus, damage or injury, MRI”. The retrieval results were analyzed, and the trends were described in words and graphics. SELECTION CRITERIA: ①The documents related to the types, treatment, effects and imaging features of meniscus injury diagnosed by MRI were selected; ②the literatures included articles, reviews, technical studies and proceedings papers; ③Unpublished articles, meeting abstracts and those needed to be obtained by manual or phone search were excluded. MAIN OUTCOME MEASUREMENTS: The literatures were analyzed by national distribution, institutional information, foundation, publish year, discipline distribution, citation frequency and authors. RESULTS: A total of 448 literatures were retrieved. The United States published the largest number of the articles, with 43% of all literature in the field. The funded projects were dispersed. The amount and citation frequency of the literature were increased year by year. CONCLUSION: This paper provides a valuable reference for researchers to understand the overview and present situation of this field in order to set further research. References | Related Articles | Metrics

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Stress distribution of proximal screw fixation of single and double cortex different combinations in less invasive stabilization system-distal femur treatment: A finite element analysis   Zhang Yan1, Yang Tie-yi1, Liu Shu-yi1, Wang Zhi1, Liu Yue1, Gong Lu-lu2, Ding Zu-quan2 2012, 16 (4):  581-584.  doi: 10.3969/j.issn.1673-8225.2012.04.002 Abstract ( 265 )   PDF (254KB) ( 370 )   Save BACKGROUND: How to determine the less invasive stabilization system-distal femur (LISS-DF) proximal cortical screw fixation of single and double cortex in a reasonable collocation way to reach a relative balance of fixation strength in screw at both ends of fractures, decrease shear stress between the screws and cortical bone, avoid stress concentration of the screws, receive a better clinical effect. All of those are the key to prevent internal fixation failure. OBJECTIVE: To observe the LISS-DF treatment of distal femoral fractures proximal cortex of different combinations of single and double screw fixation by finite element analysis and mechanical evaluation. METHODS: Solid model and finite element model of the LISS-DF plate for distal femoral fractures (AO/OTA33-A3 type) were builded in ANSYS9.0 software. Proximal screws in single and double cortex fixation of different combinations, axial compression torsion test were detected through the simulation of physiological stress, and stress changes the proximal screw was evaluate. RESULTS AND CONCLUSION: In 16 different combinations, when the combination of proximal screw 1, 3 single and 2, 4 double fixed cortex, mean stress of the proximal 4 screws was minimum (24.219 75 N), and the mean shear stress was also the minimum, displacement was close to other fixation and all were tiny. Proximal screw near the end of femoral fractures, and the remaining cortical screws followed by alternating single and double fixed, the LISS-DF system stress is decentralized, effect of anti-pull and anti-reverse is well, thereby the early loosening of plate and screw off is reduced.   Related Articles | Metrics

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null Bai Chuan-yi1, Ning Ning1, Ling Wei2, Tian Zhen-xing2, Dang Xiao-qian1, Wang Kun-zheng1 2012, 16 (4):  585-588.  doi: 10.3969/j.issn.1673-8225.2012.04.003 Abstract ( 319 )   PDF (231KB) ( 456 )   Save null References | Related Articles | Metrics

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Treatment for cervical spondylotic myelopathy with laminoplasty based on individual accurate transverse diameter of the spinal canal Zhang De-qiang, Yang Qun, Wu Chun-ming, Ma Kai 2012, 16 (4):  589-592.  doi: 10.3969/j.issn.1673-8225.2012.04.004 Abstract ( 300 )   PDF (303KB) ( 340 )   Save BACKGROUND: Traditional methods of posterior open-door laminoplasty use intraoperative anatomical landmark location, the location is ambiguous and is easy to be influenced by individual difference of patients, as well as the experience of the surgeon. OBJECTIVE: To evaluate the results of treatment for cervical spondylotic myelopathy with laminoplasty based on individual accurate transverse diameter of the spinal canal. METHODS: From January 2006 to December 2009, a total of 119 patients with cervical spondylotic myelopathy were treated with laminoplasty based on individual accurate transverse diameter of the spinal canal. The single-door laminoplasty was improved, and underwent with the laminoplasty based on individual accurate transverse diameter of the spinal canal. The clinical outcome was observed, and the Japanese Orthopaedic Association score and visual analogue scale score prior to and post operation and during follow-up were compared. RESULTS AND CONCLUSION: 112 patients were followed-up of average 39 months (range, 15-53 months). Compared with the preoperative, the JOA score of the 6 months postoperative and the last follow-up were significantly increased (P < 0.01). To classify the therapeutic effect in the last follow-up, 57 patients got excellent and 43 got good and the sum was 89.3%. Compared with preoperative, the visual analogue scale score of the 6 months postoperative and the last follow-up were significantly decreased (P < 0.01). Only three patients suffered from the palsy of C5 nerve root, and the incidence rate was 2.67%. The laminoplasty based on individual accurate transverse diameter of the spinal canal is proved effective in treating cervical spondylotic myelopathy. The method manage to thoroughly decompress and shift backward the spinal cord which benefits on relief of cervical/shoulder pain, lower rate of the palsy of C5 root. And it is practical and easy to be standardized.  Related Articles | Metrics

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Establishment of a normal human lumbar three-dimensional finite element model based on CT image and reverse engineering methods Hao Jian1, Piao Zhe1, Li Ji-hai1, Li Wa-li1, Mu Guang-tao1, Hao Jun-hang1, Shen Yi-xin2, Niu Wen-xin3 2012, 16 (4):  593-596.  doi: 10.3969/j.issn.1673-8225.2012.04.005 Abstract ( 275 )   PDF (407KB) ( 433 )   Save BACKGROUND: Finite element method can analyze biomechanics of normal human spinal under stationary and activity, and also can predict risk of stress. OBJECTIVE: To establish a three-dimensional finite element model of normal human L3-L5 motion segment. METHODS: In this study, a detailed L3-L5 level three-dimensional finite element model of a normal aged 30 men was established with the aid of two softwares, Geomagic and Ansys, which can derive a three-dimensional finite element model from CT images. Then border conditions and load were set. Angular displacement and stress concentration sites were recorded. Average model stiffness was calculated. RESULTS AND CONCLUSION: A finite element model of the spinal segments (L3-L5) was developed, including vertebrae, ligament, disc, fibrous ring and the facet joints. The model had 51 905 units. The model was validated by quantitative and qualitative. Three-dimensional finite element model of L3-L5 motion segment is approximate to the natural biomechanical of spine and it can be used for further study. Related Articles | Metrics

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R318Application of lower limb exoskeletons rehabilitation robots in rehabilitation treatment of activity limited knee joint Wan Da-qian1, Xu Yi-ming1, Bai Yue-hong1, Yin Yue-hong2 2012, 16 (4):  597-600.  doi: 10.3969/j.issn.1673-8225.2012.04.006 Abstract ( 311 )   PDF (279KB) ( 778 )   Save BACKGROUND: Limb exoskeletons rehabilitation robots can stimulate the natural resilience of body through simulated human movement to achieve tissue compensation based on its theoretical basis of continued combined active and passive activities.  OBJECTIVE: To dynamically observe and realize the rehabilitation effect of limb exoskeletons rehabilitation robots on functional exercise of patients with activity limited knee joint. METHODS: Twenty early postoperative patients with activity limited knee joint were divided into experiment group and control group randomly. The functional exercise with limb exoskeletons rehabilitation robots was performed in the experiment group. The control group underwent functional exercise with passive training devices CPM. Psychological guide, low-frequency pulse electrotherapy and infrared physiotherapy were performed in both groups during the treatment. RESULTS AND CONCLUSION: The active degree of retroflexion and protrusive movement of knee joint in all cases was improved. The muscle strength of the quadriceps femoris in experiment group was significantly improved after treatment (P < 0.01). The active degree of retroflexion and protrusive movement of knee joint in experiment group was further improved after 2 months follow-up treatment (P < 0.01). The indexes above did not change in control group. The results showed that the application of limb exoskeletons rehabilitation robots or passive training devices CPM combined with psychological guide, low-frequency pulse electrotherapy and infrared physiotherapy both could significantly improve the active degree of retroflexion and protrusive movement of knee joint in patients with activity limited knee joint, at the same time, the limb exoskeletons rehabilitation robots could recover the muscle strength of the quadriceps femoris. Related Articles | Metrics

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Creep characteristics before and after cervical facet joint excision Wu Zhi-feng1, 2, Wang Dan-dan1, Liu Guang-yao2, Ma Hong-shun3 2012, 16 (4):  601-604.  doi: 10.3969/j.issn.1673-8225.2012.04.007 Abstract ( 329 )   PDF (344KB) ( 333 )   Save BACKGROUND: Trauma and degeneration of cervical vertebrae can make cervical vertebra loses stability. That need the operation treatment, and sometimes need removal of the small joint. There are few studies on evaluation of the creep characteristics after separate resection of small joint at present.  OBJECTIVE: To compare normal cervical samples with the removal of cervical C5-6 facet joint stress relaxation of the creep mechanical properties, to determine whether the removal of the facet joint have an impact on stress relaxation properties. METHODS: Creep test on the removal of the normal facet joint specimens and the normal specimens was done on Japan shimadzu electronic universal testing aircraft. Temperature of human body on (36.5±0.5) ℃ in temperature field was simulated, stress on specimens by the speed of 5%/s was imposed, the time for 7 200 s was set. Creep equation from 100 data was calculated by three-parameter model. RESULTS AND CONCLUSION: The creep curve of normal specimens and the removal of the cervical facet joint were changed by the index relationship. It changed rapidly in the initial 600 s. With the extension of the time, the strain decline into the final phase of the balance slowly. The creep had no significant difference between the normal specimens and the removal of the cervical facet joint specimens in 7 200 s (P < 0.05). The calculation of the three-parameter model is simple, can be good fit changes in the strain curve. From this ideal equation, quantitative differences between the two groups are not significant. Related Articles | Metrics

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Plate pull-out strength of upper thoracic anterior titanium plate and anterior cervical titanium plate fixed system Liu Hui-jiang1, Zhan Xin-li1, Xiao Zeng-ming1, Gu Rong-he1, Liu Yun1, Luo Ju-li1, Liang Dong-zhu2 2012, 16 (4):  605-608.  doi: 10.3969/j.issn.1673-8225.2012.04.008 Abstract ( 245 )   PDF (285KB) ( 337 )   Save BACKGROUND: There is no dedicated upper thoracic anterior fixed system, the fixation devices deceloped by ourself has applied for a patent, which is still in the further research. OBJECTIVE: To evaluate the pull-out strength of self-designed upper thoracic anterior titanium plate fixed system and Orion anterior cervical titanium plate fixed system and to explore whether the upper thoracic anterior titanium plate fixation is feasible.  METHODS: Intact T2-T4 specimens from 6 fresh corpses were randomly divided into two groups: group A with upper thoracic anterior titanium plate fixation and group B with Orion anterior cervical plate fixation. T3 vertebral body and T2/3, T3/4 disc tissue were resected, then taken the appropriate iliac bone in the same body implanted in the T3 vertebral bone defect, and each of their fixation were installed.The pull-out strength was tested in the biomechanical testing machine and analyzed statistically. RESULTS AND CONCLUSION: The average pull-out strength of the group A was (1 005.11±252.78) N, and it was stronger than that of the group B (469.37±142.75) N, the difference was statistically significance (P < 0.05). The self-designed upper thoracic anterior titanium plate fixation device pull-out strength is superior to Orion anterior cervical titanium plate fixation device, which provided an experimental basis for later clinical application. References | Related Articles | Metrics

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Effect of the lumbar flexibility and facet joint degeneration on the improvement rate after lumbar internal fixation Yuan Jian-jun1, 2, Kan Shi-lian3, Jia Yu-tao2, Liu Yang1, Tian Rong1 2012, 16 (4):  609-612.  doi: 10.3969/j.issn.1673-8225.2012.04.009 Abstract ( 390 )   PDF (249KB) ( 298 )   Save BACKGROUND: Imaging shows that many patients with lumbar degenerative disease after internal fixation obtain sufficient neurological decompression and good bone graft fusion, but they can not satisfy with clinical effect because of residual low back pain, so there may exist other factor which affect the clinical effect. OBJECTIVE: To investigate the effect of the lumbar flexibility and facet joint degeneration on clinical effect of lumbar internal fixation. METHODS: Totally 120 cases underwent lumbar internal fixation of L4 and L5. Lumbar lordosis angle at extension and flexion position was measured preoperatively as the lumbar flexibility index. Facet joint angle of L3,4 was measured and the degeneration of facet joint was graded. Oswestry score was obtained before and after one year operation and improvement rate was calculated. The effect of the lumbar flexibility and facet joint degeneration on the improvement rate after operation was analyzed. RESULTS AND CONCLUSION: Lumbar flexibility was positively correlated with the improvement rate. Patients with severe degeneration of the facet joint and with asymmetry facet joint angle both have a bad improvement rate. Lumbar flexibility, lumbar facet joint degeneration and facet joint symmetry are the important factors which influence the outcome of lumbar internal fixation.   Related Articles | Metrics

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Six degrees of freedom in vivo stability of the knee with anterior cruciate ligament injury under anterior loading    Li Ping-yue1, Yin Qing-shui1, Huang Hua-yang1, Li Jian-yi2, Shen Hong-yuan1, Wang Ze-jin1, Wang Qing1 2012, 16 (4):  613-617.  doi: 10.3969/j.issn.1673-8225.2012.04.010 Abstract ( 295 )   PDF (330KB) ( 306 )   Save BACKGROUND: Because in vitro specimen of knee joint cannot simulate real movement of knee joint, and in vivo movement test cannot obtain movement information of bone structure, so accurate stability data of knee joint is not obtain which causes further study on early diagnosis and prevention measures of knee injury is unable. OBJECTIVE: To study in vivo stability of the 6 degrees of freedom knee kinematics in patients with anterior cruciate ligament (ACL) injury under 134 N anterior loading by using three-dimensional (3D) reconstruction, two-dimensional (2D)/3D image registration and image processing technology. METHODS: Totally 8 volunteers with unilateral ACL rupture and contralateral normal knee, CT (3D) images and 2D orthogonal images of the knee at 0°, 30°, 60°, and 90° under 134 N anterior loading were captured. These orthogonal images were used to recreate the in vivo knee positions at each of the targeted flexion angles by the method of 2D/3D registration. Comparison between the motion data of the mirror imaging uninjured knee and the injured knee was to get the 6 degrees of freedom kinematic difference of the intact and ACL deficient knee. RESULTS AND CONCLUSION: After ACL injury, tibia antelocation were all increased. Tibia antelocation was minimal at 0°, maximal at 30°, gradually decreased at 60° and 90° and all the differences in each angle have statistical significance (P=0.000). The ACL injury knee has increased internal tibial rotation and internal tibial shift than intact knee (P=0.000). It is indicated that in vivo stability analysis of knee joint under static loading can achieve by the method of 2D/3D registration technique, and the ACL injured knee has increased tibia antelocation, internal tibial rotation and internal tibial shift. Related Articles | Metrics

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Biomechanical comparison of locking plate and ordinary plate internal fixation for treatment of humeral intercondylar fractures of elderly patients Zhuo Nai-qiang, Wan Yong-Xian, Lu Xian-bo 2012, 16 (4):  618-621.  doi: 10.3969/j.issn.1673-8225.2012.04.011 Abstract ( 248 )   PDF (248KB) ( 342 )   Save BACKGROUND: Humeral intercondylar fractures with osteoporosis are often fixed by ordinary plate and bolt which are likely to get loose. Locking plate has a good pullout strength and the function of angle stability. OBJECTIVE: To compare the biomechanical changes of locking plate and ordinary plate fixation for treatment of complex humeral intercondylar fractures of elderly patients. METHODS: The humerus specimens from five elderly formalined cadavers were divided into two groups for bone density measurement of the metaphysis. The humerus was cut by electric pendulum saw from inside and outside the condyle to the olecranon fossa at right angles in order to prepare the C3 type complex intercondylar fracture model of the humerus. The fractures were fixed with locking plate and ordinary plate respectively after reduction. The specimens of the two groups underwent axial pressure test under 600, 800, and 1 000 N load, as well as torsion test under 2 N•m using universal biomechanical ergograph. RESULTS AND CONCLUSION: The average bone mineral densities of the metaphysis in the two groups had not significant difference (P > 0.05). The vertical compressive displacements under 600, 800 and 1 000 N loads in the locking plate group were obviously reduced compared with the ordinary plate group (P > 0.05). The average load of the locking plate group was obviously bigger than the ordinary plate group (P > 0.05), and the rotation angle was obviously smaller (P < 0.05) according to the failure standard of 3 mm for vertical displacement system. It is indicated that the locking plate has stronger biomechanical properties of anti-bend and anti-torsion than the ordinary plate for treatment of complex humeral intercondylar fractures of elderly patients.   Related Articles | Metrics

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Retrospective analysis of deep venous thrombotic risk factors in prosthetic hip surgery Qian Wen-wei, Weng Xi-sheng, Chang Xiao, Lin Jin, Jin Jin, Zhang Bao-zhong, Wang Wei 2012, 16 (4):  622-625.  doi: 10.3969/j.issn.1673-8225.2012.04.012 Abstract ( 275 )   PDF (280KB) ( 375 )   Save BACKGROUND: It is rarely reported that the occurrence of deep venous thromboembolism after artificial hip replacement in the patients group which is strictly complied with “China’s major orthopedic surgery venous thromboembolism prevention guidelines” for thromboprophylaxis. OBJECTIVE: To investigate the morbidity of deep venous thrombosis (DVT) in patients who underwent artificial hip replacement for standard prophylactic anticoagulant therapy. METHODS: The data of patients who underwent artificial hip replacement from Department of Orthopedics, Peking Union Medical College Hospital were selected. Then patients who occurred DVT after replacement were retrospective analyzed involving the risk factors, preventive measures, symptomatic characters, treatments and prognoses. RESULTS AND CONCLUSION: Totally 670 patients who underwent artificial hip replacement were selected including 16 patients with DVT, eleven patients with artificial femoral head replacement and five patients with unilateral total hip arthroplasty. The diagnoses included: 14 cases for femoral neck fracture, 1 case for avascular necrosis of femoral head, 1 case for hemophilia arthritis. The number of comorbidity was 1 to 4 in a patient, including hypertension, diabetes, rheumatoid arthritis, chronic renal failure and so on. All patients underwent standard mechanical and pharmacological thromboprophylaxis. Fourteen cases developed with swelling and pain in lower leg, and 2 cases developed with pulmonary embolism as the first symptom. Most patients recovered well. One patient of pulmonary embolism died of pulmonary infection which had no correlation with DVT, one patient of pulmonary embolism developed complication of cerebral bleeding after thrombolysis, which lead to persistent vegetative state. It is indicated that DVT morbidity can be reduced but can not eliminated by standard thromboprophylaxis. Hip fracture, long-lasting bed rest, aged, and co-existing medical diseases are the high-risk factors of DVT. Related Articles | Metrics

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Total hip arthroplasty with large-diameter metal/metal femoral head for treatment of avascular necrosis of the femoral head   Zhang Hai-ning, Lü Cheng-yu, Xu Hao, Wang Ying-zhen 2012, 16 (4):  626-629.  doi: 10.3969/j.issn.1673-8225.2012.04.013 Abstract ( 447 )   PDF (454KB) ( 295 )   Save BACKGROUND: The new generation of large-diameter metal has the advantages of longer service life, low abrasion and low dislocation rate in using for metal total hip compared to the high wear rate and high rate of acetabular loosening of previous large-diameter femoral head. OBJECTIVE: To assess the clinical effects of total hip arthroplasty with large-diameter metal/metal femoral head in treatment of patients with avascular necrosis of the femoral head.  METHODS: Twenty-six patients with avascular necrosis of femoral head underment unilateral total hip arthroplasty with large-diameter metal/metal femoral head were involved for retrospective analysis. RESULTS AND CONCLUSION: All patients were followed up. The prosthesis was in the good position, and no loosening of the prosthesis and dislocation were seen by imaging during follow-up. The Harris score was increased from 49.5 before operation to 92.5 after arthroplasty. The excellent and good rate was 96%. The overall satisfaction rate was 96%. There was no prosthesis loosening, dislocation and infection before and after arthroplasty and during the follow-up. Good short-term effects can be obtained from the total hip arthroplasty with large-diameter metal/metal femoral head in treatment of patients with avascular necrosis of the femoral head. No significant changes in renal function of this treatment can be seen in short time. Related Articles | Metrics

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Prevention of prosthesis dislocation in hemiplegic patients subjected to total hip replacement by decreasing the abduction angle of the acetabulum Liu Zhi-gang, Chen Jing-yong, Chen Ru-jian, Li Zhong, Lu Li-sha 2012, 16 (4):  630-633.  doi: 10.3969/j.issn.1673-8225.2012.04.014 Abstract ( 286 )   PDF (282KB) ( 406 )   Save BACKGROUND: Currently reports on dislocation rate of joint replacement in hemiplegic patients with femoral neck fracture are different. OBJECTIVE: To decrease the abduction angle can decrease dislocation rate in elderly hemiplegic patients with side of the femoral neck fractures after joint replacement. METHODS: Date of 19 patients who using total hip replacement for the treatment of hemiplegic side femoral neck fracture were retrospective reviewed. RESULTS AND CONCLUSION: All the patients were followed-up from 3 months to 7 years postoperatively (average of 4 years and 3 months). There were no infection and hip joint dislocation in all the patients whose wounds were healed except two patients died for other diseases at 2 years postoperation. At 3 months postoperation, Harries hip score showed excellent and good rate was 89%, evaluation excellent for 5 and good for 12. It is indicated that decreasing the abduction angle of the acetabulum during the joint replacement to prevent the dislocation of hip joint is a feasible method.   Related Articles | Metrics

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Efficacy of rotating hinged knee prosthesis replacement for the treatment of malignant bone tumors Zhang Shao-lan1, Liu Hong-qi2, Xu Xiao-zu2 2012, 16 (4):  634-637.  doi: 10.3969/j.issn.1673-8225.2012.04.015 Abstract ( 289 )   PDF (315KB) ( 244 )   Save BACKGROUND: Under new adjuvant chemotherapy and artificial false body design help, effects of body malignant bone cancer treatment can be greatly improved, and joint replacement becomes the main limb-salvage method for malignant bone cancer treatment. OBJECTIVE: To observe curative effect of rotating hinged knee prosthesis on malignant bone tumors limb-salvage treatment. METHODS: Totally 15 patients with knee malignant bone tumors were treated with prosthesis rotating hinged replacement from Department of Orthopedics, First People’s Hospital of Yancheng between January 2005 and October 2009. Postoperative Enneking musculoskeletal tumor by limb function after knee surgery reconstruction assessment standards were used for evaluation. RESULTS AND CONCLUSION: Totally 15 patients were followed-up for 7-51 months. Postoperative complications were found in one patient, check results of erythrocyte sedimentation rate was increased, after debridement, joint solution and anti-inflammatory treatment, joint function was restored. Postoperative tumor recurrence, lung metastasis, prosthesis loosening and fracture were not appeared in all the patients. Enneking function evaluation, limb function excellent for seven cases (46.7%), good for five cases (33.3%), poor for three cases (20.0%), excellent and good rate was 80%. It is indicated that the effect of rotating hinged knee prosthesis replacement for knee malignant tumor is well, which can keep good limb function and is a kind of relatively satisfactory limb-salvage method. Related Articles | Metrics

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Preliminary clinical results of artificial disc replacement for degenerative disc disease in 16 cases Wu Liang1, Sun Xiao-liang1, Zhang Lei1, Wu Guo-feng1, Zhou Jian1, Yve Cartonne2○, Pascal Moussellard2○ 2012, 16 (4):  638-641.  doi: 10.3969/j.issn.1673-8225.2012.04.016 Abstract ( 309 )   PDF (336KB) ( 382 )   Save BACKGROUND: Simple discectomy and spinal fusion surgery were the classical methods for the degenerative disc disease. Comparing to them, artificial disc replacement (ADR) showed more theoretical superiority. OBJECTIVE: To present the preliminary clinical results of ADR for the treatment of degenerative disc disease. METHODS: From May 2007 to October 2010, ADR were preformed on 16 cases for the treatment of degenerative disc disease. 9 males and 7 females with average age of 40.5 years underwent ADR. RESULTS AND CONCLUSION: The follow-up time averaged 21.5 months (6-36 months). Postoperative visual analogue scale, Oswestry Disability Index and intervertebral height were significantly improved as compared with those in preoperation (P < 0.01). The postoperative range of motion (ROM) of the involved lumbar segment was effectively kept. The ROM before and after operation showed no significant difference (P > 0.05). ADR can acquire satisfactory preliminary clinical results for the treatment of degenerative disc disease. However, further research is needed to study its long-term impact. Related Articles | Metrics

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The clinical efficacy of application of posterior screw internal fixation system in instable axis fractures Wei Hai-feng1, Teng Hong-lin2, Bian Jian1, Li Hai-jun1, Chen Chun-mao1 2012, 16 (4):  642-646.  doi: 10.3969/j.issn.1673-8225.2012.04.017 Abstract ( 235 )   PDF (336KB) ( 313 )   Save BACKGROUND: During posterior screw-rod internal fixation of upper cervical spine, placement of atlas lateral mass screw is the key technology. OBJECTIVE: To summarize entrance point for screw insertion of posterior screw-rod internal fixation system in instable axis fractures. METHODS: From January 2007 to December 2010, nineteen patients with instable axis fractures, including 12 males and 7 females, with an average age of 49.5 years (range, 21-75 years), were treated with Vertex posterior screw-rod internal fixation. Atlas lateral masses screw and axis pedicle screw were performed in 6 cases for internal fixation. Atlas lateral masses screw, single axis pedicle screw and neck 3 lateral masses screw were performed in 3 cases for internal fixation. Atlas lateral masses screw, double axis pedicle screws and neck 3 lateral masses screw were performed in 1 case for internal fixation. Axis pedicle screw and neck 3 lateral masses screw were performed in 9 cases for internal fixation. Fusion technique was performed in all cases. RESULTS AND CONCLUSION: Nineteen patients were followed up from 7 to 43 months. All cases had satisfactory reduction and healing in the positions of axis fractures, fusion rate in the positions of bone grafts was 100%. There were no screw and rod breakage, and no iatrogenic injury of spinal cord and vertebral artery happened. The method for the treatment of instable axis fractures is little trauma and reliable fixation. The authors according to clinical experiences, entrance point for screw insertion are summarized as follows: ①The entrance point of atlas lateral masses screw is slightly outer side in the lateral mass midpoint, at the bottom 1/3 of vertebral arch. Direction of needle is inward and upward slightly tilted about 10° and 5°. ②The entrance point of axis pedicle screw is between the upper and lower articular surface of axial, the midpoint of the middle vertical line of subtalar joint. Direction of needle is inward and upward slightly tilted about 15°-20° and 25°. ③The entrance point of neck 3 lateral masses screw is 2 mm inside of lateral mass center. Direction of needle is inward and upward slightly tilted about 20°-25°. Related Articles | Metrics

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Locking proximal humerus plate combined with OsteoSet and anti-osteoporosis treatment for proximal humeral unstable fracture in aged patients He Bin, Cheng Wei-nan, Wang Yun-hua, Wang Bo-yao, Huang Ye 2012, 16 (4):  647-651.  doi: 10.3969/j.issn.1673-8225.2012.04.018 Abstract ( 285 )   PDF (422KB) ( 418 )   Save BACKGROUND: Locking proximal humerus plate (LPHP) fixation follows the principles of elastic biological internal fixation. It is suitable for the youth comminuted fracture and aged osteoporotic fracture. OBJECTIVE: To observe the clinical effect of LPHP combined with calcium sulfate (OsteoSet) and anti-osteoporosis treatment for proximal humeral unstable fracture of aged patients.  METHODS: Twenty-six cases of aged proximal humeral fractures were treated with type classification according to Neer classification criteria: 17 cases with two-part fracture, 7 cases with three-part fracture and two cases with four-part fracture. All the patients were treated with anti-osteoporosis treatment which was detected by X-ray and CT of shoulders and radiographic absorptiometry of phalanges bone mineral density. At 5-10 days after fracture, LPHP internal fixation combined with OsteoSet were used for the treatment of proximal humeral unstable fracture. RESULTS AND CONCLUSION: Bone mass of 26 patients was decreased 4% (1 case) by radiographic absorptiometry detection and osteoporosis was 96% preoperatively. All the patients were follow-by over 12 months postoperatively. The Neer score showed that the good-excellent rate was 94% in the two-part fracture, and 67% in the three or four-part fracture. There were no incision infection, disunion of internal fixation and humeral head necrosis happened, all the fractures had united in 3.8 months (from 2.5 to 7 months). It is indicated that: ①The clinical effect of LPHP combined with OsteoSet and anti-osteoporosis treatment on proximal humeral unstable fracture of aged patients is satisfactory. ②Radiographic absorptiometry of phalanges bone mineral density detection is beneficial to the screening for fracture patients osteoporosis preoperatively. Related Articles | Metrics

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Effect of lag screw auxiliary interlocking intramedullary nail for complicated fracture of femoral shaft on callus content  Wang Sheng-qiang, He Xing-chuan, Hu Qian-yue, Wang Pan 2012, 16 (4):  652-655.  doi: 10.3969/j.issn.1673-8225.2012.04.019 Abstract ( 282 )   PDF (358KB) ( 275 )   Save BACKGROUND: Biomechanical studies and clinical cases observation discovers that using interlocking intramedullary nail for the treatment of complicated fracture of femoral shaft and using lag screw assisted fixation of comminuted fracture piece, can optimize fracture conductivity and promote fracture healing. OBJECTIVE: To explore the effect of lag screws fixation for comminuted fractures of block fixation on the significance of fracture healing during interlocking intramedullary nail fixation for the treatment of complicated fracture of femoral shaft in operation. METHODS: Totally 60 cases with interlocking intramedullary nail internal fixation for the treatment of femoral shaft were divided into pulling nail group and exclusion group. Digital X-ray posteroanterior films at 1 and 12 weeks after internal fixation in each group were randomly selected. Gray-scale density of callus area, normal bone area and normal soft tissue area was detected. Comparative analysis of callus area self control gray rate in intragroup and intergroup. RESULTS AND CONCLUSION: There was no significant difference of the gray-scale density in the normal bone area and normal soft tissue area (P < 0.01), but gray-scale density at 12 weeks after internal fixation was higher than that at 1 week after internal fixation in callus area (P < 0.01). At 12 weeks after internal fixation, gray-scale density of the pulling nail group was obviously higher than that of the exclusion group (P < 0.01). Self control gray rate of the pulling nail group was obviously higher than that of the exclusion group (P < 0.01). The lag screw fixation for comminuted fractures after auxiliary block can contribute to the formation of callus, and bone callus content in the pulling nail group is higher than that in the exclusion group. Related Articles | Metrics

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Follow-up comparison of the double neck and shaft fracture nail and dynamic hip screw in the treatment of femoral complexity fractures  Yang Guo-qing, Zhang Ming-qiang, Li Yu, Li Bo, Fan Yong-zhi, Luo Yue-sheng, Leng Yuan-hong 2012, 16 (4):  656-659.  doi: 10.3969/j.issn.1673-8225.2012.04.020 Abstract ( 284 )   PDF (311KB) ( 275 )   Save BACKGROUND: Fracture fixations are divided into an intramedullary nail fixed and steel plate fixed two methods, how to choose a fixation devices for clinical curative effect and postoperative complications is crucial. OBJECTIVE: To make a clinical curative effect comparison using reconstruction interlocking intramedullary nail (double neck and shaft fracture nail, DNS) and dynamic hip screw (DHS) steel in treating the femoral complexity fractures . METHODS: Totally 70 cases of femoral fractures merger with side femoral neck fracture, between rotor fracture, subtrochanteric fractures, femoral fractures were analyzed retrospectively. Internal fixation implant was used DNS and DHS. RESULTS AND CONCLUSION: All cases were followed-up 3 months, early functional recovery and fracture healing time in the DNS group were better than that of the DHS group. Relative complications in the DHS group were easily found hip equinovarus and fixation failure, and in the DNS group were easily found screw loosening. There was no significant difference of incision infection and fat embolism syndrome in the two groups. DNS has static and dynamic fixed function of two fractures. It is accord with biomechanics reconstruction principles and fracture healing fast. DNS is a better and effective internal fixation device as compared with DHS. Related Articles | Metrics

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Establishment of a three-dimensional finite element model of the maxillary central incisor restored with fiber post-core crown Kang Cheng-rong1, Pan Xuan1, Li Liang1, Wang Yu-dong1, Zhang Mei-chao2 2012, 16 (4):  660-664.  doi: 10.3969/j.issn.1673-8225.2012.04.021 Abstract ( 266 )   PDF (357KB) ( 498 )   Save BACKGROUND: A finite element model is useful in the stress analysis of the maxillary central incisor, providing evidence for selection of clinical restoration methods. OBJECTIVE: To establish the three-dimensional finite element model of the maxillary central incisor restored with fiber post-core crown for the stress analysis. METHODS: The three-dimensional finite element model of half damaged maxillary central incisor restored with fiber post-core crown was established by spiral CT, Mimics software and ANSYS software. The von Mises stress and maximal tensile stress were recorded. RESULTS AND CONCLUSION: The three-dimensional finite element model of half damaged maxillary central incisor restored with fiber post-core crown was established to simulate fiber post-core crown restoration. It was similar to the clinical case. The application of spiral CT, Mimics software and ANSYS software can successfully establish the three-dimensional finite element model of tooth structure. The model is similar to clinical case, and can develop to other similar models. Related Articles | Metrics

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Computer aided design and computer aided manufacture of templates in dental implantation   Liu Li-na1, Yang Min2, Hasi•Bagen3, Xiao Ling4, Fan Hong2 2012, 16 (4):  665-668.  doi: 10.3969/j.issn.1673-8225.2012.04.022 Abstract ( 295 )   PDF (369KB) ( 403 )   Save BACKGROUND: Currently, the templates widely used in implant surgery in China were prepared on plaster model. As the three-dimensional structure of the jaw is unclear, accurate implanting is difficult and complications of implantation are prone to exist. OBJECTIVE: To prepare oral implant templates with CT and computer aided design (CAD)/computer aided manufacture (CAM) in order to locate implants in the right position and direction. METHODS: Plaster models of maxillary edentulous with location marker were scanned with CT. The MIMICS software was used to reconstruct three-dimensional model and simulate implantation. Simulated implant was located in the ideal position based on the anatomical structure of the implanted jaw and the implanted methods according to prosthetic and aesthetic requests. The information of position angle of the simulated implant was transferred to the template while it was prepared. The data were input rapid prototyping equipment to prepare resin template. The accuracy of the template was tested after implantation in it. RESULTS AND CONCLUSION: The top deviation of the implant was (0.87±0.21) mm and the bottom deviation was (0.82±  0.16) mm after implantation. The deviation of the implant in the vertical direction was slightly bigger than those in the buccolingual direction and mesiodistal direction. The implant design can be accurately transferred to the template before operation. Implantation can be well guided using this, and it can improve the safety, accuracy and the successful rate.   Related Articles | Metrics

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Individual characteristics of the pedicle and correlation with insertion screws: Radiographic observation of the cervical pedicle  Guo Xiao-dong1, Zhang Jian-xiang2 2012, 16 (4):  669-672.  doi: 10.3969/j.issn.1673-8225.2012.04.023 Abstract ( 282 )   PDF (320KB) ( 262 )   Save BACKGROUND: On account of the great morphological variation and complex structure of cervical pedicles, so it is essential to get reliable and convenient monitor methods during individual screw insertion. OBJECTIVE: To describe the imaging features of subaxial cervical pedicles on roentgenogram by radiological image observation, which providing the security for cervical pedicles insertion and reducing complications. METHODS: Totally 10 fresh-bone cervical spine specimens were prepared and the isthmus of the pedicle were drawn tightly with radiopaque fine malleable wire. The images of the subaxial cervical pedicles were taken in posteroanterior (PA) and lateral, oblique positions, the morphology of the subaxial cervical pedicles were observed in different projection positions. RESULTS AND CONCLUSION: Radiographs of subaxial cervical pedicles were inclined tubular structure on both sides of the vertebral in PA positions, the long axis of the pedicle elliptical cross section tilte inward. The pedicle image was not shown directly in lateral radiograph, it was only an intensive density area made by the overlapping pedicles on the posterior-superior wall of the vertebrate in lateral radiograph. Four lateral cortex border of the isthmus in the pedicle and the shape of the cervical pedicle were demonstrated clearly in the oblique radiograph. The PA and oblique images of the subaxial cervical pedicles can better reflect subaxial cervical pedicles morphology, it is very useful to grasp the feature of every pedicle and is essential in the individual transpedicular fixation. Related Articles | Metrics

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Application of antibiotic-loaded bone cement spacer in second-stage revision for infected total hip arthroplasty   Yan Yun-fei1, Guo Ting2, Zhou Li-wu2, Wang Rui2, Bao Ni-rong2, Cheng Xiu-hong2, Zhao Jian-ning1, 2 2012, 16 (4):  673-678.  doi: 10.3969/j.issn.1673-8225.2012.06.024 Abstract ( 358 )   PDF (524KB) ( 335 )   Save BACKGROUND: Infection is one of the most serious complications of total hip arthroplasty (THA) surgery, although there are many ways can treat the infection, secondary revision procedures is recognized as an effect treatment method. OBJECTIVE: To retrospectively study the effect of antibiotic-loaded bone cement spacer in second-stage revision for infected THA. METHODS: Totally 27 hips from 26 cases who infected after THA were treated with two-stage revision using antibiotic-loaded bone cement spacer to instead the position of original prosthesis. During this procedure, a steinmann pin was load in the center of the spacer as scaffold. All the cases were followed up after the surgery and Harris score was evaluated. RESULTS AND CONCLUSION: Due to improper weight-bearing activities after surgery, the spacer of one case was ruptured, after removal of the bone cement spacer and debridement, the joint was spacious placed. The other 25 cases were all followed up for 1 to 7 years. After surgery, the mean Harris hip score reached 90.2 which improved 61.9 as compared with before operation, and the cure rate was 96.3%. It is indicated that infected THA can be successfully treated by two-stage revision surgery with antibiotic-loaded bone cement spacers, and has the advantage of higher infection control rate and joint function recovery. Related Articles | Metrics

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Pathology and imaging performance of a rabbit intervertebral disc degeneration model induced by the intermittent upright position  Zhang Chao, Li Ning-ning, Hu Zhao-hui 2012, 16 (4):  679-682.  doi: 10.3969/j.issn.1673-8225.2012.04.025 Abstract ( 300 )   PDF (267KB) ( 309 )   Save BACKGROUND: A great number of animal models were used to study intervertebral disc degeneration, but there is still lack of a consistent with human intervertebral disc degeneration in animal models. OBJECTIVE: To investigate the feasibility of establishing a intervertebral disc degeneration model with upright position and a model construction with convenience and simple. METHODS: Totally 42 New Zealand white rabbits were randomly divided into experimental group and control group. The rabbits were fixed in polyvinyl chloride (PVC) pipes. The PVC pipes were upright in the experimental group and the PVC pipes were flat in the control group. RESULTS AND CONCLUSION: At 4 weeks after modeling, there was no significant difference of the disc height index (DHI), magnatic resonance imaging and annulus change between the experimental group and the control group (P > 0.05). PAS staining of nucleus, the gray value was increased significantly (P < 0.05). At 8, 12 weeks after modeling, there was significant difference of the DHI in the two groups, which has a significant decreased in degenerative disc T2-weighted signal.  Hematoxylin-eosin staining of annulus was disordered arrangement. PAS staining of degenerative disc intervertebral nucleus showed that gray value was significantly larger (P < 0.05). It is indicated that the method of upright position can successfully establishment of disc degeneration model by their own gravity load on the intervertebral disc. Related Articles | Metrics

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Healing of micro fracture under stress Wan Yong-xian, Xu Li-li, Zhuo Nai-qiang, Lu Xiao-bo 2012, 16 (4):  683-687.  doi: 10.3969/j.issn.1673-8225.2012.04.026 Abstract ( 288 )   PDF (404KB) ( 333 )   Save BACKGROUND: Stress stimulation can promote the healing of long bone fractures. OBJECTIVE: To observe the effects of stress on the healing of micro fracture. METHODS: Micro fracture models in bilateral greater trochanter of femur of rabbits were established. The micro fractures in one side fixed by Kirschner wire were taken as control and those in the other side fixed by lag screw were experimental group. RESULTS AND CONCLUSION: X-ray showed that the growth of bone callus was quicker, external callus was more, gray value of callus was higher, and callus modeling time was shorter in the experimental group than in the control group. CT showed quicker growth of external callus and better fracture shaping of the experimental group compared with the control group. Light microscopy observation of callus tissue sections: the fracture healing way of the two groups was cartilaginous ossification; haematoma vanished , organization was quick, the recoverability fiber structure was replaced by bone callus in the early stage, the callus grew well, and healing at fracture was early and quick in the experimental group; ossification of cartilage bone callus and the transformation of trabecular bone into woven bone occurred more early, and the bone reconstruction was better of the experimental group compared with the control group. The calcium and phosphorus in callus of both groups were gradually increased before 6 weeks, and decreased at 6 weeks. The content of calcium and phosphorus at 4 weeks was obviously higher in the experimental group than that in the control group (P < 0.01). Healing way of the micro fracture is cartilaginous ossification. Appropriate compressive fixation is superior to fixation without compression because it can shorter the time of extinction of edema, deposition of calcium and phosphorus in bone callus and healing time, reduce the inflammatory response, increase the content of calcium and phosphorus in bone callus, and improve the quality of bone callus for quick shaping.  Related Articles | Metrics

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Design of a human-computer interaction radio-frequency electro-acupuncture beauty instrument based on the embedded system Chen Hai-jun, Xiao Ling, Wen Zhi-hao 2012, 16 (4):  688-690.  doi: 10.3969/j.issn.1673-8225.2012.04.027 Abstract ( 455 )   PDF (214KB) ( 438 )   Save BACKGROUND: Radio-frequency (RF) needle beauty instrument is a kind of new digital medical equipment that achieves the cosmetic results through the micro-needle technology to transfer RF energy. Because of the excellent safety and efficacy, the embedded design has been widely favored. OBJECTIVE: To design an embedded RF electro-acupuncture beauty instrument. METHODS: The system was based on embedded ARM-WinCE, the controller of the system was STM32F103 processor, and Windows CE was used as GUI development tool. RESULTS AND CONCLUSION: The embedded RF electro-acupuncture beauty instrument can provide the RF energy output and provide visual signals for human-computer interaction through the liquid crystal display screen. The results proved that the system has a small size, high reliability, low cost, excellent human-computer interaction ability.   Related Articles | Metrics

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Relationship between osteoprotegerin level in the degenerated intervertebral disc and Schneiderman’s classification   Chen Si1, Bai Ren-ju2, Wang Lin-sen3 2012, 16 (4):  691-694.  doi: 10.3969/j.issn.1673-8225.2012.04.028 Abstract ( 267 )   PDF (344KB) ( 273 )   Save BACKGROUND: Recent studies show that osteoprotegerin can inhibit the activity of osteoclast and regulate the process of cartilage reshaping. Osteoprotegerin plays a great role in maintaining the integrity of cartilage tissue of intervertebral disc. OBJECTIVE: To determine the expression of osteoprotegerin in the intervertebral disk of the patients with lumbar disc degeneration (LDD), and then to analyze the relationship between the expression levels of osteoprotegerin and the severity of LDD. METHODS: Sixty-four patients with LDD (LDD group) and twenty-five patients with disc burst fractures (control group) were enrolled in this study. The intervertebral disc tissues were collected after surgery. Then the mRNA expression and protein levels of osteoprotegerin in the intervertebral disk were examined by real-time polymerase chain reaction (PCR). The protein level of osteoprotegerin was determined by ELISA method. The grade of disc degeneration was classified according to MRI findings by Schneiderman’s classification and the association between the levels of osteoprotegerin and the Schneiderman’s grades was analyzed. RESULTS AND CONCLUSION: The mRNA expression and protein levels of osteoprotegerin in the intervertebral disc in LDD group were significantly higher than that in the control group which were tested by real-time PCR method and ELISA method. Unconditional logistic regression analysis revealed that elevated mRNA expression and protein levels of osteoprotegerin were independent risk factors of the presence of LDD. In addition, the mRNA expression and protein levels of osteoprotegerin were both significantly correlated with Schneiderman’s grades (r =0.367, P < 0.001 and r =0.412, P < 0.001, respectively). Patients with higher Schneiderman’s grade showed relatively higher levels of osteoprotegerin. The levels of osteoprotegerin were significantly elevated in the intervertebral disc of patients with LDD and were significantly associated with the severity of LDD.   Related Articles | Metrics

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Expression of matrix metalloproteinase 13 and tissue inhibitor of metalloproteinase 1 in cartilage of traumatic osteoarthritis models Li Qiang, Tang Ji-cun, Wang Rui-ying, Bei Chao-yong, Xin Lin-wei, Ru Jia, Xiao Rong-chi 2012, 16 (4):  695-698.  doi: 10.3969/j.issn.1673-8225.2012.04.029 Abstract ( 256 )   PDF (358KB) ( 324 )   Save BACKGROUND: The mechanism of articular cartilage degeneration in traumatic osteoarthritis is not yet clear. In recent years, studies found that imbalance of synthesis and degradation of extracellular matrix is one of the important reasons for the cartilage degeneration. Matrix metalloproteinase (MMPs) may plays a decisive role in this process. OBJECTIVE: To investigate the expression of MMPs-13 and tissue inhibitor of metalloproteinase-1 (TIMP-1) in cartilage of traumatic arthritis model, and relationship between MMPs-13, TIMP-1 and cartilage degeneration. METHODS: Healthy adult New Zealand rabbits were used to construct mild and severe traumatic arthritis models which were established with gravity method (1.33 kg, 46 cm height and 0.43 kg, 20 cm height, respectively). RESULTS AND CONCLUSION: Hematoxylin-eosin staining and immunohistochemical staining showed that the expression of both MMP-13 and TIMP-1 were significantly increased in the mild and severe traumatic groups (P < 0.05). Expression of TIMP-1 in the severe traumatic group was higher than that of in the mild traumatic group (P < 0.05). This shows that there is certain increase of MMP-13 and TIMP-1 in post-traumatic osteoarthritis. MMP-13 and TIMP-1 together to promote the degeneration of articular cartilage, and the over-expression of TIMP-1 may be one of the reasons in the further impairment to articular cartilage. Related Articles | Metrics

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Construction and detection of lentiviral plasmids containing human transforming growth factor beta 3, connective tissue growth factor and tissue inhibitor of metalloproteinases 1 gene  Jiang Feng, Yue Bin, Ma Xue-xiao, Zhang Guo-qing, Hu You-gu, Chen Bo-hua 2012, 16 (4):  699-703.  doi: 10.3969/j.issn.1673-8225.2012.04.030 Abstract ( 308 )   PDF (792KB) ( 496 )   Save BACKGROUND: The former tests showed that multi-gene co-expression system mediated by virus can significantly improve the transgenic curative effect of intervertebral disc degeneration. OBJECTIVE: To construct the recombinant plasmid of lentivirus containing human transforming growth factor beta 3 (TGFβ3), connective tissue growth factor (CTGF) and tissue inhibitor of metalloproteinases 1 (TIMP1). METHODS: 2A self-cleaving sequences were used to ligate the cDNA of TGFβ3, CTGF, TIMP1 in a single open reading frame derived from plasmid of lentivirus in order to obtain the recombinant lentiviral plasmid Lenti-TGFβ3-P2A-CTGF-T2A-TIMP1. RT-PCR and Western-blot were used to detect mRNA and protein expressions of TGFβ3, CTGF, TIMP1 in different times after transfection. RESULTS AND CONCLUSION: RT-PCR and Western-blot detection shows that the mRNA and protein expressions of TGFβ3, CTGF, TIMP1 were detected in transfected 293 cells, the protein expressions reached peak value at 48 hours after transfection, and the protein level of downstream gene was about 80% of upstream gene. The recombinant plasmid, Lenti-TGFβ3-P2A-CTGF-T2A-TIMP1, is constructed successfully, providing a basic model for the packaging of virus and further study on therapy of intervertebral disc degeneration. Related Articles | Metrics

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Design of a prosthetic gait experimental platform Shang Kun1, Ding Hao1, Chen Qi-ou2, Shen Li-xing1 2012, 16 (4):  704-708.  doi: 10.3969/j.issn.1673-8225.2012.04.031 Abstract ( 330 )   PDF (704KB) ( 514 )   Save BACKGROUND: At present, the evaluation of prosthesis stays in subjective feelings, lacking of an objective evaluation system. To set up the online prosthetic parameters detection system of body motion is of great significance to the evaluation of the prosthetic performance and design of prothesis. OBJECTIVE: By realizing various gait patterns of lower limb prosthesis and performing analysis of kinematics and dynamics data, to evaluate its simulation degree.  METHODS: According to the principle of bionics, we simplified the lower limb prosthesis into a four-bar and four-axis mechanical model. Using various gait patterns, the platform drove prostheses walking. We built a dynamical test platform which measured ground counterforce and the shear stress in real-time. RESULTS AND CONCLUSION: During the gait movement of prostheses, the data curve of hips and knees was in accordance with normal gait data, and the ground counterforce and the shear stress were also close to those of the normal people. The prosthetic gait experimental platform stimulates the lower limb prosthesis gait movement, and acquires a number of kinematics and dynamics parameters in real-time, with a high simulation degree. Related Articles | Metrics

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Expression of inducible nitric oxide synthase in bone lengthening patients Hu Xin-yong1, Chen Jian-wen1, Wang Yi-sheng2 2012, 16 (4):  709-712.  doi: 10.3969/j.issn.1673-8225.2012.04.032 Abstract ( 251 )   PDF (342KB) ( 319 )   Save BACKGROUND: It is unknown that how to transfer the impetus of distraction into the message of bone regeneration in limb lengthening. OBJECTIVE: To study the dynamic expression of inducible nitric oxide synthase (iNOS) in bone lengthening patients.  METHODS: Totally eight patients whose tibia and fibula are shorten in single lower limb were involved in bone lengthening group. The serum iNOS levels of the patients were measured respectively at 3 days preoperatively, at 3, 7, 8, 11, 13 days postoperatively, stopping bone lengthening, at 3, 15, 30 days after stopping bone lengthening, removing the external lengthening apparatus and at 30 days after removing the external lengthening apparatus. Eight patients with similar age to the bone lengthening group were selected as control. RESULTS AND CONCLUSION: The serum iNOS levels in the bone lengthening group began to increase at first day after the distraction (the eighth day after operation) and the peak values was at the stopping bone lengthening. The expression of iNOS in the bone lengthening group was significantly higher than that of the control group at every time point from the first day after the distraction to the day of stopping bone lengthening (P < 0.01). The serum iNOS levels in the bone lengthening group at 3 days after stopping the bone lengthening was also higher as compared with the control group (P < 0.05). It is indicated that the higher expression of iNOS is one of the molecular biological mechanisms of bone lengthening. Related Articles | Metrics

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A meta-analysis of vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures Li Da-gang1, 2, Su Pei-ji2, Chen Gan-feng2, Chen Shi-zhong2, Gao Heng2 2012, 16 (4):  713-716.  doi: 10.3969/j.issn.1673-8225.2012.04.033 Abstract ( 253 )   PDF (229KB) ( 379 )   Save BACKGROUND: There are more and more applications of vertebroplasty and kyphoplasty. However, studies on the comparison of them are few and most of the studies was all the retrospective case analysis with lacking systematic evaluation. OBJECTIVE: To evaluate the effect of vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures(OVCF). METHODS: All controlled studies of vertebroplasty and kyphoplasty for the treatment of OVCF were collected. Two reviewers assessed the quality of literatures and extracted data independently to make the systematic evaluation based on the strictly evaluated the quality of the literatures. RESULTS AND CONCLUSION: Totally 13 literatures including a total of 728 patients met the inclusion criteria. There were no significant differences of the two groups in pain and functional scores (P=0.69, 0.35). Compared with vertebroplasty, kyphotic wedge angle reduction was more significant, and the leakage of bone cement was lower in the kyphoplasty group (P < 0.000 01, 0.000 1). For the risk of new adjacent vertebral fractures, there was no difference between the two groups (P=0.41). Both vertebroplasty and kyphoplasty can significantly reduce pain and improve functional scores, though there is no significant differences between the two groups. Kyphoplasty can improve kyphotic wedge angle well and reduce the leakage of bone cement. The risk of new fractures can not be evaluated for lack of evidence, which need further confirmation by more randomized controlled studies which are design strictly. Related Articles | Metrics

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Prosthesis rotational alignment in total knee arthroplasty Wu Hao 2012, 16 (4):  717-722.  doi: 10.3969/j.issn.1673-8225.2012.04.034 Abstract ( 251 )   PDF (362KB) ( 335 )   Save BACKGROUND: Currently, studies about prosthesis rotational alignment of total knee arthroplasty (TKA) are focused on the rotational landmark location. OBJECTIVE: To summarize the clinical and basic research progress related to prosthesis rotational alignment in TKA. METHODS: Clinical articles related to anatomic landmark, location method, matching in rotational alignment and operational precision of prosthesis rotational alignment in TKA were extensively reviewed. RESULTS AND CONCLUSION: Many studies show that malrotation may lead to various complications, such as anterior knee pain, femoro-tibial and patellofemoral instability, maladjustment of patellar movement trajectory, abnormal gait, accelerated polyethylene wear, premature loosening, subluxation or dislocation, and even need for further revision. All derived data from various sources should be used in prosthesis rotational alignment at tibial and femoral side when operation, individual corrections should be made appropriately, and preoperative CT scan can be used if necessary, so as to improve the TKA outcome and longevity.   Related Articles | Metrics

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Theory and practice of total hip prosthesis replacement therapy for sports hip injury Zhang Jin-cheng, Xie Zheng-yang 2012, 16 (4):  723-727.  doi: 10.3969/j.issn.1673-8225.2012.04.035 Abstract ( 191 )   PDF (484KB) ( 296 )   Save BACKGROUND: Total hip surface replacement can maintain the original mechanical properties of hip joints as much as possible, the stability and activity of the joint after replacement are good, and no apparent age limitations are found. OBJECTIVE: To investigate the artificial hip prosthesis in the treatment of sports hip injuries, the materials and methods of hip prosthesis. METHODS: A computer-based retrieval of PubMed database and Chinese CNKI database from January 1998 to October 2011 was conducted for documents regarding the biomaterials and tissue engineered hip joints, with the key words of "hip joint injury, artificial hip joint, hip replacement, hip resurfacing arthroplasty" in both English and Chinese. Eventually 41 papers met the inclusive criteria. RESULTS AND CONCLUSION: Severe hip joint sports injuries should be treated with artificial hip joint replacement, to restore the patient's life skills, and even certain athletic ability. Currently, prosthesis material is a key factor in the hip replacement treatment, including metals, ceramics, polymers and new bone cement, each has their advantages and disadvantages. Due to long period of follow-up and clinical observations, the efficacy of various materials needs further study. Computer-based three-dimensional finite element analysis for simulation of the hip is a research focus, this means is a combination of the sports biomechanics and the materials science. Research and development of new materials are essential for the manufacture of artificial hip prosthesis in tissue engineering, and for repair and reconstruction of hip joints. Related Articles | Metrics

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Biomechanical analysis of metal plate implantation for acute bone injury Wang Yong-qiang 2012, 16 (4):  728-731.  doi: 10.3969/j.issn.1673-8225.2012.04.036 Abstract ( 244 )   PDF (366KB) ( 278 )   Save BACKGROUND: Bone injury caused by violence is common in daily life and sports, metal materials have been widely utilized in the fixation and reconstruction of the damaged bone, while the biomechanical properties of metal plate greatly affect the on the bone stability and blood supply, thereby affecting the recovery. OBJECTIVE: To summarize the properties, type and clinical applications of bone metal materials, to summarize and analyze clinical effects with emphasis on the biomechanical characteristics of bone metal plate. METHODS: A computer-based retrieval of PubMed, VIP database and Wanfang database from January 1980 to September 2011 was performed for papers regarding the treatment of bone injury and metal materials, with key words of "bone; medical; metal; materials" in both English and Chinese screening in the titles and abstracts. Documents related with the treatment measures of bone and metal materials were included, and those published recently or published in the authority journals were preferred in the same field. Initially 276 documents were screened out and 24 of them were involved in the final analysis according inclusion criteria. RESULTS AND CONCLUSION: A long-term research and clinical screenings show that, biomedical metal materials that have been widely used in clinical treatment include medical stainless steel, medical drill-based alloys, medical titanium and titanium alloys, medical shape memory alloys and medical magnetic alloys. These involved documents have discussed the influence of the material properties on the mechanical effects of the implant, the influence of screw number on the mechanical effects of bone plate, the mechanical properties of bone locking plate and common steel plate, the influence of implanting approach on the mechanical effect of steel plate, and the influence of the material shape on the mechanics of steel plate. There were many factors influencing the biomechanical properties and therapeutic effects, such as the nature and forging process of metal materials, and ways of clinical implants.   Related Articles | Metrics

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Effects of pulsed electromagnetic field on osteogenic and osteoclastic metabolism   Zhu Xiao-lu1, Chen Peng2, Tian Jing2 2012, 16 (4):  736-740.  doi: 10.3969/j.issn.1673-8225.2012.04.038 Abstract ( 333 )   PDF (421KB) ( 343 )   Save BACKGROUND: The pulsed electromagnetic field can influence the osteoblast, osteoclast, and the bone matrix synthesis. OBJECTIVE: To explore the mechanism of the pulsed electromagnetic field for treatment of osteoporosis in order to promote its clinical application. METHODS: A computer-based online search of PubMed database, CNKI database, VIP database and Wanfang database from May 1997 to August 2011 was performed to search related articles with the key words of “pulsed electromagnetic fields (PEMFs), bone metabolism, osteoporosis, osteoblast, osteoclast, bone marrow mesenchymal stem cells (BMSCs)” in English and in Chinese by screening titles and abstracts. Articles related to pulsed electromagnetic field were selected. The documents published recently or in authoritative journals in the same field were preferred. RESULTS AND CONCLUSION: A total of 389 literatures were obtained in initial retrieval, and 46 documents of them concerning the analysis and treatment of aseptic loosening of aseptic prosthesis were involved to summarize according to inclusion criteria. PEMFs can promote osteogenic metabolism, inhibit osteoclastic metabolism, regulate transforming growth factor β and Interleukin 6, promote bone matrix synthesis, improve the micro-environment for bone growth, as well as facilitate proliferation and differentiation of BMSCs. PEMFs have an important clinical value of treatment for osteoporosis and its complications.   Related Articles | Metrics

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Updates of Choukroun’s platelet-rich fibrin in dental implant bone defect   Xu Feng-wei, Liu Zhong-hao 2012, 16 (4):  741-744.  doi: 10.3969/j.issn.1673-8225.2012.04.039 Abstract ( 225 )   PDF (421KB) ( 382 )   Save BACKGROUND: Recently, Choukroun’s platelet-rich fibrin (PRF) is known as a rich source of autologous cytokines and growth factors, and special attention is paid as a new biomaterial in dental implant bone defect application. OBJECTIVE: To review experiments and clinical researches of the PRF. METHODS: A computer-based retrieval was performed by the first author in the CNKI and PubMed databases to search papers published between January 2000 and December 2011 with the key words of “Choukroun’s platelet-rich fibrin, Platelet-rich plasma, dental implant, bone defect, GBR” in Chinese and English. According to inclusion and exclusion criteria, 30 papers were included in the final analysis. RESULTS AND CONCLUSION: PRF is consist of fibrin network, platelet, granulocyte and so on. PRF is known as blood products with a rich source of osteogenesis factor. PRF has characteristics in simple operation and without other preparations addition. PRF can simulate effetely the formation of fibrin in blood clots under physiological conditions, which is similar to fibrin in human and perfectly avoiding the occurrence of immune rejection and cross-infection. PRF shows a good ability of promoting tissue healing in experiments and clinical researcher. PRF will receive more attention in the field of oral implantology due to low cost, convenient drawing materials and so on. Related Articles | Metrics

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Autologous transplantation of recovered reaming product to promote the union of long bone fracture in the lower limb   Tian Xiao-hua, Zheng Shu-qiao, Jia Qi-yu, Yu Yu 2012, 16 (4):  745-747.  doi: 10.3969/j.issn.1673-8225.2012.04.040 Abstract ( 270 )   PDF (225KB) ( 307 )   Save BACKGROUND: There are many ingredients to promote fracture healing in reaming product, which is helpful for bone regeneration and tissue healing of early fracture. OBJECTIVE: To investigate the clinical therapeutic effect of reaming product on the promotion of long bone fracture union in the lower limb. METHODS: Totally 78 patients from the Second people’s Hospital of Hefei between January 2008 to November 2010 were treated with reamed interlocking intramedullary nailing for the treatment of long bone fractures in lower limb. 38 patients were open reduction using reaming product replantation as open group, and 40 cases were closed reduction as control. RESULTS AND CONCLUSION: Long bone of lower limb healed in the two groups. Time of bone callus appearance, fracture line became ambiguous and disappear in the open group was earlier than that in the control group (P < 0.05). It is indicated that interlocking intramedullary nailing combined with autologous transplantation of reaming product can promote the union of long bone fracture in the lower limb Related Articles | Metrics

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Bone marrow transplantation and core decompression for treatment of early necrosis of the femoral head: A non-randomized controlled study   Qin Xue-liu, Xin Xiao-dong, Wang Da-wei, Chen Yue-ping, Lin Zong-han, Han Jie, Qin Jie 2012, 16 (4):  748-751.  doi: 10.3969/j.issn.1673-8225.2012.04.041 Abstract ( 236 )   PDF (315KB) ( 239 )   Save BACKGROUND: Bone marrow transplantation for the treatment of femoral head necrosis becomes a hot research topic in recent years, while the role of core decompression in the treatment is in dispute. The combined therapeutic effect of core decompression and bone marrow transplantation in treatment of femoral head necrosis is unclear. OBJECTIVE: To explore the combined therapeutic effect of core decompression and bone marrow transplantation in treatment of early necrosis of the femoral head. METHODS: Patients with early non-traumatic necrotic femoral head were included. Twenty of them with 25 hips treated by core decompression and concentrated bone marrow transplantation were taken as treatment group. Twenty patients with 23 hips in the control group underwent simple core decompression. RESULTS AND CONCLUSION: Following 6-36 months follow-up, the total efficiency rate of the treatment group was 84% and that was 65% in the control group according to the hip function criteria of Japanese Orthopaedic Association and the Radiology Stage System of bone necrosis of Pennsylvania State University. Core decompression combined with bone marrow transplantation have better curative effects in treatment of early femoral head necrosis based on their small damage and good curative effects, however, their long-term effect is still unclear. Related Articles | Metrics

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Secondary contralateral hip fractures following hip fractures in the elderly     Li Tao, Liu Zhi, Sun Tian-sheng, Zhang Jian-zheng, Dai He-ling, Zhu He-yu 2012, 16 (4):  752-756.  doi: 10.3969/j.issn.1673-8225.2012.04.042 Abstract ( 309 )   PDF (334KB) ( 393 )   Save BACKGROUND: Cases of secondary contralateral hip fractures in old people with hip fractures are increasing every year. OBJECTIVE: To analyze the clinical characteristics of secondary contralateral hip fractures among elderly patient and to improve the understanding of second contralateral hip fractures. METHODS: From January 2001 to July 2011, a total of 567 cases of unilateral hip fractures and 30 cases of secondary contralateral hip fractures in the elderly were selected. The incidence, fractures type, age, gender, bone mineral density, osteoporosis, re-fracture interval, and complications of secondary contralateral hip fractures were analyzed. RESULTS AND CONCLUSION: The age, gender and bone mineral density in the unilateral hip fractures and secondary contralateral hip fractures cases were approximate. The incidence of secondary contralateral hip fracture among the elderly who suffered hip fracture was 5.0%. The rate of the contralateral hip fracture in intertrochanteric fractures was higher than that in the femoral neck fractures (P=0.018). The incidence of osteoporosis in the secondary contralateral hip fracture group was higher than that in the unilateral fracture group (P=0.032). The average interval between the two fractures was 2.4 years, with most of secondary contralatera hip fractures occurring within one year, accounting for 40.1%. It is indicated that the incidence of secondary contralatera hip fractures is significantly high in the elderly. For patients who have osteoporosis, a variety of associated complications and intertrochanteric fractures should be strengthened prevention in order to prevent the re-occurrence of hip fracture. Related Articles | Metrics

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Application of digital titanium mesh shaping for cranial defects in 198 cases Liu Gui-biao1, Qin Kun-ming2, Huang He-qing1, Chen Jia-kang1, Wen Chao-yong1, Zheng Jie-min1 2012, 16 (4):  757-760.  doi: 10.3969/j.issn.1673-8225.2012.04.043 Abstract ( 292 )   PDF (317KB) ( 494 )   Save BACKGROUND: Traditional method of cranioplasty has many disadvantages such as modeling and shaping for long time in-operation and patients unsatisfied with their appearance after repair. Since introducing the computer aided design technology (digitalization-shaping) to neurosurgery, the clinical effect of individual repair for cranial defect is satisfactory． OBJECTIVE: To evaluate the clinical effect of digital titanium mesh shaping on skull. METHODS: Totally 198 patients were treated with Phase Ⅱ skull shape using titanium mesh, and then were divided into two groups: digital titanium mesh group (96 cases) and tradition-method group (102 cases). In the digital titanium mesh group, head CT scanning was used for obtaining skull and cranial defect data which was transmitted to the digital titanium mesh shaping manufacturing company in order to get individual prefabricated titanium mesh material for cranial repair. In the tradition-method group, titanium mesh was made by hand temporary for repair during intraoperation. RESULTS AND CONCLUSION: In the digital titanium mesh group, the digital titanium mesh was tight fit with bone window edge, the satisfaction of appearance was 100%, average operating time was shortened about 45 minutes and no complications occurred in hematoma under the scalp, infection and repair materials exposed postoperatively. In tradition-method group, one case with repair materials exposed, two cases with incision infection and four cases with hematoma under the scalp were found postoperatively. So digital titanium mesh shaping for cranioplasty can shorten the operation time, reduce the complications in repair materials exposed and secondary infection, and obtain the satisfactory effect on shaping. Related Articles | Metrics