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26 February 2012, Volume 16 Issue 9 Previous Issue    Next Issue

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Effect of apigenin on apoptotic rate and matrix metabolism of human nucleus pulposus cells cultured in vitro under hydrostatic pressure   Liu Gen-zhe, Chen Jiang, Xu Lin, Li Chun-gen, Sun Qi, Qiao Wei-ping, Zhu Zhi-qiang 2012, 16 (9):  1521-1525.  doi: 10.3969/j.issn.1673-8225.2012.09.001 Abstract ( 391 )   PDF (379KB) ( 341 )   Save BACKGROUND: Abnormal biomechanical environment and over-expression nitric oxide are the two important factors in the process of intervertebral disc degeneration. OBJECTIVE: To discuss the effect of apigenin on the apoptotic rate and matrix metabolism of monolayer cultured human nucleus pulposus cells in vitro under different hydrostatic pressures. METHODS: In the hydrostatic pressure loading system, 0.1-3 MPa pressure was imposed on the human nucleus pulposus cells (passage 4) in monolayer culture in vitro for 2 hours, while using apigenin and nitric oxide donor to intervene on nucleus pulposus cells, and analyzing the effect of apigenin on the apoptotic rate, matrix metalloproteinase and matrix metabolism of human nucleus pulposus cells under hydrostatic pressure. RESULTS AND CONCLUSION: Under 0.3 MPa hydrostatic pressure, apigenin could reduce the degradation of extracellular matrix by regulating the balance between matrix metallo proteinases-3 (MMP-3) and human tissue inhibitor of metal protease-1 (TIMP-1), and improving nucleus pulposus cells inhibition status due to the high concentration of nitric oxide. Under 3 MPa hydrostatic pressure, apigenin had a role in reducing the apoptotic rate of nucleus pulposus cells and could alleviate the unbalance between the MMP-3 and TIMP-1. The results showed that apigenin has an influence on the function status and apoptotic rate of nucleus pulposus cells, the balance between MMP-3 and TIMP-1, and the effects are different under different hydrostatic pressure environments. Related Articles | Metrics

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Three dimensional CT study on relevant parameters of atlas pedicle screw insertion He Hong-wei1, 2, Sui Tong1, Zhao Hui-yi3, Chen Li-jun1, Lin Qing-chi1, Duan Shao-yin1 2012, 16 (9):  1526-1529.  doi: 10.3969/j.issn.1673-8225.2012.09.002 Abstract ( 276 )   PDF (456KB) ( 424 )   Save BACKGROUND: As for studies on entry point and trajectory transverse angle of atlas pedicle screw insertion, different authors obtain different data. OBJECTIVE: To design an ideal route of screw insertion by CT multi-planar reconstruction (MPR), to measure parameters related to atlas pedicle screw insertion, and to evaluate effect of the height of the atlas pedicle screw and variation of atlas ponticulus on the pedicle screw insertion. METHODS: Sixty-two subjects who were performed computed tomography angiography in head and neck without any pathology of craniocervical junction from October 1, 2009 to June 30, 2010 were selected from the picture archiving and communication system. Their axial images were used to reconstruct the images by MPR techniques. The parameters were obtained including the pedicle minimum height, location of optimal insertion point, trajectory transverse angle, the maximum length of the trajectory and the length of trajectory in atlas pedicle. The incidence of atlas ponticulus was analyzed. RESULTS AND CONCLUSION: The minimum height of atlas pedicle was (3.8±0.8) mm in female and (4.4±1.2) mm in male, 91.1% of the subjects were equal to or over 3.0 mm. The distance from screw insertion point to midline was (20.8±1.3) mm in female and (21.7±1.2) mm in male. The trajectory transverse angle was (10.3±2.6)° in female and (10.1±2.1) ° in male. The maximum length of the trajectory was (26.5±1.8) mm in female and (26.9±1.8) mm in male. The length of trajectory in atlas pedicle was (7.9±1.2) mm in female and (8.0±1.1) mm in male. The incidence of atlas ponticulus was 25.8%, of which typeⅡ-Ⅳ accounts for 21.0%.It is indicated that the minimum height of atlas pedicle screw and type Ⅱ-Ⅳ posterior ponticulus can directly affect the screw insertion, and MPR imaging can devise the ideal trajectory for pedicle screw insertion, which is necessary for three-dimensional CT anatomical measurement before atlatoaxial joint screw insertion. Related Articles | Metrics

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Design features and clinical application of Tri-Lock bone preservation stem prosthesis Jin Ye, Sun Jun-ying, Zheng Hong-ming, Wang Qiang, Chen Lian, Zha Guo-chun 2012, 16 (9):  1530-1533.  doi: 10.3969/j.issn.1673-8225.2012.09.003 Abstract ( 455 )   PDF (352KB) ( 675 )   Save BACKGROUND: The new generation of Tri-Lock bone preservation stem (BPS) femoral stem prosthesis is further improved. But it’s design features and surgical techniques are still rarely reported. OBJECTIVE: To summarize design features and clinical application of the Tri-Lock BPS in total hip arthroplasty (THA). METHODS: Totally nine patients (10 hips) were treated with THA using Tri-Lock BPS. Eight patients were diagnosed preoperatively with femoral head necrosis, while the other one with osteoarthritis. The preoperative and postoperative hip functions and postoperative biological fixation of femoral stem prosthesis were evaluated by Harris and Engh score. Postoperative initial fixation quality of the femoral stem prosthesis was evaluated by Healy score. The incidence of radiolucent line and osteolysis was analyzed. Bone ingrowth of acetabulum and femoral side was described respectively by Delee and Gruen. Subsidence of the femoral stem prosthesis was measured by D’Antonio. Femoral area pain was evaluated by 10-point visual analogue score. RESULTS AND CONCLUSION: X-ray of the ten hips showed that the femoral stem prosthesis was in line with good initial fixed standard. At 3 months after surgery, the mean postoperative Harris hip score was 92 (range 85 to 96). No one had thigh pain. There was no prosthesis loosening. The results showed that the design of Tri-Lock BPS is more in line with characteristics of human anatomy, and has the advantages in rapid recovery of hip function and retains more bone mass. Related Articles | Metrics

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Application of patch in the total hip arthroplasty to reconstruct soft tissue tension after hip fusion Chen Tao, Shang Xi-fu, He Rui, Hu Fei, Ge Chang 2012, 16 (9):  1534-1537.  doi: 10.3969/j.issn.1673-8225.2012.09.004 Abstract ( 345 )   PDF (283KB) ( 387 )   Save BACKGROUND: More and more patients required total hip arthroplasty (THA) after hip fusion. However, due to apraxias of tissue with long-term, patients need reconstruct soft tissue tension during replacement to prevent dislocation of the prosthesis after replacement. OBJECTIVE: To discussion the application of patch in the THA to reconstruct soft tissue tension after hip fusion. METHODS: From January 2007 to January 2011, 21 patients with hip fusion were treated with the THA. Unequal length of lower extremities was corrected, muscle was unable to close after restoring the patient’s femoral offset. Patch was used for reconstructing soft tissue tension during the operation. RESULTS AND CONCLUSION: At 1 year after operation, Harris was (83.8±6.4 score), flexion of hip activity was (79.5°±4.6°). Two patients still needed walking stick after the operation. Lumbago, side gonalgia and the opposite side hip pain before the operation were obviously alleviated, and only two patients still had leg length discrepancy. Over 5 years after the operation, nine patients were not found the loosed performance. The patch plays an important role in the soft tissue tension reconstruction and is very important to hip function recovery and prosthesis stability. Related Articles | Metrics

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Efficiency of minimally invasive total hip arthroplasty with anterolateral approach versus the traditional total hip arthroplasty with posterolateral approach Huang Xiao-wen, Cheng Li, He Tian-da, Liu Yi, Wang Ye, Zhu Hao-ming 2012, 16 (9):  1538-1542.  doi: 10.3969/j.issn.1673-8225.2012.09.005 Abstract ( 329 )   PDF (342KB) ( 547 )   Save BACKGROUND: Now, domestic total hip arthroplasty (THA) surgeries are mainly traditional THA with posterolateral approach which has larger damage and slower recovery. Minimally invasive surgery is not popularization utilization, studies on minimally invasive THA with anterolateral approach are rarely and clinical randomized controlled trial studies are almost blank. OBJECTIVE: To compare the clinical effect of the minimally invasive THA with anterolateral approach and the traditional THA with posterolateral approach. METHODS: Totally 102 patients who treated with THA from Affiliated Wuxi People’s Hospital of Nanjing Medical University from June 2008 to September 2009 were randomly divided into experimental group (n=55) and control group (n=47). The minimally invasive THA with anterolateral approach was used for the experimental group, and the traditional THA with posterolateral approach was used for the control group. RESULTS AND CONCLUSION: Compared with the control group, incision length, operation time were shorter, hemorrhage amount was less (P < 0.05), Harris score was higher at postoperative early stage (2 weeks, 3 months) in the experimental group (P < 0.05). There was no difference in the abduction angle of acetabulum cup and complications between the two groups (P > 0.05). Harris score in the two groups had no significant difference at postoperative six weeks and one year (P > 0.05). It is indicated that the minimally invasive THA with anterolateral approach is a safe and effective technique with the advantages of less surgical trauma, shorter operation time, fewer blood loss, slighter pain and rapid recovery of function. Related Articles | Metrics

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Total hip arthroplasty for the treatment of severe hip osteoarthritis due to fluorosis  Su Wei-min1, Liu Ri-guang1, Ye Chuan1, Yu Yan-ni2, Guan Zhi-zhong2 2012, 16 (9):  1543-1546.  doi: 10.3969/j.issn.1673-8225.2012.09.006 Abstract ( 313 )   PDF (344KB) ( 491 )   Save BACKGROUND: Now, total hip arthroplasty (THA) is one of the effective methods for the treatment of severe hip osteoarthritis due to fluorosis. OBJECTIVE: To investigate the strategies and efficacy of THA for the treatment of severe hip osteoarthritis due to fluorosis. METHODS: A total of five cases with severe hip osteoarthritis due to fluorosis were treated with THA using biological prosthesis.  RESULTS AND CONCLUSION: All incisions were healed in one stage. Position of the prosthesis was good confirmed by X-rays observation at 1 week after operation. All the cases were followed-up for averagely 13.8 months. Loosening and sinking of the prosthesis were not found during the follow-up. The average Harris scores were 83.6 and 87.8 points at postoperative 3 and 6 months respectively, which was improved as compared with preoperative score (38.4 points). Heterotopic ossification occurred in two cases, one was Brooker degree Ⅰand another was degree Ⅱ. THA is an effective method to treat severe hip osteoarthritis due to fluorosis, which can significantly improve joint function and has few complications. Heterotopic ossification should be prevented after the operation. Related Articles | Metrics

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Metal-metal surface hip replacement versus total hip replacement: 18-month follow-up in young patients and those having many activities   Liang Zhi-quan, Ai Li-jiang•A Si-la, Meng Qing-cai, Lu Yong, Fang Rui 2012, 16 (9):  1547-1550.  doi: 10.3969/j.issn.1673-8225.2012.09.007 Abstract ( 365 )   PDF (271KB) ( 422 )   Save BACKGROUND: The fourth generation of metal-metal surface hip replacement is widely used in clinic, but control researches between metal-metal surface hip replacement and total hip replacement (THR) are rare. OBJECTIVE: To compare the early clinical efficacy effect of the fourth generation of metal-metal surface hip replacement and THR. METHODS: Totally 62 cases of 67 hip prosthesis with first line of THR were divided into table hip group (30 cases with 32 hip prosthesis) and ordinary group (32 cases with 35 hip prosthesis). The fourth generation of metal-metal surface hip replacement which generated from Depuy Company was used for the table hip group. Metal-polyethylene THR prosthesis which generated from Smith & Nephew Company was used for the ordinary group. RESULTS AND CONCLUSION: At 1.5 years follow-up after replacement, there was no significant difference of Harris hip score in the two groups (P > 0.05). Hip joint activities of the table hip group were higher than that of the ordinary group (P < 0.05). Compared with the ordinary group, unequal length of both lower limbs was decreased (P < 0.05), but operating time and incision were lager in the table hip group (P < 0.05). It is indicated that metal-metal surface hip replacement for the treatment of large amount of activity and young patients has a better followed-up. After replacement, hip joint function restores the hip biomechanics and bone mass. However, compared with the metal-polyethylene prosthesis, metal-metal surface hip replacement has difficult surgical operation, large surgical trauma and long operation time. Related Articles | Metrics

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Short-term follow-up for artificial cervical disc replacement: Changes of stability and range of motion in cervical vertebra  Tang Xue-ming, Xu Nan-wei, Zhou Dong, Jiang Wei, Li Hai-bo 2012, 16 (9):  1551-1554.  doi: 10.3969/j.issn.1673-8225.2012.09.008 Abstract ( 281 )   PDF (256KB) ( 399 )   Save BACKGROUND: Segment fusion after the discectomy decompression of cervical disc limits the physical exercise of the segment, which causes the accelerated degeneration due to increased stress of adjacent segment. OBJECTIVE: To observe stability and range of motion (ROM) in the replacement segment and cervical segment during short-term follow-up using artificial cervical disc replacement for the treatment of cervical disc disease. METHODS: Totally 11 cases (12 segments) who treated with cobalt-chromium alloy PCM cervical disc replacement from Department of Orthopedics, the Second People’s Hospital of Changzhou from June 2010 to August 2011 PCM were selected including seven males and four females. Among these cases, there were eight cases with cervical myelopathy, and three cases with traumatic cervical disc herniation. RESULTS AND CONCLUSION: All cases were followed-up for 3 to 12 months. ROM over flexion and extension, and flexion ROM on lateral left and right were similar to preoperation at 1, 3, 6 months and final follow-up after replacement. Japanese orthopaedic association (JOA) score at 1 month and final follow-up was significantly increased and Oswestry neck disability index (ONDI) was significantly decreased (P < 0.05). There was no difference of JOA score and ONDI between final follow-up and at postoperative 1 month (P > 0.05). At the same time, X-ray showed there were no adverse reactions in prosthesis loosening, subsidence or heterotopic ossification. It is indicated that short-term clinical effect for functional motion of cervical vertebra is satisfactory after PCM cervical disc replacement. Related Articles | Metrics

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Total knee arthroplasty for the treatment of knee osteoarthritis caused by endemic skeletal fluorosis  Luo Rui1, Liu Ri-guang1, Ye Chuan1, Yu Yan-ni2, Guan Zhi-zhong2 2012, 16 (9):  1555-1558.  doi: 10.3969/j.issn.1673-8225.2012.09.009 Abstract ( 307 )   PDF (402KB) ( 719 )   Save BACKGROUND: Knee osteoarthritis caused by endemic skeletal fluorosis is a complex and chronic systemic disease, which can cause the damage of surrounding bone and sclerotin of knee joint. OBJECTIVE: To investigate the effect of total knee arthroplasty (TKA) in the treatment of knee osteoarthritis caused by endemic skeletal fluorosis. METHODS: Nine patients suffered from knee osteoarthritis caused by skeletal fluorosis that diagnosed by local epidemiology, dental fluorosis, clinical and imaging from March 2010 to October 2011 and all the patients were treated with bilateral TKA. The clinical efficacy was evaluated according to the knee scoring system of United States Hospital for Special Surgery before arthroplasty and final follow-up after arthroplasty. RESULTS AND CONCLUSION: Score results showed that 5 knees were excellent, 3 knees were good and 1 knee was fair after knee arthroplasty. All patients have been improved in pain, function and range of motion. TKA is an effective method for the treatment of knee osteoarthritis caused by skeletal fluorosis. Related Articles | Metrics

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Early clinical efficiency of large femoral head in ceramic-on-ceramic total hip arthroplasty  Luo Qin-yu, Hu Yi-shan, Chen Chun-lei, Guo Yu-li, Zheng Gan-xuan, Lin Ben-dan 2012, 16 (9):  1559-1563.  doi: 10.3969/j.issn.1673-8225.2012.09.010 Abstract ( 313 )   PDF (351KB) ( 508 )   Save BACKGROUND: 36 mm large diameter of femoral head increases more jump distance than 28 mm diameter of femoral head, which has the characteristics of large range of motion, good stability and few dislocations. It can be appied to young patients, requiring large activities range and high quality of life. OBJECTIVE: To observe early clinical efficacy of 36 mm diameter of femoral head in ceramic-on-ceramic total hip arthroplasty. METHODS: From June 2009 to July 2010, 18 hips in 18 patients with hip disease were treated with total hip arthroplasty using Depuy PinnacleTM 36 mm diameter of large femoral head in ceramic-on-ceramic total hip prosthesis. Control group (20 cases) were treated by total hip arthroplasty with Depuy PinnacleTM 28 mm diameter of femoral head in ceramic-on-ceramic total hip prosthesis in the same period. RESULTS AND CONCLUSION: All the patients were followed up from 13 months to 26 months, incisions got primary healing without complications such as prosthesis dislocation, infection and deep venous thrombosis postoperation. Postoperative total Harris score of the two groups was more significant improved as compared with those of the two groups preoperative (P < 0.05). Postoperative range of motion score in the 36 mm group was improved more significantly than that in the 28 mm group (P < 0.05). However, the two groups had no significant difference in postoperative total Harris score, pain score and function score (P > 0.05). Modern ceramic on ceramic hip prosthesis can effectively decrease the complications of osteolysis and prosthetic loosening caused by wearing of joint interface. 36 mm diameter of femoral head in ceramic-on-ceramic total hip arthroplasty has the characteristics of large range of motion, good stability and few dislocations. It can be used as the first choice if the intraoperative conditions permit. Related Articles | Metrics

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Intramedullary nail InterTan and locking plate internal fixation for intertrochanteric fractures:   A follow-up study Mao Yong-tao, Xu Wei, Xie Zong-gang, Zhou Hai-bin, Xu You-jia, Dong Qi-rong 2012, 16 (9):  1564-1568.  doi: 10.3969/j.issn.1673-8225.2012.09.011 Abstract ( 286 )   PDF (363KB) ( 649 )   Save BACKGROUND: Intramedullary and extramedullary fixation for trochanteric fractures has its own advantages and disadvantages. OBJECTIVE: To compare the effects of intramedullary nail InterTan and locking compression plate for the treatment of intertrochanteric fractures. METHODS: A total of 50 patients with intertrochanteric fractures from Department of Orthopedics, the Second Affiliated Hospital of Soochow University from January 2009 to December 2010 were divided into two groups. Intertrochanteric fractures were treated with InterTan and locking compression plate respectively in the two groups. RESULTS AND CONCLUSION: Totally 50 patients were followed-up for 6 to 10 months. Fractures in all the patients were healed. Approach incision and blood loss of the InterTan group were lower than those of the locking compression plate, but operation time of the InterTan group was longer than that of the locking compression plate (P < 0.05). There was no difference of fracture healing time and Harris score between the two groups (P > 0.05). It is indicated that InterTan for the treatment of the intertrochanteric fractures has slight invasion. Related Articles | Metrics

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Surgical treatment of lumbar spondylolisthesis using short or long segment pedicle screw fixation☆ Shen Ning-jiang, Wang Xian-an, Lin Qing-biao, Chen Jian, Li Yi-bo 2012, 16 (9):  1569-1572.  doi: 10.3969/j.issn.1673-8225.2012.09.012 Abstract ( 328 )   PDF (258KB) ( 481 )   Save BACKGROUND: There are a lot of controversies regarding the choice of short versus long segment pedicle screw fixation for the treatment of isthmic spondylolisthesis and degenerative spondylolisthesis treatment. OBJECTIVE: To investigate clinical efficacy of short versus long segment pedicle screw fixation in treatment of lumbar spondylolisthesis. METHODS: A total of 146 spondylolisthesis patients were included in this study, 36 males and 110 females, aged 22-73 years at a mean of 53 years; disease duration was from 1 to 18 years at a mean of 5 years. These patients were treated with lumbar spinal window-opened decompression or laminectomy decompression, a short or long segment pedicle screw internal fixation, transverse interbody fusion. RESULTS AND CONCLUSION: Among 146 involved patients, 72 cases were treated with four pedicle screw fixation (short segments), while 74 cases with six pedicle screw fixation (long segments). Interbody graft was performed in 101 cases, while intertransverse fusion given in 45 cases. Totally 134 cases were followed up for postoperative 1.5-14 years. According to clinical grading standards of Steffee system, the clinical efficacy was assayed excellent in 74 cases, good in 41 cases, mild in 13 cases and poor in 6 cases, with good rate of 85.8%. 77 cases achieved a complete reduction, including 32 cases using a short segment fixation and 45 cases using a long segment fixation. 69 cases achieved partial reduction, including 40 cases using a short segment fixation and 29 cases using a long segment fixation. Pedicle screws ruptures were found in 13 screws of eight patients undergoing short segment fixation, while no pedicle screw fracture was found in long segment fixation. Choice of short or long segment for the fixation is based on the analysis of spondylolisthesis type, severity, duration of disease, emergence of adjacent segment disc degeneration and instability. Related Articles | Metrics

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Effect of topical application of alendronate on implant osseointegration in non-load period:     A X-ray observation Ji Lin-lin1, Liu Zhong-hao2, Zhou Wen-juan2, Xu Sheng2 2012, 16 (9):  1573-1576.  doi: 10.3969/j.issn.1673-8225.2012.09.013 Abstract ( 301 )   PDF (403KB) ( 333 )   Save BACKGROUND: As the third-generation of bisphosphonates, alendronate has a strong ability in inhibiting bone resorption. OBJECTIVE: To study the effect of alendronate on non-load period bone around the implants. METHODS: Six healthy adult Beagle dogs were randomly divided into experimental and control groups. The second and fourth premolar totally 24 tooth positions in bilateral mandibular from each dog were treated with immediate implant surgery at 1, 29, 43 and 50 days. Alendronate was local injected around the implant twice a week in the experimental group, but in the control group alendronate was instead by normal saline. RESULTS AND CONCLUSION: X-ray film showed that implant osseointegration was in good condition at 57 days, and the formation of trabecular bone at 2 weeks around the implant in the experimental group was significantly earlier than that in the control group. It is indicated that alendronate can promote the early formation of trabecular, thus affecting the bone remodeling to increase the osseointegration at non-load period around the implants. Related Articles | Metrics

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Noise of different tissues in chest CT scanning based on digital simulated technique Zhao Feng1, Zeng Yong-ming1, Peng Gang1, Cao Hui-zhi2, Liao Jing-min2, Yu Ren-qiang1, Peng Sheng-kun1, Tan Huan1 2012, 16 (9):  1577-1580.  doi: 10.3969/j.issn.1673-8225.2012.09.014 Abstract ( 285 )   PDF (329KB) ( 325 )   Save BACKGROUND: Image noise level is closely related with the image quality in the CT images, it directly affects and limits of CT resolution of low-contrast material. OBJECTIVE: To evaluate the correlation of estimated noise with the noise of different tissues and to analyze characteristic of different tissues noise on low dose chest scan by adding noise on raw data to simulate low dose scan. METHODS: The noise was artificially introduced to the images of 20 volunteers using an image space noise addition tool to simulate nine groups of low dose scans with tube current of 10, 30, 50, 80, 100, 120, 150, 180 and 240 mA. The estimated noise of images was recorded. The noise of aorta, tissue of chest wall, vertebra, lung and air on levels of aortic arch, heart and liver were measured. RESULTS AND CONCLUSION: There was significant statistical difference between the estimated noise and the measured noise in the index of aortic artery and other tissues estimated noise (P < 0.05), which had linear correlation. The noise of different tissues increased significant in groups of 10-50 mA, and decreased gradually with the increase of current in groups of 80-240 mA. There was no statistical difference of the estimated noise value between the noise of 120 and 180 mA groups (P < 0.05). The estimated noise of noise addition tool can be used to evaluate the image noise of different tissues. The tube current of 120 mA to 180 mA in low dose chest CT scan can reduce radiation dose and keep the image quality of different tissues. Related Articles | Metrics

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Effect of L4, 5 pedicle CT morphological differences on the internal fixation of implant in Han and Uygur young men Gao Xiao-liang1, 2, Huang Wei-min1, Hu Yong-sheng1, Wang Wu-chang1, Chu Ge3, Yang Yi2, Jin Ge-le2 2012, 16 (9):  1581-1586.  doi: 10.3969/j.issn.1673-8225.2012.09.015 Abstract ( 314 )   PDF (368KB) ( 391 )   Save BACKGROUND: In China, there are no studies about the inner deflection angle on cross section, head/tail declination on sagittal plane and morphological differences of the lumbar pedicle CT. OBJECTIVE: To evaluate the CT morphological defferences of L4, 5 pedicle between Han and uygur and whether the differences have an influence on internal fixation of posterior lumbar. METHODS: Totally 400 cases who treated with L4,5 posterior pedical screw internal fixation due to lumbar disc herniation were seclected. Han and uygur were 200 male cases respectively aged 20 to 30 years old, height 170-175 cm. Pedicle transverse diameter, length of screw path, transverse section angle and sagitalseetion angle were measured by using length and angle measurement tool of patient browser after imags was eshtablished by conventional spiral CT scan+three-dimensional image processing. RESULTS AND CONCLUSION: Pedicle diameter of L4 vertebral body in Han should be smaller than that in the uygur, otherwise it might increase the risk of pedicle crack. Inner deflection angle of the Han should be larger than that in the uygur, otherwise it might increase the risk of vertebral body piercing the screws. Pedicle diameter of L5 vertebral body and left inner deflection angle in Han should be smaller than those in the uygur, otherwise it might increase the risk of pedicle crack and screw into the spinal canal to damage nerve. Related Articles | Metrics

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Traction radiographic assessment technique and the strategy of management for vertical instability in lumbar spondylolisthesis  Zhang Hong-qi1, Chu Ge2, Kahaer•Aikenmu2 2012, 16 (9):  1587-1592.  doi: 10.3969/j.issn.1673-8225.2012.09.016 Abstract ( 258 )   PDF (621KB) ( 406 )   Save BACKGROUND: Lumbar spondylolisthesis is commonly confirmed by using flexion and extension radiographs, and the severity is determined through slip distance and slip angle. OBJECTIVE: To define and demonstrate the presence of “vertical instability” in lumbar spondylolisthesis, and to determine the most useful radiographic views for clinical purposes and analysis of the surgical strategy. METHODS: Lateral and flexion extension radiographs of the lumbosacral spine in 37 patients with spondylolisthesis taken in standing and recumbent positions and under pelvic traction in the prone or supine positions were suitable for analysis. The changes in disc area, intervertebral kyphotic slip angle, and amount of anteroposterior shift (olisthesis) were measured from the radiographs using a computer digitizer. RESULTS AND CONCLUSION: Maximum slip angle, maximum olisthesis, and minimum normalized disc area were found in patients under erect flexion. Conversely, prone traction and recumbent extension produced minimum slip angle, whereas the lowest anteroposterior shifts were seen in patients under prone and supine traction. Prone traction also resulted in a significantly larger normalized disc area than any other posture. The change in kyphotic slip angle between erect flexion and prone traction was correlated with the change in normalized olisthesis and disc area. Erect flexion and prone traction radiographs represent the extremes of subluxation and reduction of the olisthesis, respectively, and the change in olisthesis seen between these extremes is correlated with the change in disc area and the intervertebral slip angle. Vertical laxity of the affected functional spinal unit resulting from disc degeneration produces laxity in the ligaments and disc anulus, allowing olisthetic motion. Restoration of disc height in turn restores tension to the soft tissues around the disc and results in a spontaneous reduction of the subluxation. Restoration and maintenance of disc height with a spacer or interbody fusion therefore is recommended as a goal in the treatment of spondylolisthesis. When spondylolytic spondylolisthesis involves a posterior column deficiency, additional reconstruction of this column with posterior instrumentation is recommended. Related Articles | Metrics

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Imaging study of the relationship between clavicle and adjacent peripheral vessels: Safe area and hazardous area of screw insertion   Ji Hang-yu1, Pan Gong-mao2, Xie You-yang2, Luo Yu-chun3, Xia Yun-bao2, Yu Chang-chun4, Wang Shi-bo3 2012, 16 (9):  1593-1596.  doi: 10.3969/j.issn.1673-8225.2012.09.017 Abstract ( 336 )   PDF (310KB) ( 339 )   Save BACKGROUND: The adjacent data between clavicle and the subclavian vessels mostly come from human observation and measurement of anatomical specimens. The measurement results slightly differ from the actual body. OBJECTIVE: To observe and analyze the relationship between the clavicle peripheral vascular in vivo and anatomy of collarbone for finding the safe area and hazardous area of screw external fixation. METHODS: Totally 44 patients were conducted chest and neck enhanced CT scanning to examine coronary angiography. The collected CT image of clavicle area were used to reconstruct three-dimensional images of intact clavicle and clavicle peripheral vascular using ADW4.4 workstation. The adjacent relationship between the clavicle and clavicle peripheral vascular was observed and measured on the images. RESULTS AND CONCLUSION: Subclavian vein and artery near the clavicle, clavicle angle formed between the lower edge of the left was (53.75°±10.64°), the right side was (52.85±11.41)°. If the length of the clavicle was divided into five equal parts, the clavicle artery and vein at the surface of the clavicle in its projected range from the inside out about the second 1/5 of the left brachiocephalic vein from the clavicle shortest average distance (4.81±1.66) mm, the right innominate artery shortest distance from the average of the clavicle was (5.09±2.60) mm. In vivo imaging measurements are closer to the normal human body, clavicle surgery is likely to damage the site of the subclavian vessels from the inside out of the second 1/5 of the sternum and clavicle end, to grasp the anatomical characteristics of the source can be maximum avoided health peripheral vascular injuries of the clavicle. Related Articles | Metrics

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Histopathological changes and rule of migration associated with chondrocytes in acupuncture-induced intervertebral disc degeneration model in rabbits Wang Shi-jun, Li Chun-de, Sun Hao-lin, Liu Xian-yi, Zhu Tian-yue, Li Wen 2012, 16 (9):  1597-1600.  doi: 10.3969/j.issn.1673-8225.2012.09.018 Abstract ( 285 )   PDF (338KB) ( 282 )   Save BACKGROUND: The notochordal cells will be replaced by chondrocytes along with the aggravation of degenerative intervertebral disc, but the origin and migration rule of the chondrocytes of the model established by puncturing the annulus fibrosus are still unclear. OBJECTIVE: To observe the histopathological process of degenerative intervertebral disc model established by puncturing the annulus fibrosus, and to explore the origin and migration rule of the chondrocytes. METHODS: Twenty-four New Zealand white rabbits were divided into operation group and sham operation group. In the operation group, lumbar discs of L2-3, L3-4, L4-5 and L5-6 of each rabbit were punctured by 16 gauge needle. In the sham operation group, the anterior surfaces of the lumbar discs were exposed without puncture. RESULTS AND CONCLUSION: The chondrocytes of the nucleus pulposus originated and migrated from the cartilage endplate. At the junction of the nucleus pulposus and the cartilage endplate, the chondrocytes departed from the cartilage endplate to the nucleus pulposus vertically. At the junction of the inner annulus fibrosus and the cartilage endplate, the chondrocytes migrated along the collagen fibers from the cartilage endplate to the shrinked margin of the nucleus pulposus. The non-calcified layer thinned gradually, and the non-calcified layer/calcified layer ratio decreased.   Related Articles | Metrics

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C-reactive protein and erythrocyte sedimentation rate associate with bone graft union in patients with spinal tuberculosis following internal fixation**★ Lan Chang-gong, Tang Yu-jin, Lu Min-an, Wei Wei, Xie Ke-gong, Pan Sheng-cai, Lu Xian-zhe 2012, 16 (9):  1601-1604.  doi: 10.3969/j.issn.1673-8225.2012.09.019 Abstract ( 290 )   PDF (215KB) ( 346 )   Save BACKGROUND: Tuberculosis clearance, bone graft, internal fixation with or without plate for patients with spinal tuberculosis always lead to C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) changes, which are associated with bone graft union time to certain degree. OBJECTIVE: To analyze the correlation between CRP, ESR and bone graft union time in patients with spinal tuberculosis. METHODS: A total of 60 patients with spinal tuberculosis underwent tuberculose focus clearance, autologous iliac bone grafting, and internal fixation without or with plate, including 38 undergoing fixation and 22 not undergoing fixation. They were divided into mild elevation, moderate elevation, high elevation, and extremely high elevation groups according to CRP and ESR. Correlation between CRP, ESR and bone graft union time was analyzed. RESULTS AND CONCLUSION: (1) CRP: there were 18 cases of mild elevation, 21 of moderate elevation, 13 of high elevation and 8 of extremely high elevation. There were significant differences in bone union time among groups (P=0.003). Spearman correlation analysis showed a correlation coefficient r=0.420, P=0.001, indicating positive correlation between CPR and bone union time. (2) ESR: there were 16 cases of mild elevation, 20 of moderate elevation, 13 of high elevation and 11 of extremely high elevation. There were significant differences in bone union time among groups (P=0.003). Spearman correlation analysis showed a correlation coefficient r=0.414, P=0.001, indicating positive correlation between ESR and bone union time. (3) Bone union was rapider in fixation group compared with non-fixation group, indicating that immediate, strong fixation can benefit bone Related Articles | Metrics

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Stress relaxation study of tibial fractures treated by three types of fixation devices  Wu Zhi-feng1, Li Yan-ling2, Liu Guang-yao3, Ma Hong-shun4 2012, 16 (9):  1605-1608.  doi: 10.3969/j.issn.1673-8225.2012.09.020 Abstract ( 261 )   PDF (215KB) ( 277 )   Save BACKGROUND: Bone mechanics is a branch of biomechanics. Biomechanical property research of fractures after internal and external fixation is an important method to estimate the fixed-effects. OBJECTIVE: To compare the stress relaxation properties of tibial fractures fixed by three different internal and external fixation devices. METHODS: The simulated tibial fractures were fixed by the intramedullary nails, plate, and external fixation respectively. Axial compression stress relaxation experiment was performed in the specimens of the three groups using electronic universal testing machine. RESULTS AND CONCLUSION: Axial compression stress relaxation curves of the specimens fixed with internal and external fixation in each group showed that the stress relaxation at 7 200 s in the external fixation group was higher than those of the plate fixation group and the intramedullary nail fixation group, but the differences were not significant (P > 0.05). The results preliminary showed that the effects of plate fixation, intramedullary nail fixation, and external fixation on stress relaxation property of bone in femoral neck fractures were similar. Related Articles | Metrics

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Evaluation of gender differences for gait in normal elder by the gait rehabilitation robots  Ding Min1, Wu Qing-wen2, Liu Bao-guo3, Yang Xiao-gang3, Yang Hai-ping3 2012, 16 (9):  1609-1612.  doi: 10.3969/j.issn.1673-8225.2012.09.021 Abstract ( 320 )   PDF (244KB) ( 454 )   Save BACKGROUND: In China, there are few studies on the evaluation of gait in normal elder by using gait rehabilitation robot, but no definitive conclusion is drawn. OBJECTIVE: To evaluate the indicators of the muscle force, range of motion (ROM), spasticity and so on by using the gait rehabilitation robot, so that to understand the feature of the gait in the elder people. METHODS: A total of 30 healthy elder people were selected with the age of (62.40±1.58) years old including 15 males and 15 females. The muscle force, spasticity and ROM of all the people were tested with the assessment tools of L-FORCE, L-STIFF and L-ROM in the gait rehabilitation robot. RESULTS AND CONCLUSION: Results of L-FORCE of the elder subjects were indicated that the bilateral hip flexor forces and bilateral knee flexor and extensor forces were different in different genders, which showed significant difference (P < 0.05). Results of L-STIFF of the elder subjects were shown that 60 (°)/s left hip extension, 120 (°)/s left hip flexion and extension spasticity in different genders were different, which had significant difference (P < 0.05). Results of L-ROM of the elder subjects showed that there was no difference of ROM in different genders (P > 0.05). It is indicated that the value of L-FORCE and L-STIFF of healthy elder people are higher in the male than those of in the female. The therapists should consider gender factors in the evaluation of patients with L-STIFF and there is no difference of L-ROM in different genders. Related Articles | Metrics

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Design and biomechanical analysis of trigeminal form expansion hollow compression screw Yin Yi-ran, Chen Ge, Lu Xiao-bo, Xu Yang-bo, Ye Li-zi 2012, 16 (9):  1613-1617.  doi: 10.3969/j.issn.1673-8225.2012.09.022 Abstract ( 427 )   PDF (301KB) ( 523 )   Save BACKGROUND: Traditional fixation device for femoral neck fracture can cause screw loosening, extraction and higher failure rate when fixation device on bone-screw interface with insufficient grasping force or bearing load too large. OBJECTIVE: To develop and evaluate biomechanical characteristics of the trigeminal form expansion hollow compression screw. METHODS: Based on the special biomechanical characteristics of the femoral neck fracture, the trigeminal form expansion hollow compression screw was designed, which was composed of two parts: hollow nail and inside plug which could be screwed into the channel of the hollow nail. Within the bolt screwed through the nail produced pressure effect. Then AO cannulated screw by anti-axial compression was made as control. Axial compression test, three-point bending test and maximal axial pullout strength test were detected respectively. RESULTS AND CONCLUSION: Under 300 N axial or bending external force, axial compression stiffness and bending stiffness in the experimental group were higher than those of the control group (P < 0.05), but axial displacement and radial degree in the experimental group were lower than those of the control group (P < 0.05). The maximal axial pullout strength of the experimental group was higher than that of the control group (P < 0.05). It is indicated that trigeminal form expansive hollow compression screw is significantly superior to AO cannulated screw in fixation firmly and biomechanical properties. Trigeminal form expansive hollow compression screw has good performance in anti-axial compression, anti-bend, anti-torsion and anti-pullout which is the advantage that AO cannulated screw does not have. Related Articles | Metrics

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Meta-analysis of rivaroxaban safety after total hip arthroplasty Li Jun, Wang Jian, Shi Zhan-jun, Li Yang 2012, 16 (9):  1618-1621.  doi: 10.3969/j.issn.1673-8225.2012.09.023 Abstract ( 347 )   PDF (257KB) ( 407 )   Save BACKGROUND: Many experiments have proved that rivaroxaban can prevent the venous thromboembolism after total hip arthroplasty, but its safety has not been confirmed. OBJECTIVE: To systematically review the safety of rivaroxaban and enoxaparin for prevention of venous thromboembolism after total hip arthroplasty. METHODS: We searched the documents about the safety of rivaroxaban and enoxaparin in the prevention of venous thromboembolism after total hip arthroplasty at home and abroad. Selected the literatures met evaluation criteria and made a Meta-analysis by RevMan 5.1 software. RESULTS AND CONCLUSION: Six randomized controlled trials involving 9 611 patients were included in our Meta-analysis, five in English and one in Chinese. The results showed the incidence of major bleeding event of rivaroxaban was higher than that of enoxaparin after total hip arthroplasty, RR was 1.75 (95%CI, 0.76-4.04), Z=1.31(P=0.19); clinically relevant non-major bleeding incidence of rivaroxaban was higher than that of enoxaparin, RR was 1.29 (95%CI, 0.99-1.68), Z=1.85(P=0.06); the minor bleeding event incidence of rivaroxaban were lower than that of enoxaparin, RR was 0.98 (95%CI, 0.76-1.25), Z=0.20(P=0.84); total bleeding events incidence of rivaroxaban were higher than enoxaparin, RR was 1.13 (95%CI, 0.95-1.35), Z=1.38(P=0.17). The safety of rivaroxaban in the prevention of venous thromboembolism after total hip arthroplasty was corresponding to enoxaparin, and the difference was not significant. Related Articles | Metrics

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Meta-analysis of acupotomology versus acupuncture for cervical spondylopathy   Liu Fu-shui1, 2, Zhang Yi1, Zhong Ding-wen1, Guo Chang-qing1 2012, 16 (9):  1622-1625.  doi: 10.3969/j.issn.1673-8225.2012.09.024 Abstract ( 382 )   PDF (328KB) ( 644 )   Save BACKGROUND: Though acupotomology and acupuncture are commonly used to treat cervical spondylopathy, there are no systematic reviews of randomized clinical trials on it. OBJECTIVE: To evaluate the therapeutic effect and safety of acupotomology versus acupuncture for cervical spondylopathy. METHODS: Randomized controlled trials (RCTs) of acupotomology versus acupuncture in the treatment of cervical spondylopathy were retrieved from CBM (1978 to 2010), CNKI (1979 to 2010), VIP (1989 to 2010), PubMed (1966 to 2010), and Cochrane Library (Issue 4, 2010). And some relevant journals were manually searched. Data were extracted and evaluated by two reviewers independently according to Cochrane Reviewers’ Handbook (5.0). The Cochrane Collaboration’s RevMan 5.1 software was used for meta-analyses. RESULTS AND CONCLUSION: Totally 10 RCTs involving 1 085 cases were included. The results of meta-analyses showed that the total effect rate and cure rate both at short-term and long-term of the acupotomology for cervical spondylopathy were higher than the acupuncture, and improvement of symptom scores of the acupotomology group for cervical spondylopathy was superior than the acupuncture group. Acupotomology is superior to acupuncture in the treatment of cervical spondylopathy. However, due to low quality of included studies, rigorously designed RCTs are needed to confirm the above conclusions. Related Articles | Metrics

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Three-dimensional finite element analysis of mini-external fixation and Kirschner wire internal fixation for the treatment of Bennett fracture Meng Li-min1, Su Xiao-tian2, Zhang Yin-guang3, Lu Yun4 2012, 16 (9):  1626-1630.  doi: 10.3969/j.issn.1673-8225.2012.09.025 Abstract ( 319 )   PDF (379KB) ( 533 )   Save BACKGROUND: Finite element analysis can be applied in imitate orthopaedic operations and biomechanics of orthopaedic model. Finite element analysis has been considered as an important and new method in surgery for orthopaedic biomechanics research. OBJECTIVE: To analyze the stability of Bennett fracture treated by mini-external fixation and Kirschner wire (k-wire) internal fixation using the finite element analysis. METHODS: CT Images of the left distal radius from 25 healthy male volunteers were analyzed in order to build three-dimensional models of the first metacarpal, the second metacarpal, and the trapezium, as well as the model of k-wire and mini-external fixation devices by Mimics software. All the data were output in STL style and then input into Geomagic software to build model entities which were output in IGES form. Finally, the data were input in Aansys software to simulate Bennett fracture and establish treatment models of mini-external fixation and k-wire internal fixation. Finite element models were built following unit type and property were given to the two models. Nonlinear analysis was performed in the two models under the same load (50 N) at the same point of the first metacarpal. RESULTS AND CONCLUSION: The max displacements of the fracture piece of the mini-external fixation treatment model: X-component displacement was -0.492 mm for the distal end and -0.34 mm for the proximal end, and displacement vector in sum was 0.638 mm for the distal end and 0.659 mm for the proximal end. Relative displacements of the distal and proximal fracture ends: X-component displacement was 0.15 mm, and displacement vector in sum was 0.033 mm. The max displacements of the fracture piece of the k-wire internal fixation model: X-component displacement was -2.873 mm for the distal end and -2.546 mm for the proximal end, and displacement vector in sum was 5.361 mm for the distal end and 4.294 mm for the proximal end. Relative displacements of the distal and the proximate pieces of fracture: max X-component displacement was 0.676 mm and displacement vector in sum was 1.667 mm. The consequences indicate that the fixation stability of Bennett fracture treated by mini-external fixation is better than that by k-wire internal fixation. The former one can reduce the incidence of traumatic arthritis after treatment. Related Articles | Metrics

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Technology of pedicle screw implantation by individual design and anatomical localization for treatment of atlantoaxial instability   Lin Yong, Li Qiang, Zhao Yong-sheng, Peng Guo-dong 2012, 16 (9):  1631-1634.  doi: 10.3969/j.issn.1673-8225.2012.09.026 Abstract ( 278 )   PDF (314KB) ( 401 )   Save BACKGROUND: The pedicle screw internal fixation is usually used for treatment of atlantoaxial instability. The implanted location and angulation of these pedicle screws are statistically determined by anatomy data. But this method always leads to inaccurate implant of the screw into the injured atlantoaxial. OBJECTIVE: To evaluate the security and reliability of pedicle screw implantation by individual design and anatomical localization for treatment of atlantoaxial instability. METHODS: A total of 16 cases with atlantoaxial dislocation were fixed with atlantoaxial pedicle screw by location through inferior and inner wall of atlas and superior and inner wall of axis. Combined with the first image measurement, the implanted location, angulation and screw length of atlas were determined, and pedicle screw fixation system was implanted. RESULTS AND CONCLUSION: All the 16 patients were implanted successfully with atlantoaxial pedicle screw. The post-implantation X-ray film and CT image showed the position of pedicle screw was well. They were followed up for 9 to 24 months after the operation. All of them obtained bony union with improved function of the spinal reached 84.6% which containing excellent in 6 cases (46.2%), good in 5 cases (38.5%) and moderate in 2 cases (15.4%). No aggravation was observed, and no complications such as vascular injury, either. It indicates that pedicle screw implantation by individual design and anatomical localization for treatment of atlantoaxial instability has the characteristics of accurate implanted location and angulation, and the security and reliability of pedicle screw implantation. Related Articles | Metrics

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Application of semi-constrained and non-restrictive prostheses in cervical disc replacement Lei Gao1, Luo De-min1, Xue Hou-jun2, Fang Guo-fang1, Pan Ya-wei1, Zhang Ding-cheng1, Zhou Jian-he1, Pan He-ke1 2012, 16 (9):  1635-1638.  doi: 10.3969/j.issn.1673-8225.2012.09.027 Abstract ( 282 )   PDF (239KB) ( 424 )   Save BACKGROUND: The artificial disc replacement (non-fusion technology) is a new surgical procedure based on traditional anterior cervical decompression and interbody fusion, and the use of non-fusion technology is a new concept. OBJECTIVE: To compare the clinic results between semi-constrained and non-restrictive prostheses used in cervical disc replacement. METHODS: A retrospective analysis was performed in 22 patients who received cervical artificial disc replacement. Two cases were replaced with non-restrictive prosthesis of Bryan, 15 cases were with semi-constrained prosthesis of Prodisc-C, and 5 cases were replaced with semi-constrained prosthesis of Activ-C. Comparisons of the operation time, bleeding and the active degree of cervical vertebrate after operation were performed in order to compare the displacement effects. RESULTS AND CONCLUSION: Replacement with Bryan prosthesis had better active degree of cervical vertebrate after operation, but it cost longer operation time and its installation was more complicated. Installation of Prodisc-C and Activ-C was simple, but patients with these prostheses replacement had poor active degree of cervical vertebrate after operation. It is indicated that cervical disc replacement is effective in treatment of cervical spondylosis. Both semi-constrained and non-restrictive prostheses used in cervical disc replacement can lead to satisfied clinic results, and installation of Prodisc-C and Activ-C is simpler. Related Articles | Metrics

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Comparative study of biomechanical characteristics of two kinds of forepart-expansible cages for treating lumbar instability with microendoscopic discectomy Zhang Chun-lin, Yang Tong-bao, Zhu Hong-he, Yan Xu 2012, 16 (9):  1639-1642.  doi: 10.3969/j.issn.1673-8225.2012.09.028 Abstract ( 323 )   PDF (345KB) ( 422 )   Save BACKGROUND: The forepart-expansible cage is a kind of novel expansible cage developed in recent years, of which there are circular and square cages all with larger contact area. OBJECTIVE: To compare the clinical effect of the two kinds of forepart-expansible cage in treatment of lumbar instability with microendoscopic discectomy (MED). METHODS: Totally 97 cases with lumbar instability were underwent posterior lumbar interbody fusion (PLIF) using double tractors swing microendoscopic discectomy. Fifty-one patients were treated with the circular cages and forty-six with the square cases bilaterally or unilaterally. RESULTS AND CONCLUSION: Evaluating clinical effect according to the Oswestry disability Index, the result for the circular group was excellent in 34 cases, good in 13 cases, fair in 3 cases and poor in 1 case. And for the square group, it was excellent in 33 cases, good in 10 cases, fair in 2 cases and poor in 1 case. There was no significant difference between the two kinds of forepart-expansible cages. The vertebral height loss rate of the circular group was higher than that of the square group at 6 and 12 months after procedure (P < 0.05). At the end of the follow-up, 47 cases of the circular group and 44 cases of the square group achieved bony healing. Complications such as one circular cage overturned and moved backward in 3 cases, and minor dural trauma occured in 1 case. The result indicates that the circular cage is much better with lower subsidence rate, larger contact area and more excellent stability. And two square cages can be placed conveniently unilaterally using the “isolation placing technique”. Related Articles | Metrics

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Accuracy of closed reduction for displaced subcapital femoral neck fractures assisted by C-arm X-ray machine   Qi Shan-hong 2012, 16 (9):  1643-1646.  doi: 10.3969/j.issn.1673-8225.2012.09.029 Abstract ( 314 )   PDF (388KB) ( 504 )   Save BACKGROUND: Traction bed C-arm X-ray machine is used for closed reduction and internal fixation to treat femoral neck fracture has some errors. OBJECTIVE: To perspectively analyze the accuracy of closed reduction for femoral neck fractures by assisted C-arm X-ray machine. METHODS: Complete reduction of artificial femoral neck fractures was realized under direct vision and then fixed by kirschner pins which were knocked in at both fractured ends respectively on lateral femoral neck to be used as metal marker. Femoral neck specimens and C-arm X-ray machine were not removed and then the femoral neck specimens revolved 15° clockwise and 30° anticlockwise respectively. Anterior-posterior of the standard femoral neck was examined by C-arm X-ray machine, then corresponding imaging was collected. RESULTS AND CONCLUSION: There was no significant difference of the displacement in the both ends of the subcapital femoral neck fractures (around 1 mm both) when the necks were located at the position of 15°, 30° clockwise and anticlockwise respectively. There was significant difference of the displacement in the both ends of the subcapital femoral neck fractures (around 2 mm both) when the necks were located at the position of 30°, 30° clockwise and anticlockwise respectively. It is shown that C-arm X-ray machine is used to observe the subcapital femoral neck fractures and can meet the reduction requirement of Garden scores, but the femur head rotation cannot be identified. As a result, displaced femoral neck fractures necessitate open reduction. Related Articles | Metrics

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Diffusion tensor imaging on the proximal sciatic nerve of normal adults Chen Jing-cong1, Li Xin-chun1, Sun Chong-peng1, Chen Miao-ling2, He Jian-xun1, Zhao Kang-yan1, Yu Jia-xi1 2012, 16 (9):  1647-1650.  doi: 10.3969/j.issn.1673-8225.2012.09.030 Abstract ( 331 )   PDF (370KB) ( 359 )   Save BACKGROUND: The appearance of diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) technology provides new methods to show tiny structure of peripheral nerves and quantitative analysis. OBJECTIVE: To prospectively analyze the possibility of DTI and DTT on the proximal sciatic nerve of normal adults and their optimal parameters. METHODS: The bilateral sciatic nerves from 28 healthy volunteers were preformed with DTI and DTT through single-shot spin-echo-echo-planar technique, the b value was 1 200, 1 400 and 1 600 s/mm2 respectively. RESULTS AND CONCLUSION: 26 cases were successful reconstructed by DTI and DTT, and the success rate was 93%. The proximal sciatic nerve could show clearly on the DTT map and better integrated with the anatomical images on T1WI. The right and left sciatic nerve had the same dispersion characteristics, with the b value increased, the signal to noise ratio (SNR) was gradually reduced. Longest fibers, maximum SNR and fiber density index were found at b values of 1 200 s/mm2 and the maximum SNR was 142.72±32.25. There was no significant difference of the diffusion tensor parameters in different b values, and there was nosignifiant difference of diffusion tensor parameters between bilateral sciatic nerves (P > 0.05). It indicates that the DTI and DTT on the proximal sciatic nerve of normal adults are feasible. DTI and DTT can show the diffusion characteristics and architecture of the sciatic nerves, and the optimal b value is 1 200 s/mm2. Related Articles | Metrics

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Anterior cervical decompression plus MC+® cervical fusion cage versus anterior corpectomy plus titanium plate internal fixation for treatment of single-level cervical spondylotic myelopathy He Bin1, Fan Lei2, Cheng Wei-nan1, Wang Yun-hua1, Wang Bo-yao1, Liu Jun1, Huang Ye1 2012, 16 (9):  1651-1655.  doi: 10.3969/j.issn.1673-8225.2012.09.031 Abstract ( 345 )   PDF (517KB) ( 601 )   Save BACKGROUND: Anterior cervical decompression and fusion has become the golden standard of anterior cervical surgery for the treatment of cervical spondylotic myelopathy (CSM). But for single level CSM, whether fixation is needed remains controversial. Cervical cage fusion combined with bone grafting plays a very important role in treating single-level CSM in recent years. OBJECTIVE: To compare the clinical curative effects of anterior decompression and implantation of MC+® cervical intervertebral fusion cage combined with bone grafting with anterior cervical vertebrectomy and fixation of titanium plate on the treatment of single-level CSM. METHODS: Totally 42 single-level CSM patients were randomly divided into two groups. Patients treated by anterior decompression and implantation of MC+® cervical intervertebral fusion cage combined with bone grafting were taken as experimental group. Patients in control group were treated by anterior corpectomy and titanium plate internal fixation combined with bone grafting. RESULTS AND CONCLUSION: The postoperative Japanese Orthopedic Association (JOA) scores and cervical curvature improved obviously in both groups (P < 0.05). All cases were followed up for 12-29 months. At six months after surgery and the final follow-up, the JOA scores and the cervical curvature showed no significant differences from those postoperatively (P > 0.05). The JOA scores and cervical curvature showed no statistical differences between the two groups prior to and after surgery as well as at each follow-up (P > 0.05). At the final follow-up, the fusion rate was 100%, neither of the groups had implantation loosening or protrusion. After operation, one case of hoarseness occurred in the experimental group, and in the control group there were one case of hoarseness, three cases of dysphagia, and two cases of esophageal injury. The results indicated that both of the two surgical methods have reliable clinical outcomes for single-level CSM; however, the former one is simpler and has fewer early complications. Related Articles | Metrics

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Systematic review of arthroplasty combined with internal fixation for displaced femoral neck fractures in elderly patients  Chen Yue-ping1, Gao Hui1,Chen Liang1, Luo Dong-fang1, Yin Qing-shui2 2012, 16 (9):  1656-1660.  doi: 10.3969/j.issn.1673-8225.2012.09.032 Abstract ( 303 )   PDF (1285KB) ( 398 )   Save BACKGROUND: Treatment of femoral neck fracture in elderly patients is always through internal fixation or arthroplasty, but how to choose the two procedures for the treatment is the debate focus of orthopedic surgeons. OBJECTIVE: To review the clinical outcomes and safety between arthroplasty and internal fixation in treatment of elderly patients with femoral neck fracture. METHODS: Cochrane central register of controlled trials (fifth book in 2011), MEDLINE (1966-01/2011-05), EMbase (1984-01/2011-05) and CNKI (1979-01/2011-05) were (> 60 years) searched. Only randomized clinical trials that compared arthroplasty with internal fixation for the treatment of femoral neck fracture in the elderly (>60 years) were included. The analysis was performed with software RevMan5.1.2 from the Cochrane collaboration. The study was rated by GRADEpro version3.2.2 Software. RESULTS AND CONCLUSION: There were 87 potentially relevant papers and 13 published studies met all the inclusion criteria and proved eligible for this investigation at last. A total of 2 436 patients were included. The meta-analysis showed there was no significant difference of the mortality between the arthroplasty group and the internal fixation group at 2, 10 or over 10 years follow-up. Reoperation rate and surgical complication at 2, 10 or over 10 years follow-up in the arthroplasty group were significantly lower than those of the internal fixation group. It is indicated that whether short or long-term option arthroplasty for displaced femoral neck fractures in the elderly can significantly reduce the reoperation rate and major complications. Related Articles | Metrics

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The comparative research and international analysis of the application of anticoagulant to prevent thrombosis after knee replacement surgery   Fan Shao-di, Wang Xiao-kun, Bai Feng, Liu Jian, Yu Jie, Chen Rong-bo, Zhou Feng-jin, Hu Wan-hua 2012, 16 (9):  1661-1670.  doi: 10.3969/j.issn.1673-8225.2012.09.033 Abstract ( 296 )   PDF (480KB) ( 532 )   Save BACKGROUND: The application of anticoagulant to prevent thrombosis after knee replacement surgery has become the subject community consensus. OBJECTIVE: To multivariately analyze the literature on the application of anticoagulant to prevent thrombosis after knee replacement surgery through Science Citation Index Database (SCI) and its analysis tool. DESIGN: Bibliometric analysis. DATA RETRIEVAL: A retrieval was performed for the literature of the application of anticoagulant to prevent thrombosis after knee replacement surgery, including knee arthroplasty/prosthesis, thrombosis, prevention/prophylaxis, warfarin, low molecular weight heparin/LMWH, rivaroxaban, aspirin during 2001-01 and 2010-12 in SCI. The retrieval results were analyzed, and the trends were described in words and graphics. SELECTIVE CRITERIA: Articles on the application of anticoagulant to prevent thrombosis after knee replacement surgery including the following types: (1)Peer-reviewed original paper; (2)Reviews; (3)Meeting notes and abstracts; (4)Letters; (5)Editorial materials. Exclusive criteria were included (1)Articles unrelated the study of the application of anticoagulant to prevent thrombosis after knee replacement surgery. (2)Articles published before 2001. (3)Articles which were not published on journals. (4)Articles which need to be retrieved by phone or manually. MAIN OUTCOME MEASUREMENTS: The literatures were analyzed by national distribution, publication year, citation frequency, journal distribution, discipline distribution, institutional information and authors. RESULTS: (1) A total of 484 literatures on the application of anticoagulant to prevent thrombosis after knee replacement surgery were retrieved in SCI database, in which 391 literatures were published as original articles. Six articles were identified as classic literature. The overall number of literature had an upward trend from 2001 to 2010. Thrombosis and Haemostasis published most papers in this field (33 literatures, 6.818%). 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. Related Articles | Metrics

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Influencing factors in the recovery of the survivors with upper limb fracture 1 year after earthquake in Yushu: The analysis with Canadian Occupational Performance Measure  Zhu Yi1, Cheng Jie1, Tang Fang-yi2, Ren Qing3, Huang Jian2, Zhao Yi2 2012, 16 (9):  1671-1675.  doi: 10.3969/j.issn.1673-8225.2012.09.034 Abstract ( 362 )   PDF (280KB) ( 363 )   Save BACKGROUND: Comprehensive evaluation of the real needs of fracture patients in work activities after earthquake and the occupational therapy centered by the survivors can improve the rehabilitation effect. OBLECTIVE: To analyze the relationship between the various factors and functional recovery after upper limbs fracture of earthquake survivors in Yushu district. METHODS: Seventy-four victims with upper limb fracture were invested by on-site survey. The performance and satisfaction of work activities before and after therapy was evaluated by Canadian Occupational Performance Measure (COPM) in order to confirm the occupational issues under resolving of patients. The uniariate analysis and multiple linear regression analysis were employed. RESULTS AND CONCLUSION: The multiple linear regression analysis showed that the performance of work activities was positive correlated with the living conditions, the social interaction activities, the community activities, dialect and housework (P < 0.05) , while negatively with the distance between the inhabitation and the rehabilitation points (P < 0.05). This may provide evidence for future strategy making for developing local therapists of rehabilitation, improving living conditions, reducing the dependence on living conditions, shortening the distance between the inhabitation and the rehabilitation points and enhancing the self-care ability, producing and leisure. Related Articles | Metrics

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Corrosion resistance of orthopedic implants Wang Jun-hong 2012, 16 (9):  1676-1679.  doi: 10.3969/j.issn.1673-8225.2012.09.035 Abstract ( 367 )   PDF (463KB) ( 704 )   Save BACKGROUND: The practical function and service life of the implant materials are affected by electrochemical dissolution of biomedical metallic materials and corrosion damage caused by attrition interaction. OBJECTIVE: To review the corrosion resistance of orthopedic implants. METHODS: A computer-based online search of PubMed database and VIP database was performed for articles related to the corrosion resistance of orthopedic implants, published between January 1995 and October 2011, with the key words of “corrode”, “metal material” and “orthopedic implants” in English and Chinese. RESULTS AND CONCLUSION: Biomedical metallic materials include stainless steel materials, Magnesian and Magnesium alloys materials, titanium materials and Nitinol. The main problem existing in the application of biomedical metallic materials is that the corrosion of the physical environment will cause metal ions to diffuse into the surrounding tissues and property transformations of the implanted material itself. The former may lead to toxic effects while the latter frequently leads to the failure of the material implantation. Therefore to satisfy the demand of clinical medical applications, first of all, the biomedical metallic materials should have biocompatibility and biological safety; second, they should have good corrosion resistance and mechanical properties. Related Articles | Metrics

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Application of intermediate screw technology on thoracolumbar fractures Lü Hao-zhen, Lin Hong, Zhang Shao-kun, Yan Ming, Liu Li-di 2012, 16 (9):  1680-1683.  doi: 10.3969/j.issn.1673-8225.2012.09.036 Abstract ( 363 )   PDF (360KB) ( 559 )   Save BACKGROUND: For thoracolumbar fractures, there are a lot of fixed ways, however, at present intermediate screws in short segment pedicular fixation is minimal damage, cost less, and fixed tightly. OBJECTIVE: To systemic illustrate the technology of intermediate screw and clinical application effect. METHODS: A computer-based online search was performed on PuMed database and CNKI database with key words of “Intermediate screws, pedicular screw fixation, thoracolumbar fracture” in English and Chinese from January 1983 to June 2011. Repeated literatures were eliminated. RESULTS AND CONCLUSION: A total of 48 articles were included to review. Biological mechanics experimental and clinical application result indicates that intermediate screws in short segment pedicular fixation can instantly reset vertebral fracture, restore vertebral body height, and compared with the traditional short segments of the posterior fixation, intermediate screws in short segment pedicular fixation can effectively reduce the incidence of complications of internal fixation loose or screw breakage, vertebral height lost again. Related Articles | Metrics

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Computer reconstruction of a digital visible model of the mandible Yao Hong-lei 2012, 16 (9):  1684-1687.  doi: 10.3969/j.issn.1673-8225.2012.09.037 Abstract ( 311 )   PDF (389KB) ( 503 )   Save BACKGROUND: With the development of the combinations of computer technology and medical science, medical science and engineering, more and more methods are used to reconstruct mandible. OBJECTIVE: To explore the application and significance of three dimensional (3D) computer technology in the reconstruction of mandibular defects. METHODS: A computer-based online search of Wanfang, VIP and PubMed databases was performed for articles related to the digital 3D reconstruction of mandible, which were published between January 1999 and October 2011 with the key words of “mandible”, “digital”, “3D reconstruction” and “computer technology” in Chinese or “CAD/CAM”, “mandible” and “3D mandible model” in English in the titles and abstracts. RESULTS AND CONCLUSION: There are many types of mandibular defects; given the wide individual variation of the mandibular morphology, it is not appropriate to simply use the normal average of mandible instead of the individual mandible to repair. Therefore performing individual design before the mandibular reconstruction is essential. With the wide application of digital technology in the medical field, computer aided design and computer aided manufacturing have effectively solved such problems. An ideal form of the mandible and its anatomical relationship with the maxilla has been designed using the computer; then the physical replication model has been constructed through rapid prototyping technology. It is convenient for the accurate measurement and analysis in vitro as well as the operation design. With the help of computers, bone tissue engineering can build a 3D individual bone tissue which is consistent with the shape of the defects, making the accurate repair of mandibular morphology and function possible. Related Articles | Metrics

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Application of three-dimensional spiral CT reconstruction technology in traumatic fractures  Wu Qing-wu, Yue Jun-yan, Yang Rui-min, Chen Jie, Dou Wen-guang 2012, 16 (9):  1688-1691.  doi: 10.3969/j.issn.1673-8225.2012.09.038 Abstract ( 346 )   PDF (375KB) ( 922 )   Save BACKGROUND: Three-dimensional reconstruction technology of spiral CT has a very important value in bone fractures with complex anatomical structure and more overlapping, which can significantly improve the diagnostic rate, reduce the rate of misdiagnosis, and provide more diagnostic information in clinic. OBJECTIVE: To investigate the principle and clinical application of three-dimensional or multi-plane spiral CT reconstruction at different bone fracture sites. METHODS: A computer-based search of Wanfang, VIP and PubMed databases (1999-01/2011-09) was performed for articles related to multi-plane spiral CT reconstruction in orthopedics. Relevant articles published recently or in authorized journals were preferred. A total of 157 articles were retrieved and finally 30 met the requirement. RESULTS AND CONCLUSION: Three-dimensional or multiple-plane reconstruction after spiral CT scan shows an important value in the examinations of traumatic fractures, and it can visually display fracture damage of the joints, benefit to the right typing of fractures, and provide the basis for orthopedic surgeons to choose appropriate treatments. With the rapid development of multi-slice spiral CT, three-dimensional CT reconstruction is more efficient, simple and practical, and CT images become more clarity. Currently, a computer-assisted surgical system has been developed on the basis of computer image processing technology, which is combined with three-dimensional image reconstruction to enable clinicians to better assess the prognosis for surgical planning or follow-up after treatment. It has a good application value and future prospect. Related Articles | Metrics

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Ideal choice of joint replacement for osteoporotic femoral neck fractures in elderly patients: Hemiarthroplasty or total hip arhtroplasty  Zhao Yao, Tang Jian, Li Quan-li 2012, 16 (9):  1692-1695.  doi: 10.3969/j.issn.1673-8225.2012.09.039 Abstract ( 305 )   PDF (372KB) ( 723 )   Save BACKGROUND: Femoral neck fractures in the elderly are frequent, especially those suffering from osteoporosis. Hip arthroplasty is the major method for treatment, which includes unipolar or bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA). OBJECTIVE: To evaluate the clinical effects of HA and THA for femoral neck fractures in patients over 60 years old suffering from osteoporosis. METHODS: A computer-based online search of Wanfang and PubMed databases was retrieved for articles published between 1990 and 2011 using the keywords of “femoral neck fractures, unipolar hemiarthroplasty, bipolar hemiarthroplasty, total hip arthroplasty” in Chinese and English. Totally 516 articles were retrieved. RESULTS AND CONCLUSION: Many kinds of surgical methods can be selected for femoral neck fractures in the elderly. By the method of HA, anatomic and functional reduction can hardly be achieved. HA, therefore, should only be selected for patients with low functional demands and limited life expectancy. THA is a better choice than HA, as regard to the functional recovery, pain rate and reoperation rate. In conclusion, THA is the first choice for femoral neck fractures in patients over 60 years old who suffer from osteoporosis. Related Articles | Metrics

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Effects of local delivery antibiotics on cells in site Cao Zheng, Hou Shu-xun 2012, 16 (9):  1696-1700.  doi: 10.3969/j.issn.1673-8225.2012.09.040 Abstract ( 212 )   PDF (427KB) ( 412 )   Save BACKGROUND: Local antibiotic delivery can achieve adequate local antibiotic levels and low serum concentrations for the treatment of bone and soft tissue infections. However, the toxic effects of high local antibiotic concentrations on local cells may affect the progress of healing. OBJECTIVE: To understand the effects of antibiotics on local cells, and find a method to reduce the adverse effects of local antibiotics. METHODS: PubMed database and Chinese Biomedical Literature Database (CBM) were searched for articles with the effects of antibiotics on orthopedics local cells published between 1990 and 2011. Totally 40 representative articles were selected to analyze the effects of antibiotics on local cells. RESULTS AND CONCLUSION: At high antibiotic concentrations, most of antibiotics inhibited the survival, proliferation, metabolism and differentiation of cells. While in some conditions, few antibiotics enhance the proliferation, function and differentiation of some cells at special dosage. The effect depended on the kinds of antibiotics and cells. And the drug-induced cells alterations were reversible. The side effects of antibiotics could be overcome by bone morphogenetic protein and preventing the pH from decreasing in traumatized areas. The effects of local delivery antibiotics on cells in site can help to reduce side effect in the treatment of infection by the selection of appropriate kind and dosage of antibiotics. Further studies are needed to optimize local antibiotic delivery. Related Articles | Metrics

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Application of motion sensor based on micro electro mechanical systems for human motion measurement Ye Qiang1, Dai Jian-song1, Gao Shan2, Gao Run3 2012, 16 (9):  1701-1706.  doi: 10.3969/j.issn.1673-8225.2012.09.041 Abstract ( 380 )   PDF (510KB) ( 810 )   Save BACKGROUND: Motion sensor based on micro electro mechanical systems (MEMS) has many features, such as simple installation, use conveniently and lower cost and so on, so it has brought an opportunity for human movement measurement changes. OBJECTIVE: To summarize the motion sensors which suit for the measurement of human movement and research achievements about its applications. METHODS: Articles about the application of MEMS sensor in human movement measurement were retrieved from CNKI and ISI databases with the key words of “micro electro mechanical systems sensor, human motion, human movement” in both Chinese and English from 2005 to August 2011. Articles in the same circle published in the authoritative journals or recently published (past 5 years) were included. RESULTS AND CONCLUSION: Totally 180 articles were initialy retrieved, and 34 were selected in the final analysis. There are increased awareness and application of MEMS sensor techniques in human movement measurement field. Motion sensors can quickly and easily detect the body movement information which can be widely used in clinical field. With the continuous development of hardware and software technology, MEMS sensor techniques will be mainstream means of human movement measurement. Related Articles | Metrics

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Autologous bone marrow transplantation and extracorporeal shock wave as well as plaster fixation for the treatment of tibial fatigue fracture   Cui Hai-feng, Miao Xu-man, Shi Wei, Liu Ming-xi 2012, 16 (9):  1707-1710.  doi: 10.3969/j.issn.1673-8225.2012.09.042 Abstract ( 282 )   PDF (339KB) ( 419 )   Save BACKGROUND: Fatigue fracture is common injuries in military training. To date, the therapy of the injuries is mainly conservative with the characters of long healing time, poor functional recovery and there is no specific treatment for the fatigue facture. OBJECTIVE: To compare the effect of extracorporeal shock wave (ESW), autologous bone marrow transplantation (ABMT) and plaster fixation treatment (PFT) on the healing of fatigue fracture in order to seek for the best therapy． METHODS: Thirty male patients with tibial fatigue fracture type Ⅱ in hospital were randomly divided into three groups: ① ESW group, positioned by the CT, took the fatigue fracture center as the impact point and gave a single treatment. ② ABMT group, took the bone marrow 3-5 mL from lower part of anterior superior iliac spine or the thicker part of posterior inferior iliac spine and injected it in the fatigue fracture ends and gave a single treatment. ③ PFT group, the patients were treated with rest, fixation of the fracture and took blood activating medicine. The fracture healing conditions of three groups were evaluated according to the X-ray imaging and functional recovery standard at the 2nd, 4th, 6th and 8th weeks after treatment, respectively. RESULTS AND CONCLUSION: According to X-ray results, the difference of fracture healing was not significant in ESW group and ABMT group at 8 weeks after treatment and both of which were better than PFT group (P < 0.05). Functional recovery observation results showed that ESW group is better than ABMT, which is still better than PFT group. ESW treatment is an effective mean in the healing of fatigue fractures. Related Articles | Metrics