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    26 March 2014, Volume 18 Issue 13 Previous Issue    Next Issue
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    Mechanical analysis of total hip replacement with cup of different diameters in patients with developmental dysplasia of hip
    Xu Jie, Ma Ruo-fan, Cai Zhi-qing, Li Deng
    2014, 18 (13):  1969-1974.  doi: 10.3969/j.issn.2095-4344.2014.13.001
    Abstract ( 446 )   PDF (785KB) ( 395 )   Save

    BACKGROUND: The anatomical structure of acetabulum is different for the developmental dysplasia of the hip, which is small and shallow, with abundant callus and scar tissue. It is difficult to determine the diameter of cup and installation of the cup during arthroplasty. Loosening and survival of postoperative prosthesis were influenced by local mechanical changes.
    OBJECTIVE: Using the three-dimensional finite element analysis, the stress distribution in acetabular cup-bone interface after implanting cups with different diameters was studied during total hip replacement in treating the dysplasia of hip.
    METHODS: Pelvis of developmental dysplasia of the hip patients was selected in this study. Acetabulum in the dysplasia was scanned by spiral CT. The computer simulation technology was applied to reconstruct the three-dimensional model of the pelvic for observing the dysplasia of hip from CT scan picture. Implanting cups with different diameters were simulated. Then the pelvis and acetabular cup model were meshed. The mechanics analysis tool was used to analyze three-dimensional model.
    RESULTS AND CONCLUSION: For the developmental dysplasia, we chose cup with small diameter that could lead to better bone bed inclusion of cup during total hip replacement. Small diameter cup induced a small contact area and increased unit area stress. On the other hand, with implanting the larger cup and increasing degree of acetabular grinding, the acetabular wall bone breaks more obvious, so that the stress (compressive stress and shearing force) concentration at the top of the acetabulum and uneven stress in the rest were apparent increasingly. Thus, in clinical practice, under the premise of the bone bed inclusion, a large diameter cup is helpful to good distribution of stress during total hip replacement, but the perforation of acetabular wall induced by enlarged bone bed should be avoided or minimized.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Posterior hip dislocation combined with femoral head fractures: effects of typing and repair methods
    Tan Zhang-yong, Wang Jian-liang, Guo Feng, Liu Wei-feng, Xu Ke-feng
    2014, 18 (13):  1975-1980.  doi: 10.3969/j.issn.2095-4344.2014.13.002
    Abstract ( 1020 )   PDF (780KB) ( 608 )   Save

    BACKGROUND: Posterior hip dislocation combined with femoral head fractures easily induced femoral head necrosis, ectopic ossification, osteoarthritis and deep vein thrombosis. Different therapeutic methods should be utilized according to the type of fracture.
    OBJECTIVE: To investigate the factors affecting the therapeutic effects and complications following surgery of posterior hip dislocation combined with femoral head fractures.
    METHODS: Twenty-eight patients, who had been diagnosed as posterior hip dislocation combined with femoral head fractures in the 101 Hospital of Chinese PLA from September 2004 to May 2010, were enrolled in this study. According to Pipkin typing, operative approach and the time from injury to surgery, therapeutic effects were evaluated using radiographs and the recovery conditions of hip function (Epstein method), and the occurrence of complications was recorded.
    RESULTS AND CONCLUSION: A total of 28 patients were followed up from 1 to 5 years, averagely 2.8 years. Using the Epstein method, there were excellent in 6 cases, good in 12 cases, average in 7 cases, and poor in
    3 cases, with an excellent and good rate of 64%. The therapeutic effects in patients with Pipkin I and II were good, with excellent and good rates of 100% and 78%, respectively. Moreover, the complications were less, with a rate of 17% and 22%, respectively. The therapeutic effects of patients with Pipkin III and IV were poor, especially, Pipkin IV patients, whose excellent and good rate was only 20% and the incidence of complications was 80%. No significant difference in the incidence of complications was detected in patients undergoing Smith-Peterson anterior approach and K-L posterior approach (P > 0.05). No significant difference in the incidence of complications was detectable among patients from three groups (the time from fracture to operation < 12 hours, 12-48 hours, and > 48 hours) (P > 0.05). Results indicated that the choice of treatment method should be 
    determined by the type of fracture. The prognosis depends on the patient’s age, time of treatment, types of fracture and dislocation, methods of treatment and related measures of prevention of complications.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Gait parameters in lower extremities of patients in sequela period after unilateral total hip arthroplasty
    Zhao Jiang-li, Wu Pei-hui, Xu Guang-qing, Mao Yu-rong, Liao Wei-ming, Huang Dong-feng
    2014, 18 (13):  1981-1987.  doi: 10.3969/j.issn.2095-4344.2014.13.003
    Abstract ( 363 )   PDF (633KB) ( 807 )   Save

    BACKGROUND: Total hip arthroplasty is known to be a successful surgical procedure to alleviate hip pain and to regain gait ability, but there are many debates on whether patients’ gait could reach a normal level several years later.
    OBJECTIVE: To investigate spatiotemporal parameter characters of lower extremities in patients during walking in sequela period following unilateral total hip arthroplasty, and to probe into patients’ walking abilities.
    METHODS: In accordance with the method of Case Database Data Analysis detected by Motion Reconstruction Laboratory, 14 patients at 5-10 years after total hip arthroplasty served as the experimental group, and 14 matched healthy persons served as the control group. Gait parameters of lower extremities during walking were collected by Vicon Nexus. Spatiotemporal parameter characters of lower extremities during gait cycle were analyzed by using Polygon.
    RESULTS AND CONCLUSION: Compared with the control group, walking speed, cadence, stride length and step length decreased, but double support and opposite foot off increased on both affected and unaffected sides in the experimental group (P < 0.05). Both stride time and step time of the operated lower extremities increased (P < 0.05). Foot off of non-operated lower extremities increased (P < 0.05). There was no significant difference in all spatiotemporal parameters between operated and non-operated lower extremities (P > 0.05). The results suggested that gaits of patients showed good gait symmetry at 5-10 years after surgery. However, they do not reach the level that observed in healthy subjects, and walking ability was poorer than normal persons. Systematic rehabilitation training is needed to improve walking ability.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Synthes cable system for periprosthetic femoral fractures after total hip replacement
    Liu Yi, Yan Jian-jun, Cui Sheng-yu, Cui Zhi-ming
    2014, 18 (13):  1988-1993.  doi: 10.3969/j.issn.2095-4344.2014.13.004
    Abstract ( 937 )   PDF (2012KB) ( 816 )   Save

    BACKGROUND: Recently, periprosthetic femoral fractures have been a common complication after total hip replacement. Vancouver type B1 periprosthetic femoral fractures commonly received internal fixation due to stable femoral prosthesis and less bone defects.
    OBJECTIVE: To evaluate the effect of the application of Synthes cable system in the treatment of Vancouver type B1 periprosthetic femoral fractures after total hip replacement.
    METHODS: From May 2009 to October 2012, 18 patients with Vancouver type B1 periprosthetic femoral fractures were treated with Synthes cable system in the Department of Orthopedics, Nantong First People’s Hospital. There were 8 males and 10 females with an average age of (62.67±8.67) years ranging 45 to 80 years. They received a further consultation at 1, 3 and 6 months after treatment. The function of hip joint was evaluated by Harrris evaluation standard: full marks, 100 points, ≥ 90 points, excellent; 80-89 points, better; 70-79 points, good;
    < 70 points, poor.
    RESULTS AND CONCLUSION: All 18 patients were followed up for 6 to 43 months. Mean healing period was (19.06±4.04) weeks. Harris score was (22.3±3.6) points before treatment in 18 cases. Harris score was higher significantly at 1, 3 and 6 months after treatment compared with that before treatment (P < 0.01), and the recovery of hip function was good. Results indicated that Synthes cable system could help to restore the normal anatomic structure of femur in the greatest extent, showing simple operation, little injury, high stability and high safety. It is an ideal method for treating Vancouver type B1 periprosthetic femoral fractures.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Reasons for revision in 33 patients after total hip replacement
    Zeng Mian-dong, Li Chang-shu, Hu Han-sheng, Wang Le, Li Yuan-hui, Qiu Qin-ye, Zhang Zhi
    2014, 18 (13):  1994-1999.  doi: 10.3969/j.issn.2095-4344.2014.13.005
    Abstract ( 367 )   PDF (765KB) ( 417 )   Save

    BACKGROUND: The number of complications after hip replacement, such as infection, implant loosening, fracture prosthesis wear, osteolysis, and recurrent dislocation, had drastically increased. These complications would induce the increased occurrence of total hip revision.
    OBJECTIVE: To analyze the causes and treatment measures of revision after total hip replacement.
    METHODS: The reasons for revision, the prosthesis selection, the treatment of bone defect and the postoperative rehabilitation were discussed in 33 cases after total hip replacement. The prosthesis for revision included general metal ring and lining (21 cases), large head and cup (8 cases), polyethylene cup (4 cases), general femoral components (15 cases, including 11 cases fixed by bone cement), and lengthening femoral components (18 cases, including 9 cases fixed by bone cement and 6 cases of combined components).
    RESULTS AND CONCLUSION: All 33 patients were followed up for 24-60 months, averagely 36.5 months. After revision, wound healed perfect, and the prosthesis was reliable. No case suffered from infection or dislocation. Hip joint function was greatly improved. Harris score was increased from 37.1 preoperatively to 91.3 postoperatively. Medium- or short-period clinical follow-up results demonstrated that if the indication of revision was right, bone defects were handled perfectly, prosthesis was chosen correctly, one-stage total hip revision can get a good clinical efficacy.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Seasonal variation in the occurrence of deep venous thrombosis after total hip and knee arthroplasty
    Qiao Zhi, Wang Yi-sheng, Yin Li, Chen Qiang, Wang Yong-sheng, Wang Xiu-li, Zhang Chi
    2014, 18 (13):  2000-2005.  doi: 10.3969/j.issn.2095-4344.2014.13.006
    Abstract ( 537 )   PDF (786KB) ( 474 )   Save

    BACKGROUND: Deep vein thrombosis and pulmonary embolism are certainly related to seasons.
    OBJECTIVE: To analyze whether there is a seasonal pattern for deep venous thrombosis (DVT) after total hip and knee arthroplasty.
    METHODS: We retrospected 866 patients (1 114 joints) underwent total hip and knee arthroplasty. There were 506 cases of total hip arthroplasty, including 287 male cases and 219 female cases, and 608 cases of total knee arthroplasty, including 133 male cases and 475 female cases. The average age was (60.98±0.87) years. After arthroplasty, patients were given color Doppler ultrasound in the deep veins of the lower limbs and pelvis to analyze the correlation between occurrence of deep vein thrombosis and seasons.
    RESULTS AND CONCLUSION: There was a significant difference in the incidence of deep vein thrombosis in summer and winter (χ²=7.190, P=0.007), in summer and spring (χ²=6.995, P=0.008), as well as in summer and autumn (χ²=5.663, P=0.017). No statistical differences were tested in spring and autumn, in autumn and winter, and in spring and winter (P > 0.05). These findings indicate that there is a seasonal variation of deep venous thrombosis after arthroplasty, and the highest incidence of deep vein thrombosis is in winter.


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    Risk factors and prognosis of perioperative hidden blood loss in hip replacement patients
    Li Shao-fei, Guo Ting, Zhao Jian-ning, Bao Ni-rong
    2014, 18 (13):  2006-2011.  doi: 10.3969/j.issn.2095-4344.2014.13.007
    Abstract ( 379 )   PDF (764KB) ( 413 )   Save

    BACKGROUND: Hidden blood loss, a frequent occurrence following artificial joint replacement, greatly affects the recovery from total hip arthroplasty. Many factors have been shown to have a correlation with the hidden blood loss, but the specific mechanism is not yet clear.
    OBJECTIVE: To investigate the correlation of patients’ baseline (sex, age, underlying disease, obesity), prosthesis types, surgical time with hidden blood loss following total hip arthroplasty, as well as the association between hidden blood loss and prognosis.
    METHODS: Ninety patients undergoing total hip arthroplasty were enrolled in this study. Using Gross formula, we calculated the total blood loss according to height, weight, and pre- and post-operative hematocrit, and subtracted the dominant loss of blood to get the quantitative value of hidden blood loss. According to the criterion, the 90 patients were divided to two groups: group I: volume of hidden blood loss > 480 mL, group II: volume of hidden blood loss < 480 mL. Then we analyze the difference in the gender, age, underlying disease, type of prosthesis, surgical time between the two groups, and whether there was a correlation between these factors and hidden blood loss. All the patients were followed for 1 year. Perioperative complications and survival curves were observed and monitored in the two groups.
    RESULTS AND CONCLUSION: There were 39 patients in the group I, including 64.1% males, 64.1% hypertension patients, 35.9% diabetic patients, 7.7% patients receiving cement prosthesis; while, there were 51 patients in the group II, including 37.3% males, 25.5% hypertension patients, 5.9% diabetic patients, 35.3% patients receiving cemented prosthesis, showing a significant difference between the two groups. Based on these experimental findings, age, hypertension, diabetes mellitus, type of prosthesis were shown to be factors independently associated with hidden blood loss; however, obesity and smoking exhibited no correlation with hidden blood loss. In addition, a statistical difference in the survival rate was found at admission and during the 1-year follow-up.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Administration of aspirin and rivaroxaban prevents deep vein thrombosis after total knee arthroplasty
    Zou Yue, Tian Shao-qi, Wang Yuan-he, Liu Jiang-jun, Sun Kang
    2014, 18 (13):  2012-2017.  doi: 10.3969/j.issn.2095-4344.2014.13.008
    Abstract ( 784 )   PDF (362KB) ( 477 )   Save

    BACKGROUND: To date, rivaroxaban has been a clinically common anticoagulant in China; however, effective prophylaxis for venous thrombosis is associated with a markedly higher incidence of perioperative hemorrhagic complications. Although it has been reported that aspirin effectively prevents deep vein thrombosis and pulmonary embolism, the use of aspirin as a routine drug for venous thrombosis after total knee arthroplasty is still controversial.
    OBJECTIVE: To compare the efficacy and safety of aspirin and rivaroxaban for prevention of deep vein thrombosis after total knee arthroplasty.
    METHODS: Totally 324 patients with osteoarthritis who underwent primary unilateral total knee arthroplasty were randomly divided into three groups. Twelve hours after the surgery, three groups were given aspirin, rivaroxaban and low-molecular-weight heparin respectively. All three groups were treated for 14 days, and all of the patients were followed for 4 weeks.
    RESULTS AND CONCLUSION: Compared with the low-molecular-weight heparin group, the incidence of deep vein thrombosis was lower (P < 0.05), but hidden blood loss and wound complications were more common (P < 0.05) in the rivaroxaban group. There were no significant differences between the low-molecular-weight heparin group and aspirin group in the incidence of deep vein thrombosis, hidden blood loss, wound complications or incidences of lower limb swelling and subcutaneous ecchymosis (P > 0.05). The results confirmed that rivaroxaban has a positive anticoagulation effect but leads to increases in wound complications in patients; there are no differences in efficacy and safety between aspirin and low-molecular-weight heparin, so aspirin as part of a multimodal anticoagulation therapy after total knee arthroplasty has good clinical safety and efficacy.


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    Total knee arthroplasty with Gemini MKII rotating-platform prosthesis
    Wang Qiang, Sun Jun-ying, Xue Feng, Sheng Xiao-wen, Peng Yu-qin
    2014, 18 (13):  2018-2023.  doi: 10.3969/j.issn.2095-4344.2014.13.009
    Abstract ( 513 )   PDF (848KB) ( 412 )   Save

    BACKGROUND: Total knee arthroplasty mainly used fixed platform, but more and more movable platform was selected year by year in the clinic. Rotary platform theoretically can apparently improve the curative effects, but it has not been verified in the clinic.
    OBJECTIVE: To summarize the design characteristics and clinical results of Gemini MKII (Link, Germany) rotary platform.
    METHODS: From January 2004 to January 2009, 108 patients (119 knees) including 31 males and 77 females were treated with total knee arthroplasty by using Gemini MKII system. There were 97 unilateral cases and
    11 bilateral cases at the first stage of replacement. Preoperative diagnosis: 1 case of hemophilic arthritis, 1 case of venereal Charcot’s disease, 8 cases of post-traumatic arthritis, 11 cases of rheumatoid arthritis, and 87 cases of degenerative osteoarthritis. The prosthesis was fixed with bone cement. None received patellar replacement.
    RESULTS AND CONCLUSION: None experienced infection, femoral condyle fracture or nerve and vascular damage. Except bilateral replacement, the average operation time of unilateral replacement was (56±13) minutes. Average postoperative hemoglobin decreased (25±5) g/L. After replacement, hemoglobin maintained over
    100 g/L in 83 patients (86%), without blood transfusion. Knee joint score and function score recovered to (92.0±4.7) points and (90.3±6.8) points at half years after replacement, and became (94.4±3.2) points and (91.6±5.9) points during final follow-up, which was significantly improved as compared with that pre-replacement (P < 0.01). No revision surgery should be done for lining prolapse or spin out, osteolysis and prosthesis loosening. These results indicated that the early and midterm results of Gemini MKII rotating-platform prosthesis were satisfactory, but the long-term results remain to be confirmed.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Surface electromyography of lower limb muscles in knee osteoarthritis patients undergoing knee joint replacement
    Huang Ping, Liu Zhi-hong, Qi Jin, Chen Bo, Xu Jian-qiang, Deng Lian-fu
    2014, 18 (13):  2024-2029.  doi: 10.3969/j.issn.2095-4344.2014.13.010
    Abstract ( 354 )   PDF (378KB) ( 442 )   Save

    BACKGROUND: It has still been controversial about the functional recovery of lower limb muscles in patients with knee osteoarthritis after knee joint replacement.
    OBJECTIVE: To evaluate the function of lower limb muscles in patients with knee osteoarthritis after knee joint replacement.
    METHODS: Lower limb muscles (rectus femoris muscle, tibialis anterior muscle, biceps femoris muscle, medial head of gastrocnemius muscle) of 25 patients with bilateral knee osteoarthritis after unilateral knee joint replacement were tested in flat land walking using surface electromyography (TELEMYO 2400R G2, USA). Before the surface electromyography, bilateral knee joint functions of the patients were evaluated using the Hospital for Special Surgery knee score.
    RESULTS AND CONCLUSION: After knee replacement, the Hospital for Special Surgery knee score showed that the average score in replacement surgery side was 91.44 points and the excellent and good rate was 100%. The average score in non-replacement side was 54.52 points. Pain and joint function of replacement surgery side was improved significantly after surgery. There was no significant difference between knee joint replacement side and non-replacement side in the amplitude, the integral electromyography, the mean frequency, the median frequency (average, minimum, maximum) of rectus femoris muscle, tibialis anterior muscle and biceps femoris muscle (P > 0.05). The amplitude and the integral electromyography in the medial head of gastrocnemius muscle were significantly higher in the replacement side than those in the non-replacement side (P < 0.05). There was no significant difference in mean frequency and the median frequency in the medial head of gastrocnemius muscle between knee joint replacement side and non-replacement side (P > 0.05). These results indicated that the lower limb muscle function did not return to normal activity levels in patients after knee joint replacement, so the muscle exercise is especially valuable in the postoperative rehabilitation of these patients.


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    Radial head replacement versus open reduction and internal fixation for comminuted radial head fractures: more advantageous? 
    Wang Si-cheng, Liu Xiang-fei, Yang Guo-qing, Zhang You-zhong, Zhao Zhen-ying, Fang Yang, He Jin-guo, Wu Xian-min
    2014, 18 (13):  2031-2036.  doi: 10.3969/j.issn.2095-4344.2014.13.011
    Abstract ( 354 )   PDF (885KB) ( 518 )   Save

    BACKGROUND: At present, the methods of treating unstable comminuted radial head fractures contain open reduction and internal fixation and metal prosthesis replacement. There were success cases treated by the two methods, but some shortcomings simultaneously existed.
    OBJECTIVE: To compare the clinical therapeutic effects of replacement of the radial head with metal prosthesis with open reduction and internal fixation for the treatment of unstable comminuted radial head fractures.
    METHODS: A prospective randomized controlled analysis was performed in 45 cases of unstable comminuted radial head fractures. These cases received open reduction and internal fixation and metal prosthesis replacement. This study compared the Broberg and Morrey elbow joint function score and the incidence of complications after fixation, and performed statistical analysis.
    RESULTS AND CONCLUSION: The subjects were followed up for 1-5 years, averagely 2.8 years. According to Broberg and Morrey scores, the average score was 90.1 and the incidence of complications was 13.6% in the prosthesis replacement group. The average score was 76.8 and the incidence of complications was 47.9% in the open reduction. Significant differences were visible between the two groups (P < 0.01). Compared with the open reduction group, prosthesis replacement for unstable comminuted radial head fractures obtained better joint function and lower incidence of complications.


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    Correlation of posterior cervical decompression with spinal cord shifting backward distance and axial symptoms 
    Wang Hao, Wang Pei
    2014, 18 (13):  2037-2042.  doi: 10.3969/j.issn.2095-4344.2014.13.012
    Abstract ( 806 )   PDF (910KB) ( 563 )   Save

    BACKGROUND: The distance of spinal cord shifting backward after treatment through cervical posterior approach is affected by various factors. In fact, it is a morphological change after spinal cord is affected by external force.
    OBJECTIVE: To analyze the influential factors for spinal cord shifting backward after posterior cervical decompression for cervical spondylotic myelopathy.
    METHODS: Case data of 70 patients with multi-segmental cervical spondylotic myelopathy undergoing posterior cervical decompression were retrospectively analyzed. According to the different distances of spinal cord shifting backward after treatment, they were divided into three groups: < 3 mm group, 3–5 mm group, and > 5 mm group. In accordance with Japanese Orthopaedic Association Scores, the degree of cervical curvature and axial symptom index were compared.
    RESULTS AND CONCLUSION: No significant difference in the recovery rate of Japanese Orthopaedic Association Scores was detected among the three groups. No significant difference in cervical curvature was visible among the three groups before and after treatment. The proportion of axial symptom was significantly higher in the patients of > 5 mm group than the other two groups after treatment (P < 0.05). These results suggested that the distance of spinal cord shifting backward was associated with axial symptom after treatment in patients with cervical spondylotic myelopathy after posterior cervical decompression.


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    Ventral release and posterior screw/rod implant fusion for irreducible atlantoaxial dislocation: one-year follow-up
    Sun Xiu-qin, Liao Wen-sheng, Wang Li-min, Bao Heng, Wang Wei-dong, Jian Yan-peng
    2014, 18 (13):  2043-2048.  doi: 10.3969/j.issn.2095-4344.2014.13.013
    Abstract ( 397 )   PDF (818KB) ( 322 )   Save

    BACKGROUND: Transoral ventral release and posterior fusion have predominated in the treatment of irreducible atlantoaxial dislocation, but there is no consistent conclusion on the clinical efficacy.
    OBJECTIVE: To explore the clinical outcomes of transoral ventral release and posterior fusion and screw/rod implantation in the treatment of irreducible atlantoaxial dislocation.
    METHODS: A total of 32 patients with irreducible atlantoaxial dislocation undergoing thetransoral ventral release and posterior fusion were selected. After treatment, they received cervical anteroposterior and lateral digital DR and cervical MRI examinations to understand the conditions of nerve compression and bone fusion. The recovery of nerve function was evaluated using Japanese Orthopaedic Association before treatment, 6 months after treatment and during final follow-up.
    RESULTS AND CONCLUSION: Post-treatment, 29 patients were followed-up for an average period of 12 months. (1) All the patients obtained perfect atlantoaxial joint reduction and bone fusion. This achieved reduction and reconstruction of spinal column stability. (2) Spinal compression was obviously lessened after treatment in all patients, and nerve functions were improved to different degrees. Significant differences in Japanese Orthopaedic Association score were detected between 6 months post-treatment, final follow-up and pre-treatment (P < 0.05). (3) There were no serious intraoperative complications such as spinal cord or vertebral artery injuries. Postoperative complications such as infection or burst were also not found. (4) Imaging evaluation revealed that transoral ventral release and posterior fusion is safe and effective for treatment of irreducible atlantoaxial dislocation.


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    Effects of anterior fusion cage fixation on cervical curvature, stability and axial symptoms
    Li Kuan-kuan, Xia Lei, Sang Liang
    2014, 18 (13):  2049-2054.  doi: 10.3969/j.issn.2095-4344.2014.13.014
    Abstract ( 472 )   PDF (887KB) ( 703 )   Save

    BACKGROUND: The combination of anterior and posterior approaches for severe cervical intervertebral disk herniation, posterior longitudinal ligament calcification and ligament flava hyperplasia can completely reduce compression. Simultaneously, cage implantation and anterior plate fixation partially recover vertebral interspace and physiological curvature of cervical vertebra.
    OBJECTIVE: To compare the effects of cervical posterior single-door laminoplasty for cervical spondylosis and anterior cage-assisted fusion on curvature, stability and axial symptoms after treatment.
    METHODS: Clinical data of 50 patients, who received surgical treatment for cervical spondylosis, were retrospectively analyzed. 22 cases underwent I-stage spinal decompression by the combination of anterior and posterior approaches (anterior fusion cage + steel plate fixation) (combination group). 28 cases underwent cervical posterior single-door laminoplasty (posterior windowing rivet fixation) (posterior approach group). They were followed up for 6 to 24 months. The recovery of neurological function, incidence of axial symptoms, cervical curvature index, and slipping degree of affected intervertebral segments were analyzed statistically.
    RESULTS AND CONCLUSION: The neurological functions were greatly improved according to Japanese Orthopaedic Association in both groups. Incidence of axial symptoms was relatively low in the combination group. Cervical curvature index was obviously improved in the combination group compared with the posterior approach group. The slipping degree of affected intervertebral segments was relatively greater in the posterior approach group than that in the combination group. Results suggested that fusion cage, anterior steel plate and posterior 
    rivet for spinal decompression in I-stage combination of anterior and posterior approaches can effectively maintain cervical physiological curvature and the balance of sagittal level, reduce incidence of axial symptoms, and play a key effect on keeping posttreatment long-period cervical stability.


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    Biomechanical changes of spine after thoracolumbar fracture and dislocation treated with pedicle screw internal fixation
    Deng Hai-tao, Wang Qing
    2014, 18 (13):  2055-2058.  doi: 10.3969/j.issn.2095-4344.2014.13.015
    Abstract ( 412 )   PDF (689KB) ( 450 )   Save

    BACKGROUND: Anterior decompression, bone graft fusion, plate and screw fixation are commonly used in clinic for the treatment of thoracolumbar burst or comminuted fractures. The posterior surgery including decompression laminectomy and pedicle screw internal fixation.
    OBJECTIVE: To explore the biomechanical changes of spine after thoracolumbar fracture and dislocation treated with pedicle screw internal fixation.
    METHODS: Forty-six patients with thoracolumbar fracture and dislocation were treated with pedicle screw internal fixation, and then the recovery of spinal cord injury and fracture reduction were observed after internal fixation, immediately after internal fixation and 1-year follow-up.
    RESULTS AND CONCLUSION: All the 46 cases were followed-up. Frankel function classification assessment was used to evaluate the spinal cord injury grade. There was no significant difference in the percentage of A grade between periods (P > 0.05), and there were significant differences in the percentage of B-E grades when compared between immediately postoperative period, 1-year follow-up period and preoperative period (P < 0.05), but there was no significant difference when compared between immediately postoperative period and 1-year-follow period (P > 0.05). The anterior height percentage, posterior height percentage and Cobb angle indicators were used to assess the fracture reduction, and the results showed there was no significant difference in posterior height between periods (P > 0.05), and there was significant difference in Cobb angle when compared between immediately postoperative period, 1-year follow-up period and preoperative period (P < 0.05), but there was no significant difference between immediately postoperative period and 1-year follow-up period (P > 0.05).  
    The results indicate that pedicle screw internal fixation system for the treatment of thoracolumbar spinal fracture and dislocation is conducive to the fracture reduction and functional recovery.


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    Percutaneous annulus fibrosus needle puncture versus muscular annulus fibrosus knife penetration for establishing a rabbit model of intervertebral disc degeneration
    He Qing, Li Bing, Zhuo Xiang-long, Lai Cao-sheng, Tie Chao-en
    2014, 18 (13):  2059-2064.  doi: 10.3969/j.issn.2095-4344.2014.13.016
    Abstract ( 369 )   PDF (887KB) ( 339 )   Save

    BACKGROUND: Studies have shown that the establishment of disc degeneration model provides experimental support for the treatment of intervertebral disc degeneration, but the current study still lacks of recognized optimal animal models.
    OBJECTIVE: To compare the differences of percutaneous annulus fibrosus needle puncture with muscular annulus fibrosus knife penetration in establishing a rabbit model of intervertebral disc degeneration.
    METHODS: The New Zealand rabbit models of intervertebral disc degeneration were established by percutaneous annulus fibrosus needle puncture and muscular annulus fibrosus knife penetration. At 4, 8 and
    16 weeks after puncture, lumbar disc degeneration and histopathological conditions were observed using magnetic resonance imaging and histopathology examination.
    RESULTS AND CONCLUSION: At 4 weeks after the puncture, T2-weighted image signal reduced, darken, and disc height decreased in rabbit nucleus pulposus of the two groups. T2 signal intensity scores were lower in the percutaneous annulus fibrosus needle puncture group compared with the muscular annulus fibrosus knife penetration group (P < 0.05). At 8 weeks after puncture, T2 signal intensity scores were increased in both groups. T2 signal intensity scores were lower in the percutaneous annulus fibrosus needle puncture group compared with the muscular annulus fibrosus knife penetration group (P < 0.05). At 16 weeks after puncture, T2 signal intensity reached a peak, and no significant difference was detected between the two groups. Intervertebral space became significantly narrowed. The brightness of the disc became black. There were no significant differences between 
    the two groups. The time of operation was shorter in the percutaneous annulus fibrosus needle puncture group than that in the muscular annulus fibrosus knife penetration group (P < 0.05). Infection rate was 5.6% in the muscular annulus fibrosus knife penetration group. No infection was observed in the percutaneous annulus fibrosus needle puncture group. Results verified that the time of establishing a rabbit model of intervertebral disc degeneration using percutaneous annulus fibrosus needle puncture was short, and the infection rate was low. Thus, its effects were better than muscular annulus fibrosus knife penetration.


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    Coflex interspinous process dynamic internal fixation for lumbar degenerative diseases: the recovery of foraminal height and curative effects
    Liang Chang-xiang, Chang Yun-bing, Gu Hong-lin, Liu Bin, Yin Dong, Zheng Xiao-qing, Huang Shuai-hao
    2014, 18 (13):  2065-2070.  doi: 10.3969/j.issn.2095-4344.2014.13.017
    Abstract ( 341 )   PDF (800KB) ( 834 )   Save

    BACKGROUND: Recently, Coflex was widely used in hospital in China for the treatment of lumbar disc herniation and lumbar spinal stenosis, and obtained perfect therapeutic effects.
    OBJECTIVE: To discuss the curative effect of treating lumbar degenerative diseases by Coflex interspinal device, and to explore the relationship between foraminal height and the curative effect by comparing the change of foraminal height and the change of lumbar function.
    METHODS: Coflex implantation for lumbar disc herniation and lumbar spinal stenosis was performed. The foraminal height and the heights of anterior and posterior borders were investigated. ODI and visual analogue scale before internal fixation, at 1 year after treatment and during follow-up were recorded.
    RESULTS AND CONCLUSION: The foraminal height and the heights of anterior and posterior borders were obviously increased after internal fixation. At 1 week after treatment, radiographs exhibited that the foraminal height and intervetebral height were maximal. The foraminal height and the heights of anterior and posterior borders decreased with prolonged follow-up time. At 26.4 months after mean internal fixation, significant 
    differences in the foraminal height and intervetebral height were detected as compared with pre-fixation. Results of ODI and visual analogue scale demonstrated that patients’ functions were significantly improved at 3 months after treatment, and further improved at about 1 year after fixation. The recovery of lumbar vertebra function was optimal. No significant difference in ODI score was detectable between final follow-up and 1-year fixation. These results suggested that Coflex for lumbar disc herniation and mild and moderate lumbar spinal stenosis obtained ideal therapeutic effects. Its therapeutic effects mainly originate from the intraoperative decompression on dura mater and nerve root. However, Coflex effects on the recovery of foraminal height gradually lost with prolonged follow-up time.


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    Unilateral or bilateral nail-rod system for schwannoma in the spinal canal or intervertebral foramen: evaluation of spinal stabilization
    Zhang Peng, Wang Ting, Qu Shao-zheng, Zhang Jin-feng, Li Shu-zhong
    2014, 18 (13):  2071-2076.  doi: 10.3969/j.issn.2095-4344.2014.13.018
    Abstract ( 443 )   PDF (1315KB) ( 342 )   Save

    BACKGROUND: The choice of schwannoma resection is strongly associated with whether the tumor was completely resected, whether stretch during resection injures spinal nerves, and finally with the prognosis of treatment.
    OBJECTIVE: To evaluate the spinal stabilization after laminectomy combining unilateral or bilateral nail-rod system for schwannoma in the spinal canal or intervertebral foramen.
    METHODS: A total of 48 cases of schwannoma in the spinal canal or intervertebral foramen of neck, chest and waist underwent laminectomy combining unilateral or bilateral nail-rod system. 34 cases in spinal canal received bilateral nail-rod system, and 14 cases in the intervertebral foramen received unilateral nail-rod system.
    RESULTS AND CONCLUSION: At 3 days and 3, 6, 12 months after internal fixation, radiograph results demonstrated that location of implants was good. Bone graft fusion was found. No spinal instability and vertebral slippage occurred. Neural functional score Bodford (1997) and quality of life score were significantly increased
    after treatment (P < 0.01). Muscle strength assessed by Lovett grade was significantly elevated after treatment (P < 0.01). Pain evaluated by Virtual Rescan grade was significantly lessened after treatment (P < 0.01). Schwannoma was completely resected in 48 patients. After treatment, six patients affected leakage of cerebrospinal fluid. One case experienced infection of cerebrospinal fluid. One case had to undergo secondary operation due to the infection. Three cases received nerve root resection due to tumor erosion. These experimental results confirmed that laminectomy combining unilateral or bilateral nail-rod system for schwannoma in the spinal canal or intervertebral foramen has the advantage of the tumor fully exposed to the operator, which can help completely resect schwannoma and effectively avoid spinal nerve injury. Even more important thing is that the spinal stability is reconstructed by unilateral or bilateral nail-rod system, which prevents the occurrence of vertebral slippage and vertebral destabilization. Long-term effect still needs further research.


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    Vertebroplasty for treatment of osteoporotic vertebral compression fractures with intravertebral cleft
    Hou Zeng-tao, Chen Bo-hua
    2014, 18 (13):  2077-2082.  doi: 10.3969/j.issn.2095-4344.2014.13.019
    Abstract ( 313 )   PDF (831KB) ( 656 )   Save

    BACKGROUND: Clinical practice verified that percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures obtained obvious curative effects.
    OBJECTIVE: To compare the therapeutic effect of percutaneous vertebroplasty for treatment for osteoporotic vertebral compression fractures with or without intravertebral cleft, in order to evaluate the efficacy and safety of percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures. 
    METHODS: A total of 76 patients with osteoporotic vertebral compression fractures were selected and divided into two groups. Experimental group consisted of 27 patients with intravertebral cleft. Control group comprised
    49 patients without intravertebral cleft. After vertebroplasty, visual analogue scale and Oswestry disability index, changes of anterior vertebral height, and types and characteristics of bone cement leakage were compared between the two groups.
    RESULTS AND CONCLUSION: Visual analogue scale and Oswestry disability index were significantly decreased after treatment in the two groups (P < 0.05). No significant differences in visual analogue scale, Oswestry disability index and incidence of bone cement leakage were detected between the two groups after treatment (P > 0.05). No significant difference in the height of injured vertebra was detectable between pretreatment and posttreatment in the two groups (P > 0.05). These results suggested that vertebroplasty is an effective method for lessening the pain in osteoporotic vertebral compression fractures in patients with or without intravertebral cleft, improving spinal activity function and elevating social activities. However, percutaneous vertebroplasty cannot effectively recover the height of the vertebra.


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    Digital and anatomical study about morphological characteristics of children’s lumbar vertebral canal and pedicle
    Wang Xing1, 2, Shi Jun3, Zhang Shao-jie, Li Zhi-jun, Zhang Yuan-zhi, Liu Hong-wei, Ma Shi-feng, Zhang Zhi-feng
    2014, 18 (13):  2083-2088.  doi: 10.3969/j.issn.2095-4344.2014.13.020
    Abstract ( 450 )   PDF (905KB) ( 392 )   Save

    BACKGROUND: Indications and therapeutic method of surgical treatment for Children’s spinal injury are still controversial.
    OBJECTIVE: To analyze the morphology, development regularities and age characteristics of lumbar pedicle of children aged 6 to 11 years old by using thin layer CT image data and three dimensional reconstruction.
    METHODS: A total of 60 children at the age of 6 to 11 years without spine trauma, deformity and neurological symptoms were selected, and were scanned with multi-row spiral CT (0.625-1.25 mm) from T12 to S1. The original data were imported into three-dimensional reconstruction software by DICOM format, and related index was measured. The data were statistically analyzed according to different segments.
    RESULTS AND CONCLUSION: ①With increasing age and vertebral levels, transverse diameter and radius vector of the spinal canal had an increasing trend. ②With the increase of age, the pedicle width and height had an increasing trend. With the increase of vertebral levels, the pedicle width had an increasing trend, but pedicle height had a slowly decreasing trend. The pedicle height was greater than pedicle width. ③With the increase of age, the nail path length had an increasing trend. In the lumbar vertebra, nail path presented “waves” on the  
    whole, and there was no significant difference between each vertebra. ④With the increase of vertebral levels, e angle had an increasing trend, but the f angle presented decreasing “wavy” trend. These results indicated that transverse diameter, radius vector, width and height of pedicle, nail path length, e angle and f angle were strongly associated with pedicle screw implantation. In clinical application, we should choose an optimal therapeutic method according to the features of pedicle of children.


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    Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for osteoporotic vertebral compression fracture: a meta-analysis
    Duman•Tulumuhan, Zupaer•Sulaiman, Tazabieke
    2014, 18 (13):  2089-2095.  doi: 10.3969/j.issn.2095-4344.2014.13.021
    Abstract ( 316 )   PDF (760KB) ( 402 )   Save

    BACKGROUND: Percutaneous vertebroplasty and percutaneous balloon kyphoplasty can effectively treat osteoporotic compression fracture, but which method is better still controversial in China.
    OBJECTIVE: To compare clinical efficacy and safety of percutaneous vertebroplasty and percutaneous balloon kyphoplasty for osteoporotic compression fracture.
    METHODS: Pubmed, Springer and Wanfang Database were retrieved by computer. Relevant Chinese and English journals were retrieved by hand. In accordance with inclusion and exclusion criteria, literatures concerned the comparison of curative effects of percutaneous vertebroplasty and percutaneous balloon kyphoplasty for osteoporotic compression fracture were searched. RevMan 5.0 software provided by Cochrane was used to statistically analyze the data.
    RESULTS AND CONCLUSION: Totally 10 literatures were included in accordance with the inclusion criteria, including 1 literature of randomized controlled trials, and 9 literatures of prospective cohort study. Meta-analysis results demonstrated that no significant differences in operation time, long-period visual analogue scale were detected. Compared with the percutaneous vertebroplasty group, anterior vertebral height was higher in the percutaneous balloon kyphoplasty group. Thus, incidence of cement leakage and long-period kyphotic angle decreased. These results indicated that compared with percutaneous vertebroplasty, percutaneous balloon 
    kyphoplasty can diminish long-period kyphotic angle, increase anterior vertebral height and reduce incidence of cement leakage.


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    Radiofrequency ablation combined with ozone in the treatment of lumbar disc herniation: a meta-analysis
    Dou Yu-gui, Wang Wen-
    2014, 18 (13):  2096-2103.  doi: 10.3969/j.issn.2095-4344.2014.13.022
    Abstract ( 355 )   PDF (877KB) ( 523 )   Save

    BACKGROUND: Support radiofrequency ablation combined with ozone provides novel idea for lumbar disc herniation. Their combination intervened with minimally invasive surgery can bring their advantages, but its therapeutic effect still lacks of evidences from evidence-based medicine.
    OBJECTIVE: To evaluate the effectiveness and feasibility of radiofrequency ablation combined with ozone for lumbar disc herniation.
    METHODS: Systematic and comprehensive database search was performed in PubMed, CENTRAL, SCI, EMBASE.com, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Wanfang database for literatures published from database establishment to June 22 2013. According to inclusion and exclusion criteria, randomized controlled trials on support radiofrequency ablation combined with ozone for lumbar disc herniation were collected. The risk of bias tool described in the Cochrane Handbook version 5.1.0 was used to assess the quality of each trial. Meta-analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION: Totally 63 records were collected. A total of 8 randomized controlled trials 
    involving 662 patients met inclusion criteria. The results of meta-analysis showed between ozone alone, and at
    1 week, 3 and 6 months after combined treatment, significant differences were detected in excellent and good rate [RR=0.36, 95%CI(0.21, 0.59); RR=0.24, 95%CI(0.14, 0.43); RR=0.41, 95%CI(0.24, 0.70)], effective rate [RR=0.31, 95%CI(0.12, 0.82); RR=0.28, 95%CI(0.09, 0.84); RR=0.22, 95%CI(0.06, 0.80)], and visual analogue scale score [MD=-1.06, 95%CI(-1.83, -0.28)]. Results indicated that radiofrequency ablation combined with ozone is effective and feasible for lumbar disc herniation, with the characteristics of fast recovery, pain relief, and good long-period therapeutic effects.


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    Clavicular hook plate and other surgical methods for type III acromioclavicular joint dislocation: a systematic evaluation
    Zhang Xiao-yun, Chen Yue-ping, Dong Pan-feng, Kang Jie, Rao Yi, Yuan Zhen-zhong
    2014, 18 (13):  2104-2112.  doi: 10.3969/j.issn.2095-4344.2014.13.023
    Abstract ( 367 )   PDF (1022KB) ( 367 )   Save

    BACKGROUND: The most common method for acromioclavicular joint dislocation is hook plate fixation. The randomized studies about different surgical treatments of type III acromioclavicular joint dislocation are seldom. Most of them are retrospective case analysis, and systematic evaluation is missing.
    OBJECTIVE: To systematically evaluate clinical outcomes and safety between different surgical methods for type III acromioclavicular joint dislocation.
    METHODS: Cochrane central register of controlled trials (No. 2 in 2013), PubMed (1966-01/2013-08), Medline (1966-01/2013-08), EMbase (1984-01/2013-08), CNKI (1979-01/2013-08) and VIP (1989-01/2013-08) were searched by computer. Six kinds of Chinese magazines about orthopedics were searched by hand. References of relevant literatures were searched. Randomized controlled trials that were related to different surgical methods for the treatment of type III acromioclavicular joint dislocation were collected. In accordance with inclusion criteria, some literatures were included. Their qualities were assessed strictly. Meta-analysis was performed with RevMan  5.2 software from the Cochrane collaboration.
    RESULTS AND CONCLUSION: 108 potentially relevant papers and 7 published studies with randomized controlled trials met all the inclusion criteria. A total of 381 patients were included, containing 193 cases of clavicle hook plate fixation, 115 cases of double Kirschner’s tension band wires fixation, 9 cases of screw fixation, 35 cases of endobutton plates, and 29 cases of internal fixation. One research addressed treatment with three ways, and the remaining were about two ways. Meta-analysis showed that the excellent rate was better in clavicle hook plate fixation than in double Kirschner’s tension band wires fixation for acromioclavicular joint dislocation (P=0.005), but poorer than endobutton plates (P=0.04), and no significant difference was detected as compared with screw fixation and internal fixation (P=0.82, P=1.00). As compared with other therapeutic manners, there were significant differences in shoulder joint pain, fixator ineffectiveness, redislocation, operation time and medical cost (P=0.05, P=0.04, P=0.02, P < 0.000 01, P=0.000 6), but no significant difference was detected in complications and bleeding amount (P=0.71, P=0.35). Results indicated that compared with other fixation manners, the efficiency of clavicle hook plate fixation for acromioclavicular joint dislocation was better than double Kirschner’s tension band wires fixation, but poorer than endobutton plates, which caused shoulder pain and shoulder joint movement disturbance. Fixator ineffectiveness or redislocation seldom occurred. Operation time was short and medical expenses were low. There was no significant difference in complications and bleeding amount. Because the number of cases in this study is few, we should design more strictly large-sample randomized controlled studies to increase the strength of the evidence.


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    Splint versus plaster cast external fixator for the treatment of distal forearm buckle fracture in children: systematic review
    Li Xiao-lei, Li Guo-hua
    2014, 18 (13):  2113-2118.  doi: 10.3969/j.issn.2095-4344.2014.13.024
    Abstract ( 532 )   PDF (735KB) ( 508 )   Save

    BACKGROUND: The distal forearm buckle fracture in children has no secondary displacement risk, and the literatures have reported that the fracture can be treated with external fixators of plaster cast, palm side plate, splint, brace and bandage, and obtain good effect. But different external fixators have different effects on the functional recovery and viability.   
    OBJECTIVE: To assess the clinical efficacy and safety of splint versus plaster cast for the treatment of distal forearm buckle fracture in Children.
    METHODS: The Medline database, Embase database, Cochrane Library, CNKI database and CBM database were searched from the database establishment to April 2011 with the computer; the relative conference papers were hand searched; the Important Clinical Trial Register was searched online without limitation of language.Randomized controlled trials and quasi-randomized control trials were selected for quality evaluation, and the Meta-analysis was performed with Revman 5.1.
    RESULTS AND CONCLUSION: Two published trials including a total of 314 patients were included, and one randomized controlled trial was evaluated as B scale, another one quasi-randomized control trial was evaluated as C scale. The results demonstrate that no fracture, un-union or re-fracture occurred after treated with splint and plaster case external fixator, and there were no significant differences in pain scores as well as the daily activities of writing, drawing, self-eating and washing; while the early bathing ability of the patients in the splint group was earlier than that in the plaster cast group, and had no significant difference in the advanced bathing ability. The regular exercise participation in the splint group was better than that in the plaster cast group. There were no significant differences in the incidence of adverse events between two groups. The results indicate that the pain score of the patients with distal forearm buckle fracture in children do not improved after treated with splint and plaster cast, but splint fixation is better than plaster cast fixation in maintaining the batching and regular exercise participation ability with good safety. But the well-designed and implement large sample and multi-center randomized controlled trials are needed for validation.


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    Various tissue repair methods for lumbar disc herniation: selection and evaluation
    Sun Quan, Mardan•Mamat
    2014, 18 (13):  2119-2126.  doi: 10.3969/j.issn.2095-4344.2014.13.025
    Abstract ( 361 )   PDF (749KB) ( 781 )   Save

    BACKGROUND: Orthopedic lumbar disc herniation is a common and frequently-occurring disease which causes low back pain. Selection of surgical therapy and postoperation efficacy on lumbar disc herniation are hot focus in present study.
    OBJECTIVE: To summarize current research and progress on surgical treatment of lumbar disc herniation.
    METHODS: The databases of PubMed and China National Knowledge Infrastructure were searched from January 1990 to January 2014 for articles on surgical treatment of lumbar disc herniation. Keywords were “Lumbar Herniated Disc; Surgical Therapy” in Chinese and English. Finally, 61 literatures were chosen.
    RESULTS and CONCLUSION: There are a variety of surgical treatments for lumbar disc herniation at present, including traditional surgical procedures, lumbar fusion, percutaneous lumbar discectomy, percutaneous laser decompression, chemonucleolysis, artificial nucleus replacement, and artificial lumbar disc replacement. This study reviewed surgical methods, indication, efficacy and prognosis, and summarized the new progression of repair and therapy of lumbar disc herniation. Results found that posterior lumbar discectomy remains the most widely used and the most mature procedure, but this method has many complications and induces great trauma. Minimally invasive treatment for lumbar disc herniation is considered to be the future direction for small surgical trauma, less complications and fast recovery, but the surgical indications are narrow and the operation is relatively difficult, so this method still needs more improvement and development. Lumbar disc replacement is a new treatment for lumbar disc herniation which has a good short-term postoperative follow-up, but the long-term prognosis still has many problems and complications. Lumbar disc replacement needs more research and development in alternative materials and surgical approach, and should be widely applied after large-sample tests.


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    Effects and biomechanical features of bridge combined fixation system for femoral fracture
    Zhao Feng, Xiong Ying, Zhang Zhong-zi, Zhang Wu, Ren Yun-feng
    2014, 18 (13):  2127-2131.  doi: 10.3969/j.issn.2095-4344.2014.13.026
    Abstract ( 409 )   PDF (1035KB) ( 568 )   Save

    BACKGROUND: Intramedullary nail, plate and external fixation in treatment of comminuted fracture of shaft of femur have their advantages and limitations.
    OBJECTIVE: To explore the effects and biomechanical features of bridge combined fixation system in treatment of comminuted fracture of shaft of femur.
    METHODS: Bridge combined fixation system was used to treat 45 patients with comminuted fracture of shaft of femur. Functional exercise was performed in early stage of treatment. Therapeutic time, bleeding amount, fracture healing time and the recovery of limb function were evaluated. Biomechanical features of the bridge combined fixation system were analyzed during the treatment of comminuted fracture of shaft of femur, and compared with intramedullary nail and bone plate.
    RESULTS AND CONCLUSION: All patients were followed up for 12-24 months, averagely 18 months. The therapeutic time of the bridge combined fixation system was 1.0-2.5 hours, averagely 1.5 hours. Bleeding amount was 100-400 mL, averagely 200 mL. Fracture healing time was 4.0-6.0 months, averagely 4.5 months. After treatment, no severe complications, such as wound infection, fracture disunion, internal fixator loosening or breakage, were observed. Limb function evaluation showed: excellent in 40 cases, good in 2 cases, average in 3 cases, with an excellent and good rate of 93.3%. The bridge combined fixation system was accorded with the feature of fracture biomechanical fixation, and a blend of locking plate, interlocking intramedullary nail and external fixator. For the treatment of femoral fracture, the bridge combined fixation system is operated easily, has wide indication and satisfactory clinical therapeutic effects, and is a new choice for treatment of comminuted fracture of shaft of femur.


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