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22 April 2012, Volume 16 Issue 17 Previous Issue    Next Issue

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Relationship between the degeneration of the lumbar ligamentum flavum and the morphological changes of lumbar canal in the lumbar spinal stenosis Ke Wen-kun1, Du Qu-cheng1, Liu Ya-yun2 2012, 16 (17):  3041-3044.  doi: 10.3969/j.issn.1673-8225.2012.17.001 Abstract ( 243 )   PDF (291KB) ( 284 )   Save BACKGROUND: Studies have demonstrated that type Ⅰ and type Ⅱ collagen proteins play an important role in osteocytes proliferation and differentiation, sclerotic formation and absorption. OBJECTIVE: To study the relationship between the degeneration of the lumbar ligamentum flavum and the morphological change of lumbar canal in the lumbar spinal stenosis. METHODS: The ligament flavum specimens from 36 cases of the central lumbar spinal stenosis and 20 cases of the lumbar fracture as experimental group and control group respectively. The contents of type Ⅰ and type Ⅱ collagen were determined by ELISA. The morphological change of lumbar canal was measured by CT scanning. Histopathological changes of the ligamentum flavum were observed by hematoxylin-eosin staining and Masson staining. RESULTS AND CONCLUSION: The thickness of ligamentum flavum and content of type Ⅰ and type Ⅱ collagen in the experimental group were higher than those in the control group, the lumbar canal morphological area and the ratio of Ⅰ/Ⅱ type collagen in the experimental group were lower than those in the control group (P < 0.05). Pathological observation showed that the elastic fibers of ligamentum flavum were disorganized and decreased in experimental group, while collagen fibers proliferated. The change of the type Ⅰ and type Ⅱ collagen content in ligamentum flavum and the ratio of Ⅰ/Ⅱ type collagen may lead to the increasing hypertrophic ligamentum flavum thickness and decrease of lumbar canal cross-section which caused the lumbar spinal stenosis. Related Articles | Metrics

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Stress distribution and clinical application of the femur under different states  Fang Guo-fang1, Lin Li-jun2, Yu Bo2, Ao Jun2 2012, 16 (17):  3045-3047.  doi: 10.3969/j.issn.1673-8225.2012.17.002 Abstract ( 283 )   PDF (215KB) ( 381 )   Save BACKGROUND: New mechanical classification of femoral fractures breakthroughs the previous simple muscle stretch classification. It can provide further research direction for the internal fixation in mechanics. OBJECTIVE: To discuss the stress distribution of the femur under different states. METHODS: Three-dimensional reconstruction of the femurs was performed by the finite element method. The different parts of the femur were constrained and their stress distributions were analyzed to simulate the concentrations of stresses under different states and to provide advices for clinical internal fixation of femoral fractures. RESULTS AND CONCLUSION: Stress was concentrated at the middle femur under the condition of walking upright, and a spiral stress concentration area was at the lower femur. Under kneeling position, the stress was increased at the inferior segment of the femur, especially at the condyle. Under sitting position, the stress was mainly concentrated at the femur neck. Stresses are concentrated at different segments of the femur under different states, thus leading to different types of femoral fractures. The results provide scientific basis for internal fixation to reduce stress and prevent fixation failure. Related Articles | Metrics

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Stress analysis and establishment of three-dimensional finite element model of human femur by volume rendering Zhong Wu-xue1, Zhang Yin-wang2, Zhu Hai-bo2, Chen Yun3, Xu Ling-jun1, Zhang Hao1, Zhu Jian-min2 2012, 16 (17):  3048-3051.  doi: 10.3969/j.issn.1673-8225.2012.17.003 Abstract ( 261 )   PDF (254KB) ( 412 )   Save BACKGROUND: At present, there are several research methods of femoral three-dimensional (3-D) finite element modeling, but studies on the 3-D finite element solid model of femur by volume rendering method are few. OBJECTIVE: To establish the 3-D finite element solid model of human femur by volume rendering method, to obtain the stress distribution of the model through simulation of mechanical loading, and to assess the feasibility of this method by comparing with the previous femoral biomechanical experiments. METHODS: CT images was preprocessed by images denoising and other methods, then the 3-D finite element solid model of human femur was constructed by using Mimics and Ansys softwares through adopting rendering technique. And, the loading conditions of femur at the position of standing were simulated by importing the femur material parameter to the Mimics software. RESULTS AND CONCLUSION: The 3-D finite element solid model of human femur includes cortical bone, cancellous bone and anatomical structure of cavity, and there were 63 900 nodes and 43 552 elements generated in total after meshing. Results of simulation of the loading conditions showed that the femur compressive stress primarily concentrated in the inner side of femur, especially in the calcar femorale, and the tensile stress mainly concentrated in the outside of collum femoris and shaft of femur. The 3-D finite element solid model of human femur with high quality simulation and reflection of the anatomical structure of femur can be created by volume rendering method. So, this model can be applied to study the internal structure and details of femur, and simulate the biomechanical property of femur. Related Articles | Metrics

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Influence of step width and abduction angle on necrotic femur head by three-dimensional finite element method  Tian Feng-de, Zhao De-wei, Guo Lin, Yang Lei, Chen Bing-zhi 2012, 16 (17):  3052-3055.  doi: 10.3969/j.issn.1673-8225.2012.17.004 Abstract ( 248 )   PDF (256KB) ( 186 )   Save BACKGROUND: Now, effects of step width and abduction angle of hip joint in daily life on necrotic femur head are not well known, and related experimental studies are few. OBJECTIVE: To study the influence of step width and abduction angle on necrotic femur head with three-dimensional finite element method. METHODS: One male patient who suffered avascular necrosis of femoral head with his right femoral (ARCO II) were treated with spiral CT scan at the proximal femur. Three-dimensional finite element models were established by professional medical modeling software (MIMICS and HYPERMESH). Boundary conditions and loading conditions were set. Finite element analysis software ANSYS was used to perform calculations. RESULTS AND CONCLUSION: Along with increase of step width (0-60°) and abduction angel (0-10°), the value of maximum stress distributed on the necrotic femoral head increased. It is indicated that step width and abduction angle can affect stress distribution on the necrotic femur head, patients should reduce step width and abduction angle during the treatment and rehabilitation. Related Articles | Metrics

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Biomechanical analysis of ankle joint based on a finite element model  Guo Guo-xin1, Guo Ji-tao1, Li Wei2, Ren Guo-shan2 2012, 16 (17):  3056-3060.  doi: 10.3969/j.issn.1673-8225.2012.17.005 Abstract ( 337 )   PDF (256KB) ( 355 )   Save BACKGROUND: In recent years, the finite element analysis has been widely used in the field of biomechanics. OBJECTIVE: To perform biomechanical analysis of the ankle three-dimensional digital model through ANSYS, a large-scale software of finite element analysis, and to investigate the regularity of stress distribution and the deformation and displacement of the ankle model. METHODS: The three-dimensional digital model of ankle that processed by MIMICS, Geomagic and ANSYS was imputed into the ANSYS, then made a finite analysis of the obtained model after constraining conditions, loading pressure and solving. RESULTS AND CONCLUSION: ①Under the condition of standing, the maximum stress distribution of the ankle joint was mainly in the medial malleolus and talus junction, the anterior part of the intercondylar line of distal tibial articular surface, the leading edge of the cortex area in the middle and lower segments of the tibia and the lateral part of the trochlea of talus; the minimum stress was mainly distributed on the lateral malleolus, the medial cortical area of the distal tibia and head of talus and neck of talus; the maximum displacement was mainly occurred on the head of talus and gradually decreased from up to down; the minimum displacement was on the tibia and the 1/3 of the middle and lower segments of fibula. ②Under the condition of falling, the maximum stress distribution of the ankle joint was mainly in the leading edge of the cortex area in the middle and lower segments of the tibia, the lateral part of the trochlea of talus, the medial malleolus medial cortex and the anterior part of the intercondylar line of distal tibial articular surface. With the pressure increased in the middle and lower segments of the tibia, the stress concentration area would move to the medial slightly. The position of the maximum stress concentration area of the lateral part of talus trochlea was not changed significantly, and the area was gradually increased. The minimum stress was mainly in the lateral malleolus, the lateral part of the distal tibial articular surface, and head of talus and the lateral cortex of the medial malleolus; with the pressure increased, the small stress blue area of the medial malleolus lateral cortex was gradually decreased. The blue region with larger stress was appeared in the lateral malleolus which suggest the increasing of the stress. The maximum displacement was appeared from the head of talus and upper to the neck of talus and tibiotalar articular surface and gradually diminished in the middle and lower segments of the tibiofibula.   Related Articles | Metrics

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Design characteristics of sivash-range of motion femoral stem prosthesis and primary total hip arthroplasty Wang Qiang, Sun Jun-ying, Jin Ye, Zheng Hong-ming, Chen Lian, Zha Guo-chun 2012, 16 (17):  3061-3064.  doi: 10.3969/j.issn.1673-8225.2012.17.006 Abstract ( 503 )   PDF (274KB) ( 343 )   Save BACKGROUND: At present, the reports on the application effect of sivash-range of motion (S-ROM) femoral stem prosthesis after total hip arthroplasty (THA) are rare. OBJECTIVE: To discuss the application of S-ROM femoral stem prosthesis in primary THA. METHODS: From April 2009 to May 2011, 71 patients (75 hips) were performed primary THA with S-ROM femoral stem prosthesis in the Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University. The hip functions and the biological fixation effect of the prosthesis were evaluated after the operation. RESULTS AND CONCLUSION: X-ray films of the 71 patients showed the initial fixed stems were in line with good standard. No infection, fracture, dislocation, deep venous thrombosis or neurovascular injury occurred. The mean postoperative Harris hip score was recovered to (93.8±3.5) points at 6 months after surgery. There was no prosthesis loosening. The S-ROM femoral stem prosthesis has the advantages of reasonable design, strong adjustability and in line with patient anatomy, and it can improve the function effectively. Related Articles | Metrics

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Application of fast track surgery in 45 patients with total knee replacement  Chen Xiao-yong, Zhao Jian-ning, Wang Yu-rong, Bao Ni-rong 2012, 16 (17):  3065-3068.  doi: 10.3969/j.issn.1673-8225.2012.17.007 Abstract ( 240 )   PDF (290KB) ( 425 )   Save BACKGROUND: In recent years, some domestic hospitals focus on the research and application of fast track surgery.  OBJECTIVE: To study the clinical effect of fast track surgery in patients with total knee replacement. METHODS: Totally 45 cases with knee osteoarthritis were treated with total knee replacement, and then preoperative, intraoperative and postoperative measures were taken in accordance with the concept of fast track surgery. Knee function and pain were evaluated using HSS, range of motion and visual analog scale pain scores. RESULTS AND CONCLUSION: The average postoperative range of motion and HSS score were significantly higher than the preoperative levels, while the postoperative visual analog scale pain scores were evidently lower than the preoperative ones, which demonstrating the knee function recovery and pain relief were rapid and well. There were no complications in infection, deep vein thrombosis and pulmonary embolism. The application of fast track surgery in total knee replacement can improve the score of HSS, range of motion and visual analog scale, decrease the complication and surgical stress, accelerate rehabilitation of patients and enhance the therapeutic effect. Related Articles | Metrics

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Follow-up comparison of 128 middle-aged patients with uncemented total hip arthroplasty and bone cement total hip arthroplasty Jiang Yu, Yang Yu-sheng, Zhu Guo-xing 2012, 16 (17):  3069-3072.  doi: 10.3969/j.issn.1673-8225.2012.17.008 Abstract ( 217 )   PDF (272KB) ( 281 )   Save BACKGROUND: Many scholars think that bone cement total hip arthroplasty is suitable for old aged patients with serious osteoporosis, while uncemented total hip arthroplasty is applicable to young patients. OBJECTIVE: To compare the clinical effect of uncemented total hip arthroplasty and bone cement total hip arthroplasty on middle-aged patients. METHODS: The limbs functional restoration, radiological evaluation and Harris score of 58 cases with bone cement total hip arthroplasty and 70 cases with uncemented total hip arthroplasty was detected at 6 months, 2 and 5 years, respectively. All these 128 patients were middle-aged patients (40-60 years old). RESULTS AND CONCLUSION: Statistical data showed that the Harris score of uncemented prosthesis, as well as the 5-year survival rate after 6 months, 2 and 5 years was significantly better than cement type prosthesis (P < 0.05). Three cases had osteolysis at 6 months after cement type prosthesis arthroplasty, 3 cases had prosthesis loosing at 2 years after arthroplasty and 3 cases appeared linear permeability dissolvement at 5 years after arthroplasty. Two cases had osteolysis at 2 years after uncemented prosthesis arthroplasty and 1 case had prosthesis loosing at 5 years after arthroplasty. Uncemented prosthesis achieved a high rate of functional restoration and a low rate of complications. Uncemented total hip arthroplasty in middle-aged patients had a satisfactory clinical and radiographic outcome at a minimum of 5 years follow-up. Related Articles | Metrics

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Histological observation of micro-screws anchorage implant-bone interface with different soft tissue handling methods   Zheng Lin-lin, Liu Jun, Chen Jie, Liu Xin-qiang, Xu Hong 2012, 16 (17):  3073-3077.  doi: 10.3969/j.issn.1673-8225.2012.17.009 Abstract ( 323 )   PDF (348KB) ( 504 )   Save BACKGROUND: The micro-screw anchorage is a newly used orthodontic anchorage, there are often two ways of the implant procedure: cut the gum and non-cut gum, but there is no report about the histological research of the micro-screw-bone interface in these two ways. OBJECTIVE: To compare the osseointegration rate under two different soft tissue handling methods during implantation and to detect whether there is epithelium implantation. METHODS: Six adult male mongrel dogs were selected, and 48 self-drilling micro-screws were prepared, one side of the upper and lower jaws of dogs was randomly selected as the experimental group, and the other side was selected as the control group; Self-drilling micro-screws were implanted without cutting the gum in the experimental group while the self-drilling micro-screws were implanted after cutting the gum in the control group, both the two groups were loaded by using NiTi-coil springs with 200 g constant force immediately. After 12 weeks, the dogs were euthanized and the bone around the micro-screws was obtained as specimen. Hematoxylin-eosin staining method was used to observe the osseointegration rate and epithelium incidences under the two different soft tissue handling methods. RESULTS AND CONCLUSION: Both the groups obtained different levels of osseointegration. There was more fibrous connective tissue in the micro-screws-bone interface of the experimental group. The osseointegration rate in the control group was significantly higher than that in the experimental group (P < 0.01). Epithelial implantation was not found in both two groups. We conclude that micro-screws can obtain osseointegration and clinical stability with both two different soft tissue handling methods during implantation, but cutting gums implantation can acquire higher osseointegration rate than the implantation without cutting gums, the implantation with no cutting is simple in the procedure, the possibility of epithelial implantation with the two soft tissue handling methods seem to be very small. Related Articles | Metrics

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Formation capability of bacterial biofilm on titanium plate versus necrotic bone Zhang Zhi-hong, Sun Xiao-tang, Feng An-ping, Wang Wan-ming 2012, 16 (17):  3078-3081.  doi: 10.3969/j.issn.1673-8225.2012.17.010 Abstract ( 248 )   PDF (293KB) ( 345 )   Save BACKGROUND: Bacteria attachment and biofilm formation at the surface of metal implants and sequestrum are major reasons for chronic infection of musculoskeletal system. OBJECTIVE: To characterize and compare the formation capability of bacterial biofilm on titanium plate and necrotic bone. METHODS: The model of bacterial biofilm was developed with modified stroma culture approach. Ten titanium plate cylinders and ten pieces of necrotic bone were randomly matched. Each pair was placed in one culture flask and immersed in bacteria solution. The biofilm of each group was stained with fluorochrome, observed and photographed using confocal laser scanning microscope. RESULTS AND CONCLUSION: Compared with the necrotic bone, the thickness of bacterial biofilm on the titanium plate was less (P < 0.05) and the percentage of live bacteria in the medium layer and the bottom layer was higher (P < 0.05). Results indicate that the bacterial biofilm tends to more easily develop on the surface of necrotic bone than on the surface of titanium plate. Related Articles | Metrics

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Anterior hybrid decompression efficiently improves the cervical physiological curvature and intervertebral height in treatment of multilevel cervical spondylosis   Li Yong, Shen Cai-liang, Zhang Jian-xiang, Dong Fu-long, Zhang Ren-jie 2012, 16 (17):  3082-3086.  doi: 10.3969/j.issn.1673-8225.2012.17.011 Abstract ( 287 )   PDF (309KB) ( 332 )   Save BACKGROUND: Patients with cervical spondylosis of single or double segments are mainly treated with anterior decompression and internal fixation. The therapy selection of multilevel cervical spondylosis is still in dispute. OBJECTIVE: To discuss the surgical method and clinical effect of anterior hybrid decompression technique (subtotal single vertebrectomy combined with intervertebral discectomy) in treatment of multilevel cervical spondylosis. METHODS: Retrospective analysis was performed in 30 patients with multilevel cervical spondylosis. All the patients received anterior hybrid decompression, autogenous iliac bone grafting or ZEPHIR plate internal fixation. The neurological function scores, fusion rates, cervical physiological curvature and intervertebral height, and complications of patients were analyzed after treatment. RESULTS AND CONCLUSION: The patients were followed up for 12-72 months, with an average of 36 months. The cervical physiological curvature and the intervertebral height were significantly improved after surgery. The spinal cord of oppressed segments was well bulged. Loosening, fracture and displacement of the plates and screws were not found during the follow-up. The postoperative fusion rate was 100% at 6 months. The Japanese Orthopaedic Association scores were obviously improved after 12 months of follow-up. The improvement rate outcome showed excellent in 10 cases, good in 16 cases, fair in 4 cases, and the good rate was 86.7%. The anterior hybrid decompression can retain normal structure of the cervical spine through decompression, increase the fusion rate and efficiently improve the cervical physiological curvature and intervertebral height, thus it can be used in treatment of multilevel cervical spondylosis.   Related Articles | Metrics

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Changes of lumbar lordosis angle at the early stage after L4-5 posterior lumbar interbody fusion operation He Ke-yun1, Li Zhi-zhong2, Li Ning-ning1, Hu Zhao-hui1, Tang Yun-peng1, Zhuo Xiang-long1, Xie Xiang-tao1 2012, 16 (17):  3087-3090.  doi: 10.3969/j.issn.1673-8225.2012.17.012 Abstract ( 368 )   PDF (263KB) ( 395 )   Save BACKGROUND: It is important to observe the changes of the early lumbar lordosis angle in posterior lumbar interbody fusion (PLIF) treatment, and to analyze the clinical significance of these changes on the treatment of lumbar disc. OBJECTIVE: To analyze the variation of lumbar lordosis angle and its clinical significance on the early postoperative of PLIF at L4-5. METHODS: 116 patients who had undergone the surgery of PLIF were selected. They were suffering from lumbar disc herniation with stenosis disease at L4-5 or suffering from lumbar spondylolisthesis at L4. Then we measured the patients’ lumbar lordosis angle before and after operation. Forty cases had integrated follow-up information, 28 cases were suffering from lumbar disc herniation and stenosis disease at L4-5, 12 cases were suffering from lumbar spondylolisthesis at L4. Statistics of the variation of sacral inclination angle between preoperative and postoperative was analyzed during 12- 24 months follow-up. RESULTS AND CONCLUSION: The lumbar lordosis angles preoperatien were significantly larger than those postoperation (P < 0.05). Undergoing the operation, the changing trend of lumbar lordosis angle between the lumbar spinal canal stenosis group and lumbar disc herniation group was roughly the same (P > 0.05). Before and after the surgery, the difference of lumbar lordosis angle of optimal MacNab score patients and medium and bad MacNab score patients had no statistical significance (P > 0.05). PLIF was proved to be one of the effective methods to treat the lumbar disc herniation with stenosis disease and lumbar spondylolisthesis. Related Articles | Metrics

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Application of replantation of lamina and mini-plate fixation in patients with spastic cerebral palsy Xu Jun-jie, Zhang Kai, Wang Zhi-yun, Wu Zeng-hui, Yin Qing-shui 2012, 16 (17):  3091-3094.  doi: 10.3969/j.issn.1673-8225.2012.17.013 Abstract ( 261 )   PDF (229KB) ( 277 )   Save BACKGROUND: Selective posterior rhizotomy (SPR) has been widely used in the treatment of spastic cerebral palsy. Traditionally, total resection of lamina of L1 or L1+T12 at the level of conus is the main method to expose the spinal canal. This method has the potential to cause major damage to the normal anatomical structures of the lumbar spine, resulting in deformity of the spine in the long term. OBJECTIVE: To evaluate the replantation of lamina and mini-plate fixation and its clinical results in patients with spastic cerebral palsy treated with SPR. METHODS: Twenty-nine cases with spastic cerebral palsy were treated operatively with SPR from January 2008 to January 2011, accomplished with the replantation of lamina on site and mini-plate fixation after the corresponding segments were completely intercepted by the swing saw. Muscular tension of the lower extremities was observed pre- and post-operatively. X-ray films and CT images were used to observe the status of fusion, stability and shape of the vertebral canal. RESULTS AND CONCLUSION: All the patients were followed-up, the average reduction of Ⅱ-Ⅲ grade of muscular tension was observed in most patients. The replanted lamina got bony fusion without spinal stenosis or spinal instability at the last follow-up. SPR is an effective therapy for spastic cerebral palsy. After widely exposure of the spinal canal, the method of spinal reconstruction can provide good clinical results for patients treated with SPR. It can avoid compression owing to scar and maintain the spinal integrity. Related Articles | Metrics

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Interventional therapy selection for treatment of noncontained lumbar intervertebral disc herniation   Zhao Hong-zeng1, Guan Wen-hua2, Cheng Jing-liang1, Yang Rui-min3 2012, 16 (17):  3095-3099.  doi: 10.3969/j.issn.1673-8225.2012.17.014 Abstract ( 293 )   PDF (423KB) ( 290 )   Save BACKGROUND: Noncontained lumbar intervertebral disc herniation is a common type in clinic. It is also the primary cause of failure in the conservative and microinvasive-interventional treatments. How to improve the treatment effect is the main point in the research of noncontained lumbar intervertebral disc herniation. OBJECTIVE: To compare the effects among three interventional therapies in treating noncontained lumbar intervertebral disc herniation and explore how to improve the treatment effect of noncontained lumbar intervertebral disc herniation. METHODS: A total of 174 cases of noncontained lumbar intervertebral disc herniation with various interventional treatments were involved. Percutaneous lumbar discectomy with forceps was performed in 66 cases, chemonucleolysis was performed in 52 cases, and double interventional therapy (DIT) of the above two methods was performed in 56 cases. RESULTS AND CONCLUSION: After follow-up of 6 months, the excellent and good rate in the DIT group was significantly higher than those of the percutaneous lumbar discectomy group and chemonucleolysis group (P < 0.05). The uncomfortable rate in the DIT group was significantly lower than other groups. It is suggested that DIT could improve the excellent and good rate and reduce the uncomfortable rate in treating noncontained lumbar intervertebral disc herniation. DIT is an effective and safe method in treating noncontained lumbar intervertebral disc herniation without obvious increased difficulty.   Related Articles | Metrics

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Interbody fusion with pedicle screw fixation for the treatment of lumbar disc herniation Li Xiao-long, Wang Sheng-jie, Xia Cai-wei, Liu Wei-feng, Yang Lei, Jiang Xiao-jun 2012, 16 (17):  3100-3104.  doi: 10.3969/j.issn.1673-8225.2012.17.015 Abstract ( 276 )   PDF (371KB) ( 351 )   Save BACKGROUND: Spine bilateral fixation is widely used in the treatment of lumbar degenerative disease, but the long-term follow-up found that the rigid internal fixation-formed stress shielding effect can cause the bone loss of fusion vertebral and accelerate the degeneration of adjacent vertebral bodies. OBJECTIVE: To explore the efficiency of unilateral vertebral plate interbody fusion with pedicle screw fixation in treatment of lumbar disc herniation. METHODS: From January 2006 to January 2010, 45 patients with lumbar disc herniation were treated with unilateral transforaminal lumbar interbody fusion and unilateral internal fixation in Affiliated Wujin Hospital to Jiangsu University. RESULTS AND CONCLUSION: All the 45 patients were followed up. The mean follow-up period for 45 patients was 6-24 months. None of the patients got incision infection. The JOA score and visual analogue score were improved obviously after fixation; the difference was significant (P < 0.01) compared with pre-fixation. Among the 45 patients, 36 cases were excellent, 5 cases were good, 4 cases were mean, and the good rate was 91%. The X-ray film and the CT image at 6 months after fixation showed the interbody fusion without displacement and settlement, as well as the fixation with no loosening and fracture. Unilateral neural decompression interbody fusion and unilateral pedicle screw fixation are feasible spinal surgery techniques and are satisfactory in treating patients with lumbar disc herniation. Related Articles | Metrics

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Comparison of Triple-Endobutton and clavicular hook plate implantation for the treatment of acromioclavicular joint dislocation  Wang Hai-ming, Chen Yun-feng, Lu Ye, Zhang Chang-qing, Zeng Bing-fang 2012, 16 (17):  3105-3110.  doi: 10.3969/j.issn.1673-8225.2012.17.016 Abstract ( 291 )   PDF (303KB) ( 380 )   Save BACKGROUND: Clavicular hook plate once serves as the preferred solution of the acromioclavicular joint dislocation, but there are still many complications after implantation. Double-Endobutton for the treatment of acromioclavicular joint dislocation has a satisfactory short-term follow-up result.  OBJECTIVE: To improve the Double-Endobutton, to reconstruct the coracoclavicular ligament with Triple-Endobutton technology, and then to compare the clinical efficacy of Triple-Endobutton technology and clavicular hook plate for the treatment of acromioclavicular joint dislocation. METHODS: Forty-five patients with acute acromioclavicular joint dislocation were collected to perform the control observation, 23 patients were treated with Triple-Endobutton and 22 patients were treated with AO clavicular hook plate. Preoperative assessment of patients showed there was no significant differences in general information. Related indicators during surgery and hospitalization, postoperative visual analogue score, shoulder Constant score and complications were analyzed. RESULTS AND CONCLUSION: The overall efficacy of Triple-Endobutton for the treatment of acromioclavicular joint dislocation was similar to clavicular hook plate, but the Triple-Endobutton had the advantages of coracoclavicular ligament reconstruction, hard internal fixation and early activities, as well as the low incidence of shoulder pain and shoulder activity limitation, shorter recovery time and fewer complications postoperatively. Triple-Endobutton had a good biocompatibility and could long-term stay in the body with no need to remove, thus avoiding secondary surgery. Related Articles | Metrics

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Anatomy type steel plate versus lock plate fixation for tibial Pilon fracture Gao Zhan-jun1, 2, Kan Shi-lian3, Ding Er-qin2, Li Wen-cheng2 2012, 16 (17):  3111-3115.  doi: 10.3969/j.issn.1673-8225.2012.17.017 Abstract ( 292 )   PDF (301KB) ( 417 )   Save BACKGROUND: The difficulty of Pilon fractures with open reduction and internal fixation is the reconstruction of the articular surface and soft tissue protection, compared with the ordinary fixation material, the anatomy type steel plate and lock plate have the advantage of three-dimensional fixation. OBJECTIVE: To investigate the structural characteristics of anatomical plate and lock plate as well as the curative effect on anatomical reduction of the articular surface of the distal tibial Pilon fractures. METHODS: Retrospective study was performed on 79 Pilon fracture cases from March 2004 to August 2010, including 22 cases of open injury, 57 cases of blunt trauma, 31 cases of Ruedi-Allgower type Ⅱ and 48 cases of Ruedi-Allgower type Ⅲ; partly open injured patients were operated urgently, the blunt trauma patients accepted open reduction and internal fixation at 7 to 12 days after injury. According to the different fracture morphology and soft tissue injury, open reduction internal fixation, lock plate fixation and tibia external fixation treatment were performed respectively.  RESULTS AND CONCLUSION: All the patients obtained the 4-9 months follow-up and the treatment effects were evaluated by Tornetta scoring system, 97% excellent and good rate in Ruedi-Allgower type Ⅱ, and 79% in type Ⅲ. Patients of type Ⅲ accepted open reduction internal fixation surgery reached 88% good rate. The frame external fixation patients were dissatisfied with the function recovery. For the patients with external fixation, some skins were superficial infected and the soft tissue was necrosis, and all the infection patients were recovered after treatment, and there were no osteomyelitis and nonunion appeared. To treat Pilon fracture with anatomy type steel plate or lock plate has an ideal effect, the main points of the treatment is to retain the soft tissue coverage and to reconstruct a stable articular surface.  Related Articles | Metrics

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Minimally invasive percutaneous plate osteosynthesis for distal tibial fractures: Compared with intramedullary nail fixation and open reduction and plate fixation Liang Bo-wei1, Zhao Jin-min1, Yin Guo-qian2, Hu Feng1, Pan Rong-gui1 2012, 16 (17):  3116-3120.  doi: 10.3969/j.issn.1673-8225.2012.17.018 Abstract ( 332 )   PDF (328KB) ( 408 )   Save BACKGROUND: Minimally invasive percutaneous plate osteosynthesis (MIPPO), intramedullary nail fixation (INF) and open reduction and plate fixation (ORPF) are the effective treatments for distal tibial fracture with different advantages and disadvantages, respectively. OBJECTIVE: To compare the different clinical outcomes of MIPPO with INF and ORPF for treatment of distal tibial fractures. METHODS: From March 2007 to May 2010, 85 cases of distal tibial fracture treated with MIPPO (n=25), INF (n=31) and ORPF (n=29) were selected. The indexes of surgical trauma, systemic inflammatory response, functional recovery of tibia, soft tissue injury and union of fractures were compared among the three groups. RESULTS AND CONCLUSION: The MIPPO, INF and ORPF were all effective treatments for distal tibial fractures. There were no significant differences of the indexes in surgical trauma, soft tissue injury and functional recovery of tibia between the MIPPO and INF groups, but both were better than those of the ORPF group. In terms of fracture healing, there were no differences among the 3 groups in the treatment of type A distal tibial fracture, but obvious advantages were found in the treatment of type B and C fractures in the MIPPO and INF groups as compared with the ORPF group. MIPPO are found to have minimal surgical trauma and soft tissue injury, slighter postoperative systemic inflammatory response, better functional recovery of tibia and faster fracture healing but facing challenge of reduction intraoperatively and increasing risk of malunion postoperatively. Related Articles | Metrics

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Effects of dynamic hip screw and proximal femoral nail antirotation fixation in the treatment of intertrochanteric fracture of femur Zhang Yu-ming, Chen Bin, Chang Bao-guo, Wei Jin-bin, Yu Jian-ping, Wang Xiao-jian 2012, 16 (17):  3121-3125.  doi: 10.3969/j.issn.1673-8225.2012.17.019 Abstract ( 244 )   PDF (284KB) ( 307 )   Save BACKGROUND: There are two main fixation methods for the treatment of intertrochanteric fractures, one is the extramedullary fixation screw-plate system which represented by the dynamic hip screw (DHS), and another one is the intramedullary fixation nail system which represented by the proximal femoral nail antirotation (PFNA).  OBJECTIVE: To compare the effect of PFNA and DHS in treatment of intertrochanteric fracture in old people.  METHODS: In this retrospective study, a series of 58 patients with intertrochanteric hip fractures were reviewed from January 2008 to December 2010 in the Department of Orthopedics, Shanxi Provincial People’s Hospital. The patients were treated with PFNA and DHS respectively. RESULTS AND CONCLUSION: The mean follow-up time was 13 months in DHS group and 11 months in PFNA group, and all the patients in the two groups achieved bone healing. The full weight-bearing time and the fracture healing time in DHS group were longer than those in the PFNA group (P < 0.05); there was no significant difference of the Parker-Palmer’s score in two groups (P > 0.05). And in the DHS group, nail loose occurred in 1 case, plate fracture in 1 case; all patients were ultimately healed without wound infection, internal fixation cutting, coxa vara and other complications. For the treatment of intertrochanteric femoral fracture, both DHS and PFNA fixation could achieve a good outcome, however, the patients in PFNA fixation group get full weight-bearing stepping and fracture healing earlier than the ones of DHS fixation group. Related Articles | Metrics

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Security of vertical physiological external pressure fixator for treatment of tibiofibula fracture  Wang Xi-bin, Sun Yong-qiang 2012, 16 (17):  3126-3129.  doi: 10.3969/j.issn.1673-8225.2012.17.020 Abstract ( 293 )   PDF (315KB) ( 256 )   Save BACKGROUND: Now, most of external fixators in the clinical application are the mechanical structure of the framework, the fixator has a greater stress shielding on the fracture and is unfavorable for fracture healing. Research group combined with the development of the theory of modern orthopedic designs a sliding dovetail with the external fixator device which can use its own gravity and muscle contraction to give the appropriate pressure for fracture in the case of ensuring reliable fixation strength, thus facilitating the healing and shorten the healing time. OBJECTIVE: To observe the effect of vertical physiological external pressure fixator for treatment of tibiofibula fracture. METHODS: Totally 30 patients who from Department of Orthopedics, Chinese Medicine Hospital of Henan Province between January 2005 and March 2011 treated with vertical physiological external pressure fixator for treatment of tibiofibula fracture were selected as the treatment group. Twenty patients who previously followed-up in the same hospital treated with unilateral multifunctional external fixator for tibiofibula repair were selected as control. All other conditions were the same except for fixatior in the two groups. RESULTS AND CONCLUSION: Comprehensive analysis indicators of security, knee-joint activity, X-ray and so on in the treatment group were better than those in the control group (P < 0.05). Only one case with wound infection in the treatment group, two cases with fixed pin loosening, and one case with needle-point wound infection in the control group. By clinical symptomatic treatment, satisfactory recovery was achieved. It is preliminary showed that vertical physiological external pressure fixator has a good safety performance, and can shorten the healing time and the period of callus remodeling.   Related Articles | Metrics

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Meta analysis of reamed versus non-reamed intramedullary nailing for closed tibial fractures in adults  Wang Lei1, Chen Gen-yuan1, Wang Feng-feng2, He Yu-ping3, Wang Tao3 2012, 16 (17):  3130-3133.  doi: 10.3969/j.issn.1673-8225.2012.17.021 Abstract ( 330 )   PDF (250KB) ( 346 )   Save BACKGROUND: Some control studies attempt to answer the advantages and disadvantages of the issue on reamed and non-reamed intramedullary nailing for closed tibial fractures, but the conclusions are different. OBJECTIVE: To determine the efficiency and safety of reamed versus non-reamed intramedullary nailing for closed tibial fractures in adults by Meta analysis. METHODS: PubMed, Embase, Cochranel Library, CBMdisc, Weipu information database and Wanfang were searched by computer. Randomized controlled trials related to reamed versus non-reamed intramedulary nailing for closed tibial fractures in adults were included. The quality of trials was critically assessed. RevMan 5.0 software was used for data analysis． RESULTS AND CONCLUSION: Three randomized controlled trials were included. Meta analysis showed that compared with the non-reamed intramedulary nailing for closed tibial fractures in adults, the nonunion rate decreased [RR 0.25, 95%CI(0.08, 0.79), P=0.02] and implant failure rate decreased significantly [RR 0.25, 95%CI(0.12, 0.52) P=0.000 2] in the reamed intramedullary nailing for closed tibial fractures in adults. Compared with non-reamed intramedulary nailing for closed tibial fractures in adults, reamed intramedulary nailing decreases the nonunion rate and implant failure are rare. There is no statistical difference in the rate of delayed fracture healing, malunion rate and the incidence of compartment syndrome. Related Articles | Metrics

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Two anterior decompression and fusion treatments for two-level cervical spondylotic myelopathy: A Meta analysis  Zhang Wei, Liao Wen-sheng, Wang Li-min, Bao Heng 2012, 16 (17):  3134-3138.  doi: 10.3969/j.issn.1673-8225.2012.17.022 Abstract ( 204 )   PDF (242KB) ( 272 )   Save BACKGROUND: There are two main ways for cervical spondylotic myelopathy (CSM) in anterior approaches, one is anterior cervical discectomy with fusion (ACDF) and the other is anterior cervical corpectomy with fusion (ACCF). The optimal surgical strategy remains controversial for two-level CSM. OBJECTIVE: To compare the clinical effects between ACDF and ACCF in treating two-level CSM. METHODS: A computer-based online search of Cochrane Library (issue 4, 2011), PubMed database (1966/2011-11), EMBASE database (1974/2011-11), CBM database (1978/2011-11), CNKI database (1994/2011-11) and Wanfang database (1997/2010-11) was preformed for literatures in English and Chinese. All controlled studies of ACDF and ACCF for the treatment of two-level CSM were identified. Two reviewers assessed the trials and extracted data independently. Meta analysis was conducted with the Revman 5.1 software provided by Cochrane collaboration. RESULTS AND CONCLUSION: A total of 382 cases in 5 controlled trials were included. Totally 201 patients were in the ACDF group and 181 patients were in the ACCF group. The results of Meta analysis showed that there were statistically significant differences in operation time, bleeding amount and cervical lordosis between ACDF group and ACCF group (P < 0.05), but there was no significant difference in the function recovery rate of spinal cord, fusion rate and complications between two groups (P > 0.05). Compared with ACCF, ACDF had the advantages of a shorter operation time, less bleeding and better cervical lordosis for two-level CSM. But there was no obvious difference in the function recovery rate of spinal cord, fusion rate and complications.   Related Articles | Metrics

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Magnetic resonance imaging evaluation of the relationship between the lumbosacral spine saggital morphology and intervertebral disc degeneration  Liu Jin-rui, Yang Qing-guo, Duan Wen, Bo Ran, Zhang Yin-shun 2012, 16 (17):  3139-3142.  doi: 10.3969/j.issn.1673-8225.2012.17.023 Abstract ( 241 )   PDF (253KB) ( 290 )   Save BACKGROUND: Now, there are a large number of articles related to performance of intervertebral disc degeneration in magnetic resonance imaging (MRI) and the relationship between the intervertebral disc degeneration and low back pain. Nonetheless, there are few publications reporting the relationship between the degree of intervertebral disc degeneration and the lumbosacral morphology. OBJECTIVE: To investigate the clinical significance and relationship between the lumbosacral saggital morphology and intervertebral disc degeneration. METHODS: MRI of outpatients who went to First Affiliated Hospital of Anhui Medical University because of low back pain were retrospectively studied. 167 female patients aged 20 to 30 years old were selected. The presence and degree of intervertebral disc degeneration were evaluated on saggital T2W1 weighted MRI passing through the midsagittal line, angles of lumbar lordosis, sacral table and sacral kyphosis were also measured on the same image. RESULTS AND CONCLUSION: There were statistically significant differences about the angles of lumbar lordosis (24.31±3.48)°, (26.29±3.74)°, sacral table (102.97±5.58)°, (100.70±3.26)°, and sacral kyphosis (163.45±7.03)°, (167.24±6.71)° respectively in intervertebral disc degeneration group and without intervertebral disc degeneration group (P=0.001, P =0.002, P =0.001, respectively). The sacral kyphosis and lumbar lordosis angles decrease with the increasing of the degree of intervertebral disc degeneration, and the sacral table angle increases in parallel to the increase of the degree of intervertebral disc degeneration. The sacral kyphosis, lumbar lordosis angle and sacral table angle are the morphological parameters for intervertebral disc degeneration evaluation. Related Articles | Metrics

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A method for the human meridian visualization using image matching and three-dimensional tracker Chen Xin 2012, 16 (17):  3143-3147.  doi: 10.3969/j.issn.1673-8225.2012.17.024 Abstract ( 278 )   PDF (360KB) ( 349 )   Save BACKGROUND: The human meridian is usually invisible, but it can be displayed on the computer screen using the meridian information visualization technique based on the method of the graphics, images and computer vision. So the abstract meridian information can be displayed, and can be used to help us to locate the meridian and to do clinical treatment. OBJECTIVE: To provide a more effective and convenient method for visualizing the meridian line, and to develop a meridian detection and display system based on the magnetic tracker and the camera calibration technology. METHODS: Electrical impedance on skin with multi-channel impedance detector was measured, the three-dimensional coordinate of all electrode probes on skin was acquired by using the magnetic tracker, and the electrical impedance of each channel was matched with the three-dimensional coordinate of all probes respectively. Then, according to the lower impedance characteristic of meridian, the accurate meridian place could be selected from the candidate channels using cost function. The three-dimensional coordinate of meridian could be projected onto the two-dimensional image that was taken from skin by using the “Zhang Zhengyou” method, optimized projection transformation and the image fusion. With the moving of the electrode probe, the meridian line could be displ ayed on the two-dimensional image of skin. RESULTS AND CONCLUSION: The results of experiment showed that the system impedance detection error was less than 0.2%, and the meridian line could be displayed accurately and effectively on the image of the body surface in real time. The method achieves the human meridian visualization, and can be used for medical diagnosis, the treatment or Chinese medical teaching. Related Articles | Metrics

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Diffusion-weighted magnetic resonance imaging study on herniation pit of femoral neck Dong Jie1, 2, Zhang Yu1, Li Jun2, Zhou Zhen3, Li Hai-mei1, Sang Chun-yu1, Lin Tie-qiao1, Liu Chun-hong2 2012, 16 (17):  3148-3151.  doi: 10.3969/j.issn.1673-8225.2012.17.025 Abstract ( 428 )   PDF (391KB) ( 253 )   Save BACKGROUND: At present, the report on the characteristics of water diffusion of femoral neck herniation pit by using magnetic resonance diffusion imaging is still rare.   OBJECTIVE: To evaluate the femoral neck herniation pit and normal femoral neck by apparent diffusion coefficient (ADC) and to investigate the diffusion coefficient, imaging findings and pathogenesis of the femoral neck herniation pit. METHODS: The data of 18 cases of herniation pits proved by pathology or typical imaging manifestations were analyzed. All patients underwent conventional magnetic resonance imaging and diffusion-weighted imaging as well as CT and X-ray observation. The abnormal regions on the diffusion-weighted images were outlined by using the conventional magnetic resonance imaging or CT as guides, and the ADCs were calculated. The ADC differences between herniation pits and the femoral neck were compared. RESULTS AND CONCLUSION: Twenty herniation pits of the femoral neck were found in 18 cases. The lesions were round, oval or “8”-shaped subcortical defects which were located in the anterior lateral base part of femoral head or the femoral neck. X-ray plain film showed a round radiolucency with a thin clear sclerotic rim. CT scans showed a well-defined lesion. Magnetic resonance imaging displayed low signal intensity on T1WI and high signal intensity on T2WI. The mean ADC was markedly greater in the herniation pits than that in the normal femoral neck. Diffusion-weighted imaging can provide valuable information for regarding the diffusion properties of herniation pit of the femoral neck, and markedly increased diffusion and ADC were identified in herniation pit of the femoral neck. Related Articles | Metrics

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Feasibility of contrast-enhanced magnetic resonance imaging in assessing the morphology of surrounding tissues around the surgical site in rat models of partial brain resection Ge Yan-ming, Li Yao-wu, Xu Min, Sun Xi-he, Zhang Gui-hua, Xin Shun-bao, Liu Feng-jie, Dong Peng 2012, 16 (17):  3152-3155.  doi: 10.3969/j.issn.1673-8225.2012.17.026 Abstract ( 274 )   PDF (285KB) ( 252 )   Save BACKGROUND: A series of pathological changes can occur in the normal brain tissues around the surgical site after brain tumor resection, leading to the difficult neuroimaging identification between the residual tumor-induced contrast enhancement and normal brain tissue enhancement. OBJECTIVE: To establish rat models of partial brain resection and to evaluate the feasibility of contrast-enhanced magnetic resonance imaging (MRI) in assessing the morphology of surrounding tissues around the surgical site by using Micro23 coil. METHODS: Eighteen rats were randomly divided into experimental group and control group. In the experimental group, a partial resection of the normal brain tissue was performed under aseptic conditions, and then, the rats were given contrast-enhanced MRI using Micro23 coil at 3 and 7 days postoperatively. There was no treatment in control group. RESULTS AND CONCLUSION: The contrast-enhanced MRI findings showed that the surgical margin was clear at 3 and 7 days postoperatively and the occurrence rate of contrast enhancement of the brain tissues around the surgical site was 100% in the experimental group. Contrast enhancement occurred at 3 days postoperatively and became higher at 7 days postoperatively. The shape of the surgical margin on contrast enhancement images was line-shaped or circular corresponding to the cavity. The findings suggested that contrast-enhanced MRI by using Micro23 coil was feasible for the experimental rat models of partial brain resection and it could display the imaging features of surgical margin clearly   Related Articles | Metrics

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Automatic removal for pseudo markers in optical positioning system  Liu Su-juan, Yang Rong-qian, Wu Xiao-ming 2012, 16 (17):  3156-3159.  doi: 10.3969/j.issn.1673-8225.2012.17.027 Abstract ( 262 )   PDF (338KB) ( 384 )   Save BACKGROUND: The spatial markers can be captured by optical positioning system to form images, in which the feature points are similar and the texture information is difficult to be obtained. There is an ambiguity in stereo matching, which produce pseudo markers. OBJECTIVE: To analyze the process of stereo matching and propose an effective and automatic method for removing the pseudo markers. METHODS: Because all rays emitted from the same marker lie in the same epipolar plane, the searching for matching feature points could be determined in specific region to reduce the searching area. Pseudo markers existing in stereo matching were removed according to the abrupt change of spatial coordinates of pseudo markers. So the correct markers were obtained. RESULTS AND CONCLUSION: A simulation operation tool with three markers was tracked in the experiments. 40 groups of images were obtained and δ=0.002 5 was as the initial matching threshold for testing the algorithm. The reconstruction of the movement showed that this method could effectively isolate the pseudo markers. Compared with the real distances, the error of the computed distances of real markers at the same time was 0.284 4 mm, the relative error was 0.48%, which demonstrated the effectiveness and feasibility of the proposed algorithm. Related Articles | Metrics

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Research and realization of Tamura texture feature extraction method based on image segmentation  Lü Xiao-qi, Guo Jin-ge, Zhao Yu-hong, Ren Xiao-ying 2012, 16 (17):  3160-3163.  doi: 10.3969/j.issn.1673-8225.2012.17.028 Abstract ( 467 )   PDF (368KB) ( 671 )   Save BACKGROUND: Insight segmentation and registration toolkit is the main provider of medical image processing, segmentation and registration algorithm, but, it lacks of visual function and flexible and practical user interface. Visualization toolkit provides a wealth of medical image processing and analysis tools, with the powerful graphics and visualization capabilities. OBJECTIVE: To manage, archive and retrieve the diagnosed medical imaging resource by using the previously confirmed cases, diagnose experience and relevant medical history in order to reduce manual intervention and improve the image recall rate and precision rate. METHODS: The images were preformed with smoothing, de-noising and segmentation pretreatment process on the insight segmentation and registration toolkit platform based on visual perception mechanism, and then texture feature was extracted by Tamura algorithm. Finally, the comparative analysis was completed through experiment data collection and calculation. RESULTS AND CONCLUSION: The experiment has proved that the method based on the application of texture feature retrieval can facilitate the similarity measurement and improve the retrieval accuracy.   Related Articles | Metrics

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The information research of electrocardiography based on Health Level Seven  Wu Shu-yu, Xu Qing, Geng Qing-shan, Zhou Ling-hong 2012, 16 (17):  3163-3187.  doi: 10.3969/j.issn.1673-8225.2012.17.033 Abstract ( 317 )   PDF (1192KB) ( 697 )   Save BACKGROUND: The heterogeneous data structures in various kinds of medical instruments and lack of unified exchange standard which seriously hamper the data sharing of medical instruments. OBJECTIVE: To investigate the feasibility and superiority of Health Level Seven (HL7) based communications between various medical instruments and medical information systems as HL7 is applied in this study as the exchange standard of information interaction on electrocardiograph. METHODS: HL7 electrocardiograph was used as the interaction standard of electrocardiograph to analyze and compare the current data exchange standards. Net compact framework and extensible Markup Language core techniques were applied in WINCE embedded platform with message engine, and realized the electrocardiographic standard communication protocol for computer-assisted electrocardiography explanation and HL7 information encoding and verified its effectiveness.  RESULTS AND CONCLUSION: The encoded data of electrocardiograph was successfully converted to the HL7 electrocardiograph format and displayed correctly, which has been validated by using the HL7 schema validity. The feasibility of HL7-based research of electrocardiograph information has been confirmed. The realization method is featured by practicability, expandability and universality. Related Articles | Metrics

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r angle measurement of the different sagittal skeletal pattern Fu Wei1, Hou Xiao-li2, Ding Yuan-feng1, Wang Pei-jun1, Han Jing-ying1 2012, 16 (17):  3164-3167.  doi: 10.3969/j.issn.1673-8225.2012.17.029 Abstract ( 313 )   PDF (346KB) ( 455 )   Save BACKGROUND: An accurate anteroposterior measurement of jaw relationships is critically important in orthodontic diagnosis and treatment planning. There are some disadvantages in current cephalometric methods. OBJECTIVE: To introduce a new cephalometric measurement, named the r angle, in order to express the sagittal relationship between maxilla and mandible with accuracy and reproducibility. METHODS: One hundred and eighty patients aged 13-25 years were selected to take the pre-treatment cephalometric radiographs. They were divided into skeletal Ⅰ, Ⅱ, and Ⅲ groups on the basis of four standards. The different malocclusion types for the r angle were calculated. Finally, the differences between genders were analyzed. RESULTS AND CONCLUSION: ①The r values of skeletal Ⅰ, Ⅱ, and Ⅲ were (40.84±3.10)°, (48.85±3.09)° and (26.12±4.76)° respectively. ②There were no statistically significant differences of r value between genders. It indicates that r angle can express the sagittal relationship with good repeatability. r angle between 35 and 45 degrees can be considered to have a Class Ⅰ skeletal pattern. With an angle less than 35 degrees, patients are considered to have a skeletal Class Ⅲ relationship and with an angle greater than 45 degrees, patients have a skeletal Class Ⅱ relationship.   Related Articles | Metrics

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Measurement of dental cast with normal occlusion in Chongqing by laser scanning and three-dimensional reconstruction  Zhou Xiao-feng, Zhou Jian-ping, Huang Lan, Wang Mou, Feng Gang, Dai Hong-wei 2012, 16 (17):  3168-3172.  doi: 10.3969/j.issn.1673-8225.2012.17.030 Abstract ( 306 )   PDF (304KB) ( 446 )   Save BACKGROUND: Morphological measurement of the tooth buccal and lingual surface measured by three-dimensional measuring instrument and computer-aided system confirms that there are significant differences of the teeth date between Chinese and foreigner.  OBJECTIVE: To obtain the morphological characters of normal occlusion in Chongqing with the purpose of providing evidence for individual treatment system, and to study the discrimination in tooth profile of different races and various areas, through comparing the data of this study with those of Andrews, other domestic researchers and Ormco lingual brackets. METHODS: Forty-five casts of non-orthodontic subjects (21 males and 24 females) with normal occlusion were examined using the ATOS three-dimensional lasing scanner system. Then, the data of digital three-dimensional dental casts, including crown angulation, inclination, facial prominence and offset angle of molars both of labial and lingual surfaces of the teeth was calculated and analyzed statistically by computer-aided system.  RESULTS AND CONCLUSION: Chongqing people had their own ethnic characteristics in normal occlusion: ①the crown angulation of the upper incisors and canines were more upright, while the premolars and molars were medially more inclined compared with Caucasian. ②the upper incisors were inclined more to the labial side, while the upper molars to the lingual side, but the inclination were smaller than that of domestic researchers’ study. ③the facial prominence of molars was larger than that of Caucasian and the facial prominence of canines was larger than domestic researchers’ study. ④the offset angle of upper first molars was smaller, but was similar to that of domestic researchers’ study. Tooth profile in Chongqing was significantly different from that of Caucasian and domestic residents and had their own characteristics. The result can not only provide evidence for straight wire technique and lingual therapy, but also help our clinicians to assess the craniofacial malformation completely and objectively for diagnosis and plan individual treatment for patients from different races and various areas. Related Articles | Metrics

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Wireless pulse condition identification based on the matrix laboratory   Cao Xiao-yan1, Lei Yong2, Li Liang-gang3 2012, 16 (17):  3173-3177.  doi: 10.3969/j.issn.1673-8225.2012.17.031 Abstract ( 302 )   PDF (386KB) ( 349 )   Save BACKGROUND: The collection of pulse wave is usually based on cable way, this measure brings inconvenience with what is not easy to move and expand. At the same time, the traditional pulse condition identification also restricted by artificial experience. OBJECTIVE: In order to make up the inconvenience of the cable acquisition pulse wave and the limitation of traditional pulse condition identification by the doctor’s knowledge and experience, this paper put forward a wireless pulse acquisition and use the improved support vector machine algorithm to classify the pulse condition, in order to achieve the purposes of pulse condition wireless transmission and intelligent identification. METHODS: Firstly, we used the HK2000B+ integrated pulse sensor to collect the pulse wave, then after the pulse signal disposal circuit processed, transferred it to the computer through the wireless transceiver module, then after the pretreatment by the matrix laboratory software, the time domain and frequency domain feature were picked up. Finally, the 160 cases of pulse were classified into four kinds of pulse condition by improved support vector machine algorithm. The kinds of pulse condition were flat, smooth, string and fine. RESULTS AND CONCLUSION: The experimental results show that this method has the high classification rate, low complexity and higher classification accuracy in present classification methods. It has an important significance to realize the remote and reveal of the pulse-taking. Related Articles | Metrics

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Construction of communication mode of radiotherapy information system based on DICOM radiation therapy standard  Lei Li, Zhou Ling-hong, Xia De-guo 2012, 16 (17):  3178-3182.  doi: 10.3969/j.issn.1673-8225.2012.17.032 Abstract ( 264 )   PDF (291KB) ( 352 )   Save BACKGROUND: Radiation therapy requires a patient-centered information system to integrate all the information between different systems and equipments, to make the lossless transmission of the radiation data. OBJECTIVE: To solve the non-normalized data access issues in the field of radiotherapy by using DICOM-radiation therapy standard. METHODS: The paper designed a communication model for a DICOM-radiation therapy-based radiation therapy information system. This model, which adds the support for DICOM-radiation therapy objects was constituted of four modules: client module, TCP/IP interface module, correlation module and service class module, they all can send, receive, query and retrieve information. In addition, the system also contained the support for DICOM-radiation therapy objects. RESULTS AND CONCLUSION: DICOM-radiation therapy data transmission between DICOMan software and dcm4chePACS system were tested on this model. The results show that this model can transmit data losslessly and exchange and share radiation-related information effectively. Related Articles | Metrics

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Electronic medical records in radiation therapy plan based on DICOM structured reporting model and extensible markup language  Xia De-guo, Lei Li, Zhou Ling-hong 2012, 16 (17):  3188-3192.  doi: 10.3969/j.issn.1673-8225.2012.17.034 Abstract ( 285 )   PDF (417KB) ( 461 )   Save BACKGROUND: It is important to make a relationship and share between the DICOM and the hospital information system. OBJECTIVE: To design the electronic medical records for radiotherapy plans through the research on DICOM structured reporting standard combined with extensible markup language structure characteristics. METHODS: According to DICOM structured reporting standard, the professional templates of electronic medical records for radiotherapy plans were designed; the DICOM data was redefined by extensible markup language schema, the structured reporting extensible markup language file was generated by object-oriented representation, then, the extensible markup language was transformed and the DICOM structured reporting files were generated. RESULTS AND CONCLUSION: According to the characteristics of radiotherapy plan objects, the radiation plan structured report template was designed, it included 36 template identifiers. And the software wrote on the Visual C++ 2008 platform could generate three format files. The documents could meet the hospital information system well, and finally achieved the management of the patient information by electronization, which could reduce the handwritten error and truly realize paperless. Related Articles | Metrics

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The research and international analysis of elbow orthosis   Wu Guang-yi, Bai Yue-hong 2012, 16 (17):  3193-3200.  doi: 10.3969/j.issn.1673-8225.2012.17.035 Abstract ( 301 )   PDF (428KB) ( 530 )   Save BACKGROUND: The orthosis, which creeps or stresses relaxation principle to increase joint passive activity, plays an important role in the rehabilitation of the elbow joint dysfunction. OBJECTIVE: To multivariately analyze the literature on the elbow orthosis through Web of Science database and its analysis tool. DESIGN: Bibliometric analysis. DATA RETRIEVAL: A retrieval was performed for the literature of the elbow orthosis, including brace or splint or orthopaedic appliance or supporter or orthoses or orthosis, elbow joint during 2001-01 and 2010-12 in Web of Science database. The retrieval results were analyzed, and the trends were described in words and graphics. SELECTIVE CRITERIA: Articles on the elbow orthosis included the following types: (1)Peer-reviewed original paper; (2)Proceeding papers; (3)Reviews; (4)Editorial materials. Exclusive criteria included (1)Articles unrelated to the study of the elbow orthosis. (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 publication year, journal distribution, discipline distribution, citation frequency, national distribution, institutional information and authors. RESULTS: A total of 211 literatures on the elbow orthosis were retrieved in Web of Science database, in which most of paper were published as original articles. Seven articles were identified as classic literature. The overall number of literature had an upward trend from 2001 to 2010. Journal of Hand Therapy published most papers in this field (n=12, 5.69%). 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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Characteristics and biomechanical properties of lumbar interspinous non-fusion implant Xu Gang1, Chen Guang-dong2, Chen Jian-chang3, Zhang Yang3, Liu Cong3 2012, 16 (17):  3201-3204.  doi: 10.3969/j.issn.1673-8225.2012.17.036 Abstract ( 246 )   PDF (366KB) ( 324 )   Save BACKGROUND: Non-fusion technology can avoid the loss of original biomechanical function or aggravation of intervertebral disc as a result of intervertebral discectomy and spinal fusion fixation for the treatment of lumbar vertebral degenerative lesions. OBJECTIVE: To summarize the characteristics and treatment efficacy of various lumbar interspinous fusion implants, as well as their biomechanical changes after implantation. METHODS: An online retrieval was performed among PubMed database and Chinese CNKI database between 1990 and 2012 for articles about lumbar interspinous fusion implants in the treatment of spinal degenerative disease. RESULTS AND CONCLUSION: A total of 31 documents were screened out. Interspinous non-fusion implants can open spinous process gap at lesioned segments, prevent excessive extension, accordingly increase the spinal canal cross-sectional area and foraminal height, reduce the loads of intervertebral disc and facet joint, regulate abnormal activity, preserve motor function to prevent the degeneration of adjacent segment, maintain normal state activity of the instable lumbar vertebra, and realize the dynamic reconstruction of lumbar sequence. According to its characteristics, lumbar interspinous implants are divided into two kinds, namely static and dynamic, which are representative of X-STOP and Coflex, respectively. Due to different lumbar interspinous non-fusion implants possess various characteristics and indications, it is suggested that physicians should clearly identify the disease causes, choose the most appropriate interspinous non-fusion device for individual treatment, and make the implants more consistent with physiological stress distribution. Related Articles | Metrics

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Comparison of internal fixation of various implants in treatment of distal radius fracture Liu Zhen-yang, Zhang Ji-ren, Qi Yong, Li Lei 2012, 16 (17):  3205-3208.  doi: 10.3969/j.issn.1673-8225.2012.17.037 Abstract ( 185 )   PDF (397KB) ( 406 )   Save BACKGROUND: It is not a difficult task to reset the distal radius using the distal radius fracture therapy, but there is not a method that can treat all kinds of distal radius fracture. OBJECTIVE: To summarize the research progress of internal fixation of various implants for treatment of distal radius fracture. METHODS: We retrieved PubMed Database for relevant articles published from January 2000 to December 2011. The key words were “distal radius fracture, implant material, biocompatibility”. The language was English. Simultaneously, we retrieved China National Knowledge Infrastructure for relevant articles published from January 2000 to December 2011. The key words were “distal radius fracture, implant material, biocompatibility”, and the language was Chinese. A total of 25 articles were included in accordance with inclusion criteria. RESULTS AND CONCLUSION: Intraarticular fractures of distal radius are hard to manage in the clinic in the department of orthopedics, especially complex intraarticular fracture. No matter which methods, the aim was to obtain a satisfactory functional recovery. Nevertheless, with the development of science and technology, there is not a method that can treat all kinds of distal radius fracture. Moreover, a treatment method cannot completely solve a certain distal radius fracture. Therefore, we should choose an optimal manner with a slight trauma to treat this kind of fracture. For some complex fractures, we should combine various methods to reset the distal radius and maintain the stability of the bone post surgery.   Related Articles | Metrics

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Safety of screw internal fixation system in treatment of lumbar vertebral fracture Zhao Wei, Liu Gang, Yang Yu, Zheng Xiao-han 2012, 16 (17):  3209-3212.  doi: 10.3969/j.issn.1673-8225.2012.17.038 Abstract ( 198 )   PDF (392KB) ( 279 )   Save BACKGROUND: After fracture of lumbar vertebra, vertebral arch pedicle screw fixation has been widely used in clinic, but its safety and efficacy remains controversial. OBJECTIVE: To evaluate the safety and complication occurrence of screw internal fixation system in treatment of lumbar vertebral fracture. METHODS: We retrieved Wanfang Database (http://www.wanfangdata.com.cn/) for articles concerning screw internal fixation system in treatment of lumbar vertebral fracture published from January 2000 to December 2011. The key words were “lumbar vertebral fracture, screw, internal fixation”. Repetitive studies, common reviews or Meta analysis were excluded. A total of 31 articles were included. RESULTS AND CONCLUSION: The unreliability of screw internal fixation system for treating lumbar vertebral fracture mainly was: dislocation fixation, wrong vertebral arch pedicle location, poor reposition, excessive reposition of fracture, and nerve injury. Complications following internal fixation contained screw breakage, connecting rod breakage, prosthetic joint formation, rectification loss, and wound disruption. The operator should have good anatomic knowledge of spinal column and surgical experiences, fluently mastered equipment function and usage technique requirement. The exact location and implantation of vertebral arch pedicle screw are the key points of successful internal fixation. Usage of orthosis and crutches after internal fixation and correct bone graft technique could reduce screw breakage rate and elevate bone graft fusion rate. The implant safety would obviously elevate, because of rationality of mechanic structure of vertebral arch pedicle screw system, improvement of its design, material, artwork and operation skill, development of imaging technique and computer navigation system. Related Articles | Metrics

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Effect of inflammatory cytokines in lumbar Modic changes Jiang Shi-feng, Shen Cai-liang 2012, 16 (17):  3213-3217.  doi: 10.3969/j.issn.1673-8225.2012.17.039 Abstract ( 205 )   PDF (438KB) ( 320 )   Save BACKGROUND: Intervertebral disc degeneration and endplate abnormalities may be the cause of discogenic low back pain, extensive literatures have reported that inflammatory cytokines play an important role in lumbar degenerative diseases.   OBJECTIVE: To summary the research progress of inflammatory cytokines in the lumbar Modic changes. METHODS: The computers were used to retrieve database-related articles on Chinese biomedical literature service system from January 2010 to September 2011 with the key words of "Modic changes, Vertebral endplate” in Chinese. A computer-based retrieve was preformed on the PubMed database for the relate articles with the key words of “Modic changes, Vertebral endplate” in English. A total of 48 articles were retrieved, and finally, 30 articles were included according to the inclusion criteria. RESULTS AND CONCLUSION: The lumbar Modic change refers to the abnormal signal on MRI of the lumbar endplate and endplate under bone changes, and the lesion mechanism is not very clear. Literatures have confirmed that the nucleus pulposus degeneration of the internal generation of inflammatory substances (tumor necrosis factor/neural marker protein gene product/leukocyte interleukin) can lead to local inflammation through the endplate diffusion and finally cause the endplate degeneration. In recent years, with the rapid development of molecular biology and molecular immunology, as well as in-depth study of cytokines and inflammatory mediators, the effect of cytokines and inflammatory mediators in lumbar endplate degeneration attracted more and more attention, the current researches on the effect of cytokines and inflammatory mediators in the lumbar Modic changes are being further in-depth. Related Articles | Metrics

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Research progress of osteotomies for correction of kyphotic deformity in ankylosing spondylitis Song Ruo-xian, Zhang Yong-gang 2012, 16 (17):  3218-3222.  doi: 10.3969/j.issn.1673-8225.2012.17.040 Abstract ( 334 )   PDF (334KB) ( 447 )   Save BACKGROUND: Kyphotic deformity in ankylosing spondylitis is the flexion deformity of spine sagittal plane in the late lesion; spinal osteotomy is the only treatment method. OBJECTIVE: To review the methods and application of osteotomy on the correction of kyphotic deformity in ankylosing spondylitis. METHODS: The Chinese Biomedical Literature database, CNKI database, China Academic Journals Full-text database, PubMed database and EMbase database were retrieved for articles published from January 2000 to December 2011 with keywords of “ankylosing spondylitis; kyphosis; osteotomy” in Chinese and English. Papers concerning methods, indications and effects of osteotomy on correction of kyphotic deformity in ankylosing spondylitis were included． RESULTS AND CONCLUSION: The types of posterior spinal osteotomies include: opening wedge osteotomy, closing wedge osteotomy and closing-opening wedge osteotomy, which have been described and widely used. Polysegmental Smith-Petersen osteotomy, pedicle subtraction osteotomy, vertebral column resections and vertebral column decancellations are the most four methods of osteotomy for the correction of kyphotic deformity. The polysegmental Smith-Petersen osteotomy and pedicle subtraction osteotomy are most widely used two standardized orthopedic technology for the treatment of kyphotic deformity in ankylosing spondylitis, and the vertebral column resections and vertebral column decancellations are mainly used for the treatment of severe angular kyphosis with vertex limitations or wedging of the apical region. Different osteotomies have their own indications, operative technique and complications, so the appropriate osteotomy can help to correct the kyphotic deformity effectively.   Related Articles | Metrics

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New progress in the treatment of adult hip dysplasia Wang Lei, Shang Xi-fu 2012, 16 (17):  3223-3226.  doi: 10.3969/j.issn.1673-8225.2012.17.041 Abstract ( 346 )   PDF (404KB) ( 477 )   Save BACKGROUND: Adult hip dysplasia is a common orthopedic disease; it will be developed for hip osteoarthritis severe dysfunction. The choice of treatment modality for patients is according to different age and clinical symptoms, which has been the focus of debate hip surgery. OBJECTIVE: To summarize the new research progress from the aspects of hip dysplasia etiology, pathogenesis, diagnosis and treatment.   METHODS: A computer-based retrieval was performed by the first author in the CNKI database and PubMed database to search papers on adult hip dysplasia published between January 2000 and December 2011 using key words of “development dysplasia of the hip, total hip replacement, osteotomy” in Chinese and English. According to inclusion and exclusion criteria, 30 papers were included in the final analysis. RESULTS AND CONCLUSION: Hip dysplasia may be starting in the cartilage primordium stage of the embryonic period, and caused by cartilage developmental disorders or ossification of cartilage disorders. There are many methods of the current clinical treatment for adult hip dysplasia, and for the young patients in the early and mid-term can take various types of reconstructive pelvic osteotomy surgery to alleviate pain and prevent or delay the process of secondary osteoarthritis pathology. And for the advanced patients, the treatment is mainly dependent on the joint replacement and reconstruction of the hip normal physiological function. Related Articles | Metrics

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Evaluation of avascular necrosis of the femoral head on early stage of femoral neck fracture   Shen Jia-zuo, Lian Ke-jian 2012, 16 (17):  3227-3230.  doi: 10.3969/j.issn.1673-8225.2012.17.042 Abstract ( 259 )   PDF (316KB) ( 324 )   Save BACKGROUND: On current research, the early evaluative index of osteonecrosis risk may be base on the blood reservation of femoral head after fracture. OBJECTIVE: To summarize the methods which can early diagnose and assess whether the femoral neck fractures can result in avascular necrosis of the femoral head.  METHODS: We consulted literatures about this aspect in domestic and overseas in recent years in order to summarize the effect of ultrasonography detection in the early diagnosis and assessment of femoral head blood supplying after femoral neck fracture as well as the effect in prognosis. RESULTS AND CONCLUSION: Blood supply interruption after the femoral neck fracture is the major factor of the femoral head necrosis, whereas ultrasound selective angiography, bone inner oxygen partial pressure test, laser doppler hemodynamic detection, the radioactive isotope bone imaging detection and magnatic resonance imaging detection can early diagnose and assess vascular injury and bone necrosis, and play an important role in image typing, the prognosis of the femoral head and conduction of the surgical operation. Although there are plenty of methods to early diagnose and assess the prognosis of the femoral neck fracture, all of these methods may more or less have some drawbacks which still need continuously improvement, and we should search the more advanced and practical methods for early diagnosis. Related Articles | Metrics