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    25 June 2014, Volume 18 Issue 26 Previous Issue    Next Issue
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    Medium-term follow-up after mobile-bearing total knee arthroplasty 
    Wang Guo-dong, Guo Ai, Qiang Hua, Zhao Er-hong
    2014, 18 (26):  4101-4107.  doi: 10.3969/j.issn.2095-4344.2014.26.001
    Abstract ( 674 )   PDF (582KB) ( 549 )   Save

    BACKGROUND: Mobile-bearing prosthesis has advantages in theoretic design, in vitro kinematics and abrasion, but it remains unclear whether its clinical outcomes are better than fixed-bearing prosthesis at present.
    OBJECTIVE: To evaluate the medium-term results of total knee arthroplasty using mobile-bearing prosthesis to provide clinical evidence for the choice of prosthesis.
    METHODS: The patients who suffered from osteoarthritis or rheumatoid arthritis and underwent total knee arthroplasty with PFC Sigma RP in Beijing Tongren Hospital from December 2006 to June 2009 were included in this study. The postoperative Knee Society Score, Knee Society Score Function Score, Patellar Score and the Pain Score, range of motion, maximun flexion and extension angle were collected and compared with pre-operation. The complications, such as infection, patella clicking, polyethylene insert dislocation, and deep  vein thrombosis were recorded after replacement. The anterior-posterior, lateral and Merchant position X-ray images were taken to evaluate the tibiofemoral alignment, radiolucent lines, and patellar dislocation. Then, the results of other medium-term follow-up researches were compared with fixed-bearing arthroplasty.
    RESULTS AND CONCLUSION: Finally, 31 patients (45 knees) were followed up. The average age was 64.56±10.33 years, and follow-up period was 3.9-7.6 years. The postoperative scores, range of motion, maximun flexion and extension angle were improved obviously, but there were no differences with other medium-term follow-up researches. No radiolucent lines, prosthetic loosening or polyethylene insert dislocation was found. Lateral patellar release was done, but no patellar dislocation or subluxation appeared in all patients. Two patients (2 knees) accompanied patella clicking. Results indicated that the medium-term clinical result was satisfactory. No patellar dislocation or subluxation was found, although only lateral patellar release was done. This may be the superiority of mobile-bearing arthroplasty.


    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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    One-stage total knee arthroplasty for knee osteoarthritis combined with ipsilateral femoral extra-articular deformity: individual design
    Liu Peng-cheng, Deng Ying-jie, Fang Rui
    2014, 18 (26):  4108-4114.  doi: 10.3969/j.issn.2095-4344.2014.26.002
    Abstract ( 325 )   PDF (1247KB) ( 501 )   Save

    BACKGROUND: Total knee arthroplasty for knee osteoarthritis accompanied with extra-articular deformity is still challenging. An individual replacement plan should be designed to obtain good mechanical axis and to recover suitable soft-tissue balance.
    OBJECTIVE: To observe the safety and feasibility of individually designed one-stage total knee arthroplasty for knee osteoarthritis combined with ipsilateral femoral extra-articular deformity.
    METHODS: A total of eight patients with knee osteoarthritis combined with ipsilateral femoral extra-articular deformity were enrolled in this study. According to preoperative plan, five patients underwent intra-articular compensatory osteotomy, and the remaining three received extra-articular corrective osteotomy. Multi-planar deformities as well as soft-tissue conditions were recorded. Main outcome measures included the hospital for special surgery score, Western Ontario and McMaster Universities Arthritis Index score and alignments deviation.
    RESULTS AND CONCLUSION: The patients were averagely followed up for 29 months. The hospital for special surgery score changed from preoperative 32.5 points to postoperative 87.5 points. The Western Ontario and McMaster Universities Arthritis Index score was increased from preoperative 37.1 points to postoperative 88.8 points (P < 0.05). Mean mechanical axis deviation (either varus or valgus) changed from preoperative 17.1° to postoperative 1.4° (P < 0.05). All cases with extra-articular corrective osteotomy healed within 3 months, and none had postoperative infection, loosening or venous thromboembolic events. One patient was with 5° residual knee anti-sheets. Results verified that one-stage total knee arthroplasty procedures are effective in the treatment of knee osteoarthritis accompanied with ipsilateral femoral extra-articular deformity in accordance with individual preoperative plan.


    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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    Artificial total hip arthroplasty for proximal femur tumors: clinical efficacy and security 
    Zhou Zheng, Liu Tang
    2014, 18 (26):  4115-4119.  doi: 10.3969/j.issn.2095-4344.2014.26.003
    Abstract ( 498 )   PDF (438KB) ( 477 )   Save

    BACKGROUND: With elevated medical levels, limb salvage surgery for limb malignant tumor is valuable day by day. At present, the limb salvage surgery has substituted amputation and becomes mainstream and development direction of present surgical treatment of limb tumors. However, so far, there are no unified surgical indications for proximal femur tumor, which are controversial.
    OBJECTIVE: To investigate the efficacy of artificial total hip arthroplasty combined with extended resection of tumor sections for proximal femoral bone tumors.
    METHODS: Patients with proximal femoral bone tumors in the Second Xiangya Hospital of Central South University were selected and divided into control group and observation group, with 30 patients in each group. According to the disease, lesion curettage, aneurysm wall inactivation, autologous and (or) allogeneic bone, mixed bone graft and bone graft fixation were selected to treat the control group. The observation group patients received extended resection of tumor sections and total hip arthroplasty. The operative time, intraoperative blood loss, hospital stay and joint function of two groups were compared. 2 years later, patients were revisited. Metastasis and recurrence rate, death rate and quality of life of two groups were compared.
    RESULTS AND CONCLUSION: There was no significant difference in intraoperative blood loss and surgery time between the two groups (P > 0.05). However, hospital stay of patients in the observation group was shorter than the control group. The excellent and good rate of recovery of joint function (83%) was higher in the observation group than in the control group (53%). The metastasis and recurrence rate within 2 years after surgery (7%) and death rate (3%) were lower in the observation group than in the control group (30%, 23%). Various indicators of quality of life of patients in the observation group were significantly better than the control group (P < 0.05). These results confirmed that artificial total hip arthroplasty in the treatment of proximal femur tumors is safe and effective.


    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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    Total hip arthroplasty with onlay bone graft for treatment of severe adult hip dysplasia
    Liu Hong-ming, Zhu Ji-gui, Ye Zheng, Zhu Jian, Zhu Zhi-jun, Sun Si-xin
    2014, 18 (26):  4120-4124.  doi: 10.3969/j.issn.2095-4344.2014.26.004
    Abstract ( 473 )   PDF (733KB) ( 402 )   Save

    BACKGROUND: Joint replacement surgery becomes difficult because of the abnormal changes in hip joint, especially on the acetabular side. Therefore, the treatment on acetabulum is very important during total hip arthroplasty in patients with hip dysplasia.
    OBJECTIVE: To investigate the clinical therapeutic effects of total hip arthroplasty with onlay bone graft for treatment of CroweIII and IV adult hip dysplasia.
    METHODS: A total of in 14 patients with adult hip dysplasia were retrospectively analyzed. According to Crowe method, there were 11 cases of type III and 3 cases of type IV. All patients underwent total hip arthroplasty. Autologous femur neck was used to make an onlay bone graft around the acetabulum during replacement. Radiographs were analyzed after replacement and during follow-up. Clinical efficacy was assessed using Harris standard.
    RESULTS AND CONCLUSION: All patients were followed up for 1-9 years, averagely 4.5 years. Bone graft was partially absorbed within 1 year after replacement in 4 patients, and began to grow 2 years later. Radiographs showed that all bone graft was fused to host bone. The average coverage rate of bone grafts on acetabulum was 36%. None hip was needed to be rebuilt up to now. Harris score of hip joint function increased from 35 points (26-52 points) before surgery to 91 points during final follow-up. Total hip arthroplasty with onlay bone graft is an effective method in treatment of CroweIII and IV adult hip dysplasia.


    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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    Effects of drainage tube occlusion on drainage volume after total hip arthroplasty
    Yuan Xiang-wei, Wang Yi-sheng
    2014, 18 (26):  4125-4130.  doi: 10.3969/j.issn.2095-4344.2014.26.005
    Abstract ( 574 )   PDF (512KB) ( 564 )   Save

    BACKGROUND: At present, occlusion of the drainage tube was commonly used to reduce the drainage volume after total hip arthroplasty so as to promote the incision healing and hip function rehabilitation. However, the occlusion time is a problem deserving further investigations.
    OBJECTIVE: To research the effects of temporarily clamping drainage tube on drainage volume in early stage after total hip arthroplasty.
    METHODS: From January to October 2013, 112 patients received unilateral total hip arthroplasty in the First Ward, Department of Orthopedics, First Affiliated Hospital, Zhengzhou University in China. They were randomly divided into four groups according to the admission time (n=28): occlusion of the drainage tube for 2, 4 and 6 hours and without occlusion of the drainage tube. All tubes were pulled out in postoperative 48 hours. Moreover, 48-hour postoperative hemoglobin and drainage volume, the healing of incision and the score of hip joint function when patients were followed up at 1.5 months postoperatively were recorded accurately.
    RESULTS AND CONCLUSION: 48-hour hemoglobin drop level and 48-hour incision drainage volume were highest in the non-occlusion group, followed by 2-hour occlusion group, 4-hour occlusion group and 6-hour occlusion group (P < 0.05). However, no significant differences in the healing time of postoperative incision and the Harris score of hip joint function when patients were followed up at 1.5 months postoperatively were detected among groups (P > 0.05). Incision infection and tension split were not seen in each group. Six cases affected subcutaneous ecchymosis and swelling accompanied by pain and four cases suffered from the venous plexus thrombosis of the calf muscle in the 6-hour occlusion group. One case experienced fat liquefaction separately in the 4-hour occlusion group and non-occlusion group. These results suggested that temporary occlusion of the drainage tube in the early stage of total hip arthroplasty could reduce the drainage volume of incision. The suitable time of clamping drainage tube was 4 hours, and there were no adverse effects on healing of incision and recovery of hip function.


    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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    Application of custom-manufactured artificial total knee prosthesis in limb salvage surgery for patients with a pathologic fracture in osteosarcoma 
    Li Fu-sheng, Xu Shao-nian, Huang Hai, Du Zhen-guang, Wang Liang
    2014, 18 (26):  4131-4135.  doi: 10.3969/j.issn.2095-4344.2014.26.006
    Abstract ( 474 )   PDF (366KB) ( 376 )   Save

    BACKGROUND: Osteosarcoma combined with pathological fracture was often treated by amputation. With clinical application of neoadjuvant chemotherapy and improvement of technology and material of the prosthesis, the limbs of patients with osteosarcoma combined with pathological fracture were reserved.
    OBJECTIVE: To evaluate the effect of the application of custom-manufactured artificial total knee prosthesis replacement in limb salvage treatment for patients with osteosarcoma combined with pathological fracture.
    METHODS: A total of 11 patients with pathological fracture with osteosarcoma located in adjacent knee Joint were enrolled from June 2002 to September 2012. In accordance with individual condition of the patient, limb salvage treatment was designed for knee prosthesis for a tumor. Follow-up results were retrospectively analyzed. There were six males (54.5%) and five females (45.5%) and their age ranged from 11 to 50 years old with an average age of 25.4 years old. Onset regions: seven tumors were located in the distal femur and four tumors were in the proximal tibia. All patients received neoadjuvant chemotherapy, and limb salvage treatment with custom-manufactured artificial knee prosthesis. The follow up was performed for 9 to 105 months.
    RESULTS AND CONCLUSION: In 11 patients after prosthesis replacement, the regional recurrence rates were 18%, lung metastasis rates were 36%. The five-year survival rate was 58%. Four patients developed lung metastases and died in 9 to 24 months postoperatively. During the last follow-up, Enneking score of the affected limbs was 11 to 30 points, averagely 23.3 points, with an excellent and good rate of 82%. Results indicated that combined with neoadjuvanet chemotherapy, the application of custom-manufactured artificial total knee prosthesis replacement in the treatment of osteosarcoma located in adjacent knee joint and pathological fracture achieved an ideal outcomes of the limb salvage treatment in the near future. The lone-term effectiveness was expected to be evaluated.


    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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    Two different kinds of fixation materials in repair of distal clavicle fracture: stability of reconstruction
    Cai Teng, Chen Yong
    2014, 18 (26):  4136-4141.  doi: 10.3969/j.issn.2095-4344.2014.26.007
    Abstract ( 381 )   PDF (327KB) ( 377 )   Save

    BACKGROUND: For distal clavicle fracture, clavicular hook plate and Kirschner wire tension band were used in the clinic, but they cannot keep the dual function of stability and functional protection. However, the application of microporous locking plate of distal clavicle makes it possible to double efficacy.
    OBJECTIVE: To compare and analyze the clinical outcomes of distal clavicle microporous locking plate and clavicular hook plate.
    METHODS: From March 2011 to March 2013, 40 patients with distal clavicle fractures were involved in this study. They were divided into two groups with the voluntary principles: distal clavicle microporous locking plate group and clavicular hook plate group. We compared and observed perioperative indicators (operation time, blood loss, and hospitalization days), clinical curative effects (University of California at Los Angeles scoring system and American Shoulder and Elbow Surgeons Scale), the score of shoulder joint function (Karlsson standard) and the overall treatment (removed the plate and functional training costs).
    RESULTS AND CONCLUSION: All patients successfully underwent surgery. At 1 year after surgery, internal fixators were taken out. Necessary relevant rehabilitation training was performed for more than 3 months. There was no significant difference in perioperative indicators (P > 0.05). However, clinical curative effects and the score of Karlsson shoulder joint function showed significant advantages in the microporous locking plate group (P < 0.05). Although the distal clavicle microporous locking plate material cost was high, but there was no significant statistic difference in the overall treatment for better protection shoulder function (P > 0.05). We draw the conclusion that distal clavicle microporous locking plate can effectively reconstruct the stability of the fracture site, and better retain the function of the joints at the same time.


    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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    Three-dimensional reconstruction combined with minimally invasive titanium plate or lag screw in the repair of complex scapular fractures
    Li Xue-jin, Xu Jie, Liu Ying, Pei Bao-yan, Li Qun, Jiang Yong-chong
    2014, 18 (26):  4142-4147.  doi: 10.3969/j.issn.2095-4344.2014.26.008
    Abstract ( 419 )   PDF (831KB) ( 395 )   Save

    BACKGROUND: Complex scapular fractures were mainly treated by implant fixation. Standard fixation approach (Judet approach) had long incision and big trauma. With the application of spiral CT and three-dimensional reconstruction, minimally invasive incision could be designed before implant fixation, and then fixation could be finished by physicians. Thus, trauma was reduced and repair effect was elevated.
    OBJECTIVE: To observe the effects of the three-dimensional reconstruction design combined with titanium plate reconstruction or lag screw for treatment of scapular fractures.     
    METHODS: From February 2007 to January 2012, 33 cases of scapular fractures were enrolled from Department of Orthopedics, No. 1 Hospital of Qinhuangdao in China. They were scanned by three dimensional reconstruction of CT before implant fixation to identify the regions needed to be repositioned and fixed. Thus, minimally invasive incision of implant fixation was designed. The dissection of skin, subcutaneous tissue and muscle was reduced. Reposition was performed. Titanium plate and/or lag screw were used for fixation.
    RESULTS AND CONCLUSION: The operation lasted for 90-130 minutes in 33 patients, with intraoperative blood loss for 300-400 mL. Fracture was totally healed, and the healing time was 2-4 months. The follow up lasted for 12-24 months. According to Hardegger standard, there were excellent in 17 cases, good in 12 cases, average in 3 cases and poor in 1 case, with an excellent and good rate of 88%. These results suggested that three-dimensional reconstruction design combined with minimally invasive incision treatment for scapular fractures showed fewer traumas, can complete the satisfactory fracture reduction and implant fixation, and obtain good repair effect.


    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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    Clavicular hook plate versus threaded rivets for repair of Tossy III acromioclavicular joint dislocation: 3-month follow-up 
    Kuang Lan, Zhang Ke-gang, Shi Zhong-qi
    2014, 18 (26):  4148-4152.  doi: 10.3969/j.issn.2095-4344.2014.26.009
    Abstract ( 508 )   PDF (1067KB) ( 432 )   Save

    BACKGROUND: Clavicular hook plate fixation is a extensively used method in repair of acromioclavicular dislocation in recent years. The metal hook of the clavicular hook plate occupied subacromial space. Some patients affected joint pain. Therefore, it is necessary to find a better fixation material to replace clavicular hook plate.
    OBJECTIVE: To explore the curative effect of threaded rivets versus clavicular hook plate in treatment of the Tossy III acromioclavicular joint dislocation.
    METHODS: We retrospectively analyzed clinical data of 51 cases of type Tossy III acromioclavicular joint dislocation. All follow-up data were obtained including 27 cases in the clavicular hook plate fixation group and 24 cases in the threaded rivets group. Imaging results, clinical therapeutic effects and complications were compared and analyzed after fixation in both groups.
    RESULTS AND CONCLUSION: No significant difference in Japanese Orthopaedic Association scores was detected between the clavicular hook plate fixation group and threaded rivets group (P > 0.05). At 3 months after fixation, the incidences of subacromial impingement syndrome and acromial bone erosion were higher in the clavicular hook plate fixation group compared with the threaded rivets group, and the visual analogous scale scores were significantly higher than the threaded rivets group (P < 0.05). Results suggested that both two methods can be used to treat type Tossy III acromioclavicular joint dislocation, with similar clinical curative effects, but the threaded rivets have the advantage of preventing the postoperative complications such as acromial bone impact and erosion, subacromial impingement and lysis. 


    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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    Absorbable rod versus Herbert screw for radial head fractures: therapeutic effects and treatment costs
    Wang Si-cheng, Zhang You-zhong, Yang Guo-qing, He Jin-guo, Fang Yang, Liu Xiang-fei, Wu Xian-min, Yang Xiao-yu
    2014, 18 (26):  4153-4157.  doi: 10.3969/j.issn.2095-4344.2014.26.010
    Abstract ( 691 )   PDF (766KB) ( 556 )   Save

    BACKGROUND: Mason II type and III type radial head fractures with massive bone are mainly treated by open reduction and metal fixation, but metal implants have to be removed in the second operation, which increased patients’ travail and financial burden. Absorbable screw/rod also can be used to treat radial head fractures, and has its special advantages due to the low price and no second operation.
    OBJECTIVE: To compare the clinical therapeutic effects of absorbable rod and Herbert screw for the treatment of Mason II or III type radial head fractures.
    METHODS: A total of 80 patients with Mason II and III type radial head fractures were equally assigned to experimental and control groups. They received open reduction and internal fixation. The experimental group was treated with absorbable rod and the control group received Herbert screw.
    RESULTS AND CONCLUSION: A total of 79 patients were followed up for averagely 34 months. No significant difference in average operative time, fracture healing time, Broberg and Morrey elbow scores and incidence of complications was detected between the experimental and control groups (P > 0.05). However, treatment costs were lower in the experimental group than in the control group (P < 0.05). Results indicated that the therapeutic effects between absorbable rod and Herbert screw for Mason II or III type radial head fractures were similar. However, absorbable rod for radial head fractures can avoid the second operation for removal of the implant. Therefore, we recommend absorbable rod in the choice of internal fixation materials.


    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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    Advantages of cemented dynamic hip screw for osteoporotic intertrochanteric fracture
    She Yuan-shi, Chen Guang-xiang, Chen Guang-dong, Wang Yi-jin, Zou Tian-ming
    2014, 18 (26):  4158-4162.  doi: 10.3969/j.issn.2095-4344.2014.26.011
    Abstract ( 565 )   PDF (402KB) ( 538 )   Save

    BACKGROUND: Dynamic hip screws have been considered as a classic method for intertrochanteric fracture. However, migration of the hip screw resulting in cut-out of the femoral head remains the most common mechanical failure, which requires secondary surgery.
    OBJECTIVE: On the basis of the traditional dynamic hip screw, we modified the lag screw, designed new internal fixation system as cemented dynamic hip screws to explore the feasibility and the biomechanical properties for the treatment of osteoporotic intertrochanteric fracture.
    METHODS: A total of 24 hip samples were harvested from fresh cadavers with osteoporosis. Bone density was measured. According to the standards, the specimens were made into intertrochanteric fracture models of AO31-A1 type. Of each specimen, one side implanted with cemented dynamic hip screws served as experimental group, and another side implanted with traditional dynamic hip screw served as control group. Axial compression, twisting and fatigue load biomechanics were tested. Their biomechanical functions were compared.
    RESULTS AND CONCLUSION: Stress intensity, axial stiffness and horizontal shear stiffness were higher in the experimental group than in the control group (P < 0.05). At torsion angle of 3°, torsional moment was higher in the experimental group than in the control group (P < 0.05). Fatigue load was higher in the experimental group than in the control group (P < 0.05). Results suggested that cemented dynamic hip screw internal fixation system in the  treatment of senile osteoporotic intertrochanteric fracture can effectively enhance the hip screw holding force and prevent femoral cutting. Biomechanical property, stiffness, endurance resistance and stability of cemented dynamic hip screw are better than traditional dynamic hip screw.


    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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    Comparison of four metal fixation implants for femoral intertrochanteric fractures in old patients
    Li Jing-yang, Zhou Yu-bo, Qiao Wei-min, Yan Tao, Wang Guang-dong, Wang Hong-bo
    2014, 18 (26):  4163-4167.  doi: 10.3969/j.issn.2095-4344.2014.26.012
    Abstract ( 559 )   PDF (1362KB) ( 454 )   Save

    BACKGROUND: The selection of metal implant for old patients with femoral intertrochanteric fracture should focus on patient’s age, osteoporotic degree, perioperative status and type of fracture. Individual therapeutic program should be made.
    OBJECTIVE: To compare the therapeutic effects of four types of metal implant fixation for femoral intertrochanteric fracture in old patients.
    METHODS: 180 old patients with femoral intertrochanteric fractures treated from September 2009 to September 2012 were analyzed. Four kinds of metal implants were used for repair of fracture. There were 45 patients in the dynamic hip screw group, proximal femoral nail anti-rotation group, Gamma nail group and anatomical dynamic hip lock nickelclad group, separately. Operation time, blood loss, hospital time, Harris score after operation, fracture healing time and complications in different groups were compared.
    RESULTS AND CONCLUSION: Operation time and hospital time were shorter, and blood loss was fewer in the  anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the dynamic hip screw group and Gamma nail group (P < 0.05), but the excellent and good rate of Harris score after operation was higher (P < 0.05). No significant difference was detected between anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group (P > 0.05). The incidence of complications was significantly lower in the anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the Gamma nail group and dynamic hip screw group (P < 0.05). Results suggested that anatomical dynamic hip lock nickelclad and proximal femoral nail anti-rotation are reliable in treatment of intertrochanteric fracture in old patients, show less postoperative complications, and are ideal choices for implant fixation of femoral intertrochanteric fracture in old patients.


    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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    Effects of femoral condylar buttress plate on repair of distal femoral fractures
    Wang Xiu-min
    2014, 18 (26):  4168-4172.  doi: 10.3969/j.issn.2095-4344.2014.26.013
    Abstract ( 332 )   PDF (321KB) ( 401 )   Save

    BACKGROUND: Distal femoral fractures are complex and unstable, and combined with severe injury to local soft tissue and microcirculation. Fracture healing is difficult. Condylar buttress plate is commonly used in the clinic. However, the factors affecting its prognosis are various, and the reports are diverse.
    OBJECTIVE: To investigate the factors affecting clinical efficacy of femoral condylar buttress plate for distal femoral fractures.
    METHODS: Clinical data of 84 patients with distal femoral fractures undergoing surgical treatment with femoral condylar buttress plate were retrospectively analyzed. Possible influential factors were screened by univariate analysis and logistic regression analysis.
    RESULTS AND CONCLUSION: Of the 84 patients, 63 cases (75%) rated as excellent by Neer scores. Univariate analysis of variance showed significant differences in age, fracture category, type of injury, timing of surgery, quality of reduction and CPM exercise among groups (P < 0.05). Logistic regression analysis showed that older patients had poorer therapeutic effects (OR=0.797). Patients with satisfactory reduction, type fracture and CPM exercise had good therapeutic effects (OR=2.275, 1.756, 2.885, respectively). Results exhibited that satisfactory reduction, fitting joints, and early CPM exercises could effectively contribute to functional recovery of knee joint during implantation of condylar buttress plate in patients with distal femoral fractures. For patients with type C fracture, double plates can be used to strengthen fixation and to elevate therapeutic effects.


    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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    Minimally invasive versus open reduction and plate fixation in the repair of distal tibial fractures
    Huang Shao-hui, Xie Zhang-jia, Li Lan-quan, He Sheng, Chen Tian
    2014, 18 (26):  4173-4178.  doi: 10.3969/j.issn.2095-4344.2014.26.014
    Abstract ( 444 )   PDF (551KB) ( 391 )   Save

    BACKGROUND: In recent years, minimally invasive percutaneous plate fixation has been a selectable method to repair fracture of lower limbs, especially complex fracture of lower limbs. Its advantages are to reduce the damage to soft tissues, and do not destroy bone nutrient supply vessels. However, there is no unified criterion to select which method in the repair of distal tibial fractures.
    OBJECTIVE: To observe clinical effects of minimally invasive percutaneous plate fixation versus open reduction and plate fixation in the repair of distal tibial fractures.
    METHODS: A total of 60 cases of distal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis (n=35) and open reduction and plate fixation (n=25) were selected. The time of surgery was identified by evaluating soft tissue. We should pay attention to the protection of soft tissue in surgery and reasonable fixation method should be selected. After fixation, we guided patients to do active early functional exercise. They were followed up and regularly received X-ray reexamination. Operation time, weight loading time, healing time and functional recovery were observed and the clinical therapeutic effects of the two methods were compared.
    RESULTS AND CONCLUSION: All patients were followed-up after surgery. They were followed up for 3 to 15 months. No significant difference in healing time of type A fracture was detected between minimally invasive percutaneous plate fixation and open reduction and plate fixation. The healing time of types B and C fracture was better in minimally invasive percutaneous plate fixation group than in open reduction and plate fixation group. These results indicated that minimally invasive percutaneous plate fixation in repair of tibial fractures, especially distal complex tibial fractures, is an effective method. The healing rate of fracture was high, but postoperative complications were less.


    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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    Applied anatomy and biomechanics of atlas pedicle screw implantation
    Chang Zhi-qiang, Zhang Pei, Wu Yi-min, Li Peng-fei
    2014, 18 (26):  4185-4189.  doi: 10.3969/j.issn.2095-4344.2014.26.016
    Abstract ( 401 )   PDF (331KB) ( 387 )   Save

    BACKGROUND: A series of pathological changes were found in atlas, including atlas dislocation, atlanto-occipital junction instability and vertebral fractures. Atlantoaxial pedicle screw, nail and rod fixation or nail plate fixation is a novel repair method recently proposed, and has certain advantages.
    OBJECTIVE: To compare the repair effects of atlas pedicle screw on different types of atlas lesions.
    METHODS: A total of 42 fresh vertebrae were obtained from Department of Human Anatomy, Basic Medical School, Inner Mongolia Medical University. In accordance with bone thickness of sagittal vertebral artery groove bottom, vertebrae were divided into three types: type I (common type), type II (light variation), and type III (severe variation). All samples were subjected to atlas pedicle screw fixation.
    RESULTS AND CONCLUSION: The screw pullout force in different bone densities of vertebrae was not the same. Vertebrae with great thickness and great bone density had big screw pullout force (P < 0.05). However, the screw in different cortical bone of vertebrae had the same function. No compression on blood vessels or phenomenon affecting vertebral activity was visible. These results indicated that atlas pedicle screw implantation showed good safety, no side effects, did not affect the normal work and life of patients. 


    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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    Screw path of pedicle of upper thoracic spine and anatomical positions of prevertebral key structures: computed tomography evaluation
    Xing Wen-hua, Hao Li-xia, Huo Hong-jun, Yang Xue-jun
    2014, 18 (26):  4190-4194.  doi: 10.3969/j.issn.2095-4344.2014.26.017
    Abstract ( 539 )   PDF (392KB) ( 444 )   Save

    BACKGROUND: The structure surrounding upper thoracic spine is complicated. Transverse diameter of pedicle was relatively small. There were important organs in front of the vertebral body. Screws deviated from axis or screws were too long. The safety and effectiveness of screw implantation were not implemented. It is necessary to understand the key structure of surroundings.
    OBJECTIVE: To analyze the relationship of anatomic position between the axis of screw of pedicle of upper thoracic spine and key adjacent structure of the vertebral body.
    METHODS: A total of 30 healthy adult volunteers received T1-T4 pedicle axis parallel to CT scans. The positions of esophagus, trachea position, aortic arch, carotid and vertebral arteries were observed when the pedicle screw was implanted along the pedicle axis. The shortest distance on both sides of a vertebral pedicle axis from these structures was measured. Paired t-test was utilized for analysis.
    RESULTS AND CONCLUSION: 240 measurement parameters were analyzed. The distance from the left pedicle axis on T 1-3 to esophagus was small, and the left pedicle on T2 was minimal. The distance from the right pedicle axis on T 2-4 to trachea was small. The distance from right pedicle axis on T3, T4 to right main bronchus was small. Carotid and vertebral artery did not show the risk of injury. 62% of the patients were in the aortic arch on T4 plane, and no risk of damage was found. These results indicated that the left pedicle screws were easy to damage the esophagus, and the right pedicle screw was easy to damage trachea. Carotid artery, vertebral artery and aortic arch were not easy to be damaged. The anatomic position of easily damaged structure could be identified by careful analysis of CT data before screw implantation in the pedicle of upper thoracic spine.


    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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    Calcium sulfate cement augments transient stability of pedicle screw in osteoporotic vertebral body
    Zhu Ai-guo, Zhang Feng, Ge Yong, Cao Yong, Zhang Chi, Chen Yun
    2014, 18 (26):  4195-4199.  doi: 10.3969/j.issn.2095-4344.2014.26.018
    Abstract ( 345 )   PDF (267KB) ( 385 )   Save

    BACKGROUND: Poor implant anchorage in osteoporotic bone impacts its stability and requires the new solutions for the treatment. The augmentation technique with bone cements or bone substitutes is one strategy for the solutions.
    OBJECTIVE: To evaluate the transient stability of pedicle screw augmented using calcium sulfate cement in osteoporotic vertebral body.
    METHODS: Fresh calf lumbar vertebrae were selected to measure bone density, and then classified into four groups: the group by pedicle screw in normal vertebral body; the group by pedicle screw augmented using calcium sulfate cement in normal vertebral body; the group by pedicle screw in osteoporotic vertebral body; the group by pedicle screw augmented using calcium sulfate cement in osteoporotic vertebral body. Pedicle screw of equal specification was twisted into the tested pedicle of vertebral arch. The maximum axial screw pull-out strength and the maximum energy required to failure were recorded so as to assess the transient stability of pedicle screw augmented using calcium sulfate cement.  
    RESULTS AND CONCLUSION: The maximum screw pull-out strength and the maximum energy required to failure were significantly less in osteoporotic vertebral body compared with normal vertebral body (P < 0.05). The maximum screw pull-out strength and the maximum energy required to failure after augmentation using calcium sulfate cement were significantly increased (P < 0.05). The maximum screw pull-out strength and the maximum energy required to failure after augmentation using calcium sulfate cement were identical between normal group and osteoporosis group. These results suggested that calcium sulfate cement could effectively increase the transient stability of pedicle screw. Calcium sulfate cement is effective in augmenting fixation in osteoporotic bone, and has potential in clinical application.


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    Iodine-125 radioactive seed implantation combined with vertebroplasty and nail-rod fixation for thoracolumbar metastatic tumors
    Liu Jun-liang, Gao Guo-yong, Zhen Wan-xin, Liu Yang, Yang Da-zhi, Lin Er-hu
    2014, 18 (26):  4200-4205.  doi: 10.3969/j.issn.2095-4344.2014.26.019
    Abstract ( 319 )   PDF (831KB) ( 388 )   Save

    BACKGROUND: At present, vertebroplasty and spinal canal decompression are common methods for treatment of metastatic spinal tumors. Iodine-125 (125I) radioactive seed implantation has been shown to control the tumor. However, there were few clinical studies on combined therapy using above-mentioned methods.
    OBJECTIVE: To compare the differences of 125I radioactive seed implantation combined with vertebroplasty and titanium alloy nail-rod fixation and vertebroplasty combined with titanium alloy nail-rod fixation for treating thoracolumbar metastases on pain control, general performance and improvement of the spinal cord function, and to evaluate clinical value of 125I radioactive seed implantation combined with therapeutic plans.
    METHODS: Thoracolumbar metastases patients undergoing titanium alloy nail-rod fixation were selected in the Department of Spinal Surgery, Shenzhen Municipal People’s Hospital in China from October 2009 to March 2013. They were assigned to experimental and control groups according to with or without 125I radioactive seed implantation. Improvement in neurological function was observed before and 2 weeks, 1, 6, and 12 months after titanium alloy nail-rod fixation in both groups.
    RESULTS AND CONCLUSION: All patients were followed up for 7 to 29 months, averagely 15.8 months. There was no loosening of titanium alloy nail-rod fixation and the position of bone cement was good. No seed migration or radioactive spinal cord injury was observed. No relapse or diffusion in the surgical site was observed during   follow up. Visual Analogue Scale and Karnofsky Performance Status scores were higher in the experimental group than in the control group (P < 0.05). Frankel level was obviously improved after fixation in both groups compared with preoperation. No significant difference in the improvement of neurological function was detected between the two groups (P > 0.05). Results indicated that 125I radioactive seed implantation combined with vertebroplasty and titanium alloy nail-rod fixation for treatment of metastatic spinal tumors showed obvious outcomes in relieving cancer pain.


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    Percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradients for metastatic tumor in thoracic lumbar vertebrae
    Zhang Fan, Yang Hui-lin, Guan Hua-qing
    2014, 18 (26):  4206-4211.  doi: 10.3969/j.issn.2095-4344.2014.26.020
    Abstract ( 282 )   PDF (718KB) ( 334 )   Save

    BACKGROUND: Percutaneous vertebroplasty has been extensively applied in treatment of osteoporotic vertebral compression fractures, and now it is also used in spinal metastatic tumor.
    OBJECTIVE: To evaluate the effectiveness of percutaneous vertebroplasty for metastatic tumor of thoracic lumbar vertebrae by bone cement perfusion at different times and temperature gradient.
    METHODS: A total of 24 cases (38 vertebrae) of metastatic tumor receiving percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient were reviewed retrospectively. All patients were classified into group A (11 vertebrae in 9 cases) featured with apparent vertebral compression (≥ 1/4) and group B (27 vertebrae in 15 cases) of no obvious compression (< 1/4). The percutaneous vertebroplasty was conducted with C-arm fluoroscopy positioning. Bone cement was injected by perfusion at different times and temperature gradient method. Visual Analogue Scales and Owestry Disability Index were recorded to assess pain alleviation and functional restoration before and after bone cement injection at different times and temperature gradient. The height of treated vertebrae was also analyzed. Follow-up was performed for 12 to 56 months.
    RESULTS AND CONCLUSION: All 24 patients successfully underwent percutaneous vertebroplasty and bone  cement perfusion at different times and temperature gradient. Bone cement (4±1) mL was averagely injected into each thoracic vertebra. Bone cement (5±1) mL was injected into each lumbar vertebra. Postoperative recheck radiographs revealed good bone cement distribution, no nerve root injury or spinal compression occurred. Vertebral height was significantly higher posttreatment compared with pretreatment in both groups (P < 0.05). Visual Analogue Scales and Owestry Disability Index scores were significantly lower at 1 day, 1 month after treatment and during final follow-up compared with preoperation in all patients (P < 0.05). No significant difference in Visual Analogue Scales and Owestry Disability Index scores was detected between two groups at the same time point. Results suggested that percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient for metastatic tumor of thoracic lumbar vertebrae could reduce the occurrence of bone cement leakage, and could ease the pain quickly for apparent and non-apparent compressed tumor metastatic vertebrae. It is an effective method to treat metastatic tumor of vertebrae.


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    Minimally invasive versus open pedicle screw fixation for repair of thoracolumbar fractures
    Peng Xiao-zhong, Xiao Kan-kan
    2014, 18 (26):  4212-4218.  doi: 10.3969/j.issn.2095-4344.2014.26.021
    Abstract ( 364 )   PDF (288KB) ( 397 )   Save

    BACKGROUND: Recently, minimally invasive techniques obtained more attention. Some new minimally invasive methods have been used in the treatment of spine fracture and provide new challenges for conventional open surgery.
    OBJECTIVE: To discuss the clinical efficacy of conventional posterior open pedicle screw fixation versus minimally invasive operation (using Mast Quadrant System and Sextant percutaneous pedicle screw fixation) for treating single-segment thoracolumbar fractures without neurological damages.
    METHODS: A total of 94 cases of single-segment thoracolumbar fracture without neurological damages, who were treated in Department of Spine Surgery, Liuzhou Worker’s Hospital in China from January 2012 to January 2013, were enrolled in this study. According to patients’ conditions and willing, they were divided into open fixation group, Quadrant fixation group and percutaneous Sextant fixation group. Perioperative index, clinical efficacy, and imaging results were observed and compared among different groups.
    RESULTS AND CONCLUSION: Intraoperative blood loss, incision length and length of stay were better in the Quadrant fixation group and percutaneous Sextant fixation group than in the posterior open fixation group (P < 0.05). A total of 94 patients were followed up for 6 months. No cases of nerve damage, slippage or breakage of implants were found. The anterior vertebral body height, Cobb’s angle, and sagittal index were significantly 
    improved postoperatively compared to pre-operation in all three groups (P < 0.05), but there was no significant difference in the three groups (P > 0.05). Postoperative Visual Analog Scale scores and Oswestry Disability Index were better in the two minimally invasive groups than in the conventional open fixation group (P < 0.05). These results suggested that compared with conventional open operation, minimally invasive operation (Mast Quadrant System and Sextant percutaneous pedicle screw fixation) in the treatment of thoracolumbar fractures not only can achieve similar imaging result, but has small incision, less blood loss, quick recovery, high safety, and obtains good clinical therapeutic outcomes. In the case of strict surgical indications, minimally invasive method is an ideal choice in treating thoracolumbar fractures without neurological damages.


    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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    Establishing a three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis
    Huang Sheng-jia, Huo Hong-jun, Yang Xue-jun, Xing Wen-hua, Xin Da-qi, Li Feng
    2014, 18 (26):  4219-4223.  doi: 10.3969/j.issn.2095-4344.2014.26.022
    Abstract ( 322 )   PDF (713KB) ( 515 )   Save

    BACKGROUND: Establishment of high-quality finite element model is an important basis of biomechanical analysis. The reports on three-dimensional finite element model of complete adolescent idiopathic scoliosis are less.
    OBJECTIVE: To set up three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis for building ideal digitization platform for further biomechanical study.
    METHODS: A 14-year-old female patient with PUMCIId1 adolescent idiopathic scoliosis was included as volunteer for the current study. CT images obtained from CT transverse scanning from T1 to sacrococcyx were imported into Mimics 16.0 software to form qualified three-dimensional geometric model, including thoracic cage, which was further delivered to Geomagic Studio 11.0 software to build three-dimensional finite element model by a series of modules and optimization of cleaning. The geometric model was imported to ANSYS 14.0 software to build complete three-dimensional finite element adolescent idiopathic scoliosis model by adding ligaments, setting unit type, and defining material properties. 
    RESULTS AND CONCLUSION: A complete three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis was built successfully, consisting of 522 887 tetrahedron elements and 730 rod elements, a total of 523 617 units and 159 008 nodes. Three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis was lifelike, and can be used as the reliable digital model for further biomechanical analysis.


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    Spinal sagittal imbalance in patients with osteoporotic vertebral compression fractures
    Zhang Xiang-wei, Sun Jian-min, Cui Xin-gang, Jiang Zhen-song, Dong Jun
    2014, 18 (26):  4224-4228.  doi: 10.3969/j.issn.2095-4344.2014.26.023
    Abstract ( 322 )   PDF (249KB) ( 707 )   Save

    BACKGROUND: The reasons for spinal imbalance include spinal deformity, spinal degenerative disease osteoporotic vertebral compression fractures. We believe that the power factor (back muscle) plays a key role in spinal sagittal imbalance.
    OBJECTIVE: To analyze the reasons for spinal sagittal imbalance by observing clinical manifestations and therapeutic outcomes in patients with osteoporotic vertebral compression fractures.
    METHODS: A total of 41 patients with osteoporotic compression fractures combined with spinal sagittal imbalance were retrospectively analyzed from January 2012 to May 2013. All patients were subjected to percutaneous balloon vertebroplasty under local anesthesia. Before treatment, they received bone density, standing full-spine lateral X-ray, CT and MR imaging with injured vertebrae as the center. Using standing full-spine radiographs, the height of anterior border of the injured vertebrae, Cobb angle of kyphosis and improved angle, wedging angle of the injured vertebrae and improved angle were measured. The patients underwent weight loading test and walking test. Preoperative and postoperative data were compared.
    RESULTS AND CONCLUSION: The patients affected spinal sagittal imbalance symptoms, so the walking distance was significantly shorter than that postoperatively (P < 0.05). Moreover, the time of weight loading test was significantly shorter than that postoperatively (P < 0.05). In standing full-spine radiographs, the average difference of Cobb angle was (10.01±0.76)°. The mean difference of vertebral wedging improvement was (4.84±0.40)° (P < 0.05). All patients were followed up. Low back pain and sagittal imbalance symptoms were  relieved. No severe complications appeared after percutaneous balloon vertebroplasty. Results indicated that patients with osteoporosis compression fractures can affect the symptoms of spinal sagittal imbalance, which is not only induced by wedging of the injured vertebra. In addition, after percutaneous balloon vertebroplasty, imbalance symptoms are apparently improved, suggesting that back pain after spinal fracture limits back muscle strength and is an important cause for spinal sagittal imbalance.


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    Relationship between lumbar spinal stenosis and inflammatory factors in the vein serum of lumbar spinal canal
    Zhang Yan, Meng Yang, Zhao Wei-dong, Huang Yu-feng, Shen Bin, Wu De-sheng
    2014, 18 (26):  4229-4235.  doi: 10.3969/j.issn.2095-4344.2014.26.024
    Abstract ( 375 )   PDF (419KB) ( 461 )   Save

    BACKGROUND: Numerous studies have shown that local lumbar stenosis can cause immunological abnormalities and local chronic inflammation, which is the main cause of pain. At present, studies on inflammatory factors and lumbar spinal stenosis mainly focused on intervertebral discs, facet joint and ligamenta flava. No reports addressed the relationship between inflammatory factor in vein of lumbar spinal canal and lumbar spinal stenosis.
    OBJECTIVE: To analyze the correlation of serum interleukin-1α and tumor necrosis factor-α levels with lumbar spinal stenosis.
    METHODS: A total of 51 patients with lumbar spinal stenosis or lumbar vertebral burst fracture, who underwent posterior lumbar decompression in the Department of Spine Surgery, Shanghai East Hospital, Tongji University in China from September 2011 to December 2013, were enrolled in this study. Visual analogue scale score of low  back pain and Oswestry disability index were evaluated before treatment. Peripheral vein blood and venous blood in the vertebral canal were collected from patients with lumbar spinal stenosis or lumbar vertebral burst fracture. The concentrations of serum interleukin-1α and tumor necrosis factor-α were determined using enzyme-linked immunosorbent assay.
    RESULTS AND CONCLUSION: The concentration of interleukin-1α in degenerative lumbar stenosis group was significantly higher than that in the lumbar burst fracture group and peripheral veins (P < 0.05). The more segments of lumbar spinal stenosis, the higher the venous serum interleukin-1α levels were in the degenerative lumbar stenosis group, but the statistical difference was not significant. Linear correlation analysis results displayed that interleukin-1α levels were positively associated with low back pain and disability scores in the degenerative lumbar stenosis group (r2=0.359 3, P < 0.05; r2=0.526 4, P < 0.05). These results indicated that the lumbar spinal venous inflammatory factors may be one of the reasons of low back pain and dysfunction in patients with degenerative lumbar spinal stenosis.


    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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    Femoral posterior condylar angle of human knee joint: magnetic resonance imaging measurement
    Xu Hong-sheng, Zhao Zhi-jiang, Meng Wei-ming, Zhang Lei, Zhang Xiao-wei
    2014, 18 (26):  4236-4240.  doi: 10.3969/j.issn.2095-4344.2014.26.025
    Abstract ( 777 )   PDF (409KB) ( 486 )   Save

    BACKGROUND: The good rotational alignment of femoral prosthesis was very important in total knee arthroplasty. The research has shown that the posterior condylar angle was important to determine the alignment. The posterior condylar angle is the angle between the posterior condylar axis and the femoral epicondylar axis. MRI can clearly show the condylar cartilage, the projections of lateral epicondyle and the medial epicondyle depression, thus ensuring accuracy of measurement data.
    OBJECTIVE: To measure the posterior condylar angle of knee joint in the northern part of Baoding City in China, and to provide image evidence for identifying the rotational alignment of femoral prosthesis during total knee arthroplasty. 
    METHODS: The knee was extended on a neutral position when MRI machine was applied to scan knee joint. The scanning plane was perpendicular to the mechanical axis of the knee. The best T1 axial plane of the knee was chosen, and two observers analyzed images independently. Existence rate of femoral medial epicondyle was observed using Bravo viewer 6.0 imaging software. The posterior condylar angle between posterior condylar axis and the femoral condyle axis was measured.
    RESULTS AND CONCLUSION:
    The posterior condylar angle was (2.73±1.28)° in males and (2.35±1.37)° in females on average, which did not show significant difference. The results showed that the MRI had great superiority in measuring the posterior condylar angle. The variability of the epicondylar axis was small in total knee arthroplasty. Posterior condylar angle can be referenced to position femoral prosthesis and to avoid the complications after knee replacement.


    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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    Arthroplasty versus joint preservation for displaced 3- and 4-part proximal humeral fractures: a meta-analysis
    Zhang Hai-yang, Zhao Yan, Xie Chong, Cheng Yong-tao, Wang Cong-cong
    2014, 18 (26):  4241-4247.  doi: 10.3969/j.issn.2095-4344.2014.26.026
    Abstract ( 459 )   PDF (269KB) ( 396 )   Save

    BACKGROUND: Currently, the treatment of proximal humeral fractures mainly contains joint preservation (conservative treatment, open reduction and internal fixation) and arthroplasty, but how to choose the treatment is still controversial.
    OBJECTIVE: To evaluate and compare the clinical outcomes of joint preservation versus arthroplasty in the treatment of displaced 3-or 4-part humeral fractures in randomized controlled trials using meta-analysis.
    METHODS: Medline (January 1966 to December 2013), PubMed (January 1980 to December 2013), Embase (January 1990 to December 2013), Science (January 1990 to December 2013), Springer (January 1990 to December 2013), China National Knowledge Infrastructure (1994 to 2013), and Wanfang database (1982 to 2013) were searched for randomized controlled trials addressing joint preservation and arthroplasty for 3-or 4-part proximal humeral fractures. Articles meeting the inclusion criteria were included. The related data were extracted and loaded onto Comprehensive Meta-Analysis Software for meta-analysis.
    RESULTS AND CONCLUSION: Seven articles with 320 patients (165 patients undergoing joint preservation and 
    155 patients receiving arthroplasty) were accepted in this mete-analysis and all of them were high-quality English researches by modified Jadad Scale. Meta-analysis results displayed that the random-effects mean Constant score across all types was 55.9 (95%CI: 50.7-61.1; P < 0.001). Constant score was higher in the joint preservation group than in the arthroplasty group (P < 0.01). The study displayed significant heterogeneity (I2=88%, Q statistic=107.6, Q=13; P < 0.001). In the meta-analysis, Constant scores were decreased with increasing rate of male to female and rate of tuberosity resorption. These results suggested that 3-or 4-part proximal humeral fractures demonstrate improved Constant scores when treated with joint-preserving options compared with arthroplasty. Moreover, age, fracture pattern, gender ratio and complication rate are significant predictors of the Constant score. Given the observed heterogeneity and variance in treatment techniques in the included studies, more randomized controlled trial studies are needed to definitively recommend joint-preserving techniques versus arthroplasty for treatment of 3- or 4-part proximal humeral fractures.


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    Therapeutic effect and safety of elastic intramedullary nail versus plate fixation in repair of fracture of forearm: a meta-analysis
    Liu Guo-qing, Wang Wen-ji, Shi Hong-ping, Sun Kai
    2014, 18 (26):  4248-4253.  doi: 10.3969/j.issn.2095-4344.2014.26.027
    Abstract ( 466 )   PDF (292KB) ( 390 )   Save

    BACKGROUND: With the development of minimally invasive technique, more and more forearm fracture, especially in children, was treated by elastic stable intramedullary nailing. Recently, elastic stable intramedullary nailing was also used in elder children, even adults. In particular, this technique has obtained good curative effects for open fracture and unstable fracture.
    OBJECTIVE: To evaluate the clinical effectiveness and safety of elastic intramedullary nail and plate fixation for double fracture of forearm using evidence-based medicine.
    METHODS: We retrieved PubMed, Embase, Cochrane Library, China Biology Medicine, VIP, China National Knowledge Infrastructure, WanFang, and other electronic databases. The quality of the included studies was assessed using Cochrane Systematic Review. The analysis was performed using RevMan 5.2 software.
    RESULTS AND CONCLUSION: A total of 7 randomized controlled trials involving 468 cases were included. The results of meta-analyses showed that compared with plate fixation group, effective rate was higher in the titanium elastic nail group (P < 0.000 1), the time of fracture healing was shorter (P < 0.000 01), and the hospitalization time was shorter (P < 0.000 01). In the aspect of adverse reactions, incidence of refracture (P=0.03) and breakage of internal fixation (P=0.03) was significantly lower. These indicated that compared with plate fixation, titanium elastic nail can improve the total effective rate, shorten the time of fracture healing on X-ray and the hospitalization time, at the same time, can effectively reduce the complications of refracture and breakage of internal fixation.


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    Design principle and development tendency of artificial lumbar disc prosthesis
    Dong Ke-xin, Ma De-chun, Li Qiu-ju, Zhang Li, Li Lei
    2014, 18 (26):  4254-4259.  doi: 10.3969/j.issn.2095-4344.2014.26.028
    Abstract ( 691 )   PDF (372KB) ( 503 )   Save

    BACKGROUND: Artificial lumbar disc replacement is a new choice for the treatment of degenerative disc disease, and preserves lumbar vertebra’s biomechanical characteristics during pain elimination. The design of the prosthesis structure and material needs further study and validation.
    OBJECTIVE: To review the structure and material types of presently designed artificial lumbar discs, then to discuss the trends in the optimization design of prosthesis.
    METHODS: The PubMed database, China National Knowledge Infrastructure database and Chinese BioMedical Literature Database were searched for related articles concerning artificial lumbar disc and type and biomechanics of nucleus pulposus prosthesis material published from January 2005 to February 2013 by the first author. Key words were “artificial lumbar disc, principle of prosthesis design, structure, material, clinical trials” in Chinese and “artificial lumbar disc, total disc replacement, structure, material, clinical trial” in English. Repetitive and old studies were excluded. 135 articles were found, but 36 articles were included for review.
    RESULTS AND CONCLUSION: At present, the materials for intervertebral discs include cobalt-chromium alloy, ceramics, stainless steel, titanium alloy and ultrahigh molecular weight polyethylene. Artificial lumbar disc is commonly made by different materials. Bryan prosthesis is most commonly used in the clinic. Three-dimensional finite element analysis, in vitro trial and clinical studies verified its good biomechanical property. The successful rate of replacement was high. Nucleus prosthesis contains prefabricated type and situ polymerization type, and obtains small injury, so it is a hot focus in present study, but it cannot achieve biomechanical function of human nucleus pulposus. To dig novel material is a future direction for designing individual prosthesis. The prosthetic structure and biomaterial design experience constant improvement and development. This study combines latest study trend and prospects the development of biomimetic design, material improvement, the optimization design of prosthesis and assisted devices.


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    Prosthesis structure and application features of artificial cervical disc
    Yan Duan-guo
    2014, 18 (26):  4260-4264.  doi: 10.3969/j.issn.2095-4344.2014.26.029
    Abstract ( 817 )   PDF (352KB) ( 641 )   Save

    BACKGROUND: The design and use of artificial cervical disc prosthesis have great development, such as rubber-made artificial cervical disc with low-friction sliding surface and spring system, and other various elastic prostheses.
    OBJECTIVE: To summarize structural characteristics and present application of artificial cervical disc prosthesis.
    METHODS: The first author searched CNKI (2000-2013) and PubMed databases (1960-2013) http://www.ncbi.nlm.nih.gov/PubMed for literatures on application of artificial cervical disc prosthesis. The key words included artificial cervical disc, prosthesis, intervertebral disc herniation, the surgical therapy. 200 literatures and 56 literatures were respectively searched in CNKI and the PubMed. Titles and abstracts were read. A total of 40 literatures were in accordance with inclusion criteria and included.
    RESULTS AND CONCLUSION: Artificial cervical disc prosthesis was consistent with physiological functions of intervertebral disk. The material is characterized by abrasion, fatigue resistance and corrosion resistance, is similar to physiological and biomechanical function of human disc, maintains the stability of the spine and motor function, and avoids the accelerated degeneration of adjacent segments. Articles mainly introduced the structure of Bryan, Mobi-C, PCM, Prodisc-C, Prestige and CerviCore artificial cervical disc. Short-period therapeutic effects of artificial cervical disc replacement have obtained approval. However, it cannot completely replace anterior cervical fusion, but is another manner to treat cervical degenerative disc disease.


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    Stability of dual-incision double-plate fixation versus locking plate fixation for tibial plateau fracture 
    Li Shi-fang, Sun Jian, Zhou Dao-zheng
    2014, 18 (26):  41796-4184.  doi: 10.3969/j.issn.2095-4344.2014.26.015
    Abstract ( 486 )   PDF (422KB) ( 470 )   Save

    BACKGROUND: Schatzker V, VI fracture often causes the injuries to cruciate ligament, collateral ligaments and meniscus. Moreover, the collapse and shifting were severe. The locking plate on one side cannot support the weight or obtain satisfactory reduction.
    OBJECTIVE: To compare the effects and stability of the dual-incision double-plate fixation and knee midline incision locking plate fixation in the treatment of Schatzker V, VI tibial plateau fracture.
    METHODS: A total of 76 patients with Schatzker V, VI tibial plateau fracture were respectively treated with locking plate fixation (n=38) and dual-incision double-plate fixation (n=38). Fracture reduction and healing were assessed using anteroposterior and lateral radiographs. Varus angle and medial caster angle of tibial plateau received biomechanical measurement.
    RESULTS AND CONCLUSION: Hospital stay and postoperative load time were significantly less in the dual-incision double-plate fixation group than in the locking plate fixation group (P < 0.05). No significant difference in healing time was detected between locking plate fixation and dual-incision double-plate fixation groups (P > 0.05). The number of complications, such as ankylosis, fracture delayed union, pin tract infection,  
    delayed union, varus deformity, was significantly fewer in the dual-incision double-plate fixation group than in the locking plate fixation group (P < 0.05). There were no significant differences in the fracture of loosening, knee instability, wound infection, skin necrosis, bone necrosis and nonunion between the dual-incision double-plate fixation and locking plate fixation groups (P > 0.05). Postoperative Rasmussen classification was significantly better in the dual-incision double-plate fixation group than in the locking plate fixation group (P < 0.05). Experimental results indicated that the clinical efficacy of the dual-incision double-plate fixation is superior to that of the anterior cruciate midline incision locking plate fixation in the treatment of Schatzker V, VI type tibial plateau fractures. The dual-incision double-plate fixation has more biomechanical stability.


    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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