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    22 October 2014, Volume 18 Issue 44 Previous Issue    Next Issue
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    An intermediate-long term comparison of anatomic medullary locking versus F2L bio-femoral prosthesis in total hip arthroplasty
    Li Yong-wang, He Rong-li, Qi Hui, Zhang Qian, An Ming, Bai Xiao-liang, Liu Hai-chao, Li Liang, Ma Wen-hai, Song Xing-jian, Sun Jun-ying
    2014, 18 (44):  7053-7060.  doi: 10.3969/j.issn.2095-4344.2014.44.001
    Abstract ( 385 )   PDF (888KB) ( 395 )   Save

    BACKGROUND: Anatomic medullary locking (AML) femoral prosthesis is circular cylinder and has satisfactory efficacy. However, some scholars found the complications such as thigh pain, loss of bone at the proximal end of the femur, and wearing-related osteolysis. F2L femoral prosthesis is cone-shaped and also has satisfactory efficacy, but the thigh pain incidence is relatively low.

    OBJECTIVE: To compare the intermediate-long term results of AML versus F2L in total hip arthroplasty.

    METHODS: Between November 1997 and January 2005, we retrospectively reviewed 60 patients (66 hips) undergoing total hip arthroplasty using biological femoral prosthesis. At follow-up examination, 58 hips in      52 patients were available for clinical and roentgenographic review. 26 AML devices were placed in 24 patients, and 32 F2L devices were placed in 28 patients. The AML group were reviewed with an average of 12.7 years follow-up (range 10 years and 3 months to 15 years and 5 months), while the F2L group were reviewed with an average of 9.5 years follow-up (range 8 years and 3 months to 11 years and 1 month). The clinical results were evaluated with Harris methods and X-ray examination. Kaplan-Meier analysis was performed to evaluate the survival of femoral component. End point was radiographical loosening or revision of the femoral component for any reason.

     

    RESULTS AND CONCLUSION: There were no significant difference between AML and F2L about Harris score in the latest follow-up (P > 0.05). After surgery, the incidence of thigh pain was significantly lower in F2L group than that in AML group (P < 0.05). In AMKL group, the stress-shielding 1 level was observed in 21 hips (81%), and 2 level in five hips (19%); in F2L group, the stress shielding 0 level was observed in 20 hips (62%) and 1 level in 12 hips (38%). There were significant differences between the two groups (P < 0.05). The stress shielding showed significant differences between the two groups (P < 0.05). The incidence of osteolysis in F2L group was significantly lower than that in AML group (P < 0.05). Kaplan-Meier analysis showed that, the survival rate of both AML and F2L components were 1.0 (95% confidence interval: 0.98-1.00). Experimental findings indicate that, both AML and F2L femoral prosthesis have a satisfactory long-term efficacy after total hip arthroplasty, and the incidence of thigh pain and osteolysis is significantly lower in F2L group.

     

    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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    Correlation of trace element zinc with bone morphogenetic protein 7 and Stro-1+ cells in proximal femur: predicting hip prosthesis life
    Fu Xiao-dong, Wang Wei-li, Shen Yi, Li Xiao-miao
    2014, 18 (44):  7061-7065.  doi: 10.3969/j.issn.2095-4344.2014.44.002
    Abstract ( 304 )   PDF (293KB) ( 479 )   Save

    BACKGROUND: The correlation of zinc with Stro-1+ cells and bone morphogenetic protein 7 surrounding the prosthesis may affect the bone fusion and survival rate in hip prosthesis.

    OBJECTIVE: To analyze the correlation of zinc content with Stro-1+ cells and bone morphogenetic protein 7 in proximal femur.
    METHODS: Bone samples were obtained from the discarded metaphysis region of the proximal femur in 24 patients with primary total hip replacement. Bone marrow mesenchymal stem cells were cultured in vitro. At 14 days after culture, Stro-1+ cells in bone marrow mesenchymal stem cells were detected using flow cytometry. Bone morphogenetic protein 7 expression in cell supernatant was detected using enzyme-linked immunosorbent assay. Zinc content in supernatant was measured using radio-immunity assay.
    RESULTS AND CONCLUSION: No significant difference in the zinc content was detected in different age groups and different gender groups. Zinc content was positively associated with Stro-1+ cells and bone morphogenetic protein 7 expression. The further study of the trace element zinc in proximal femur can predict and intervene the longevity of hip prosthesis.

    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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    Reinfusion of autologous drainage blood after total hip replacement under the application of anticoagulant
    Li Wei
    2014, 18 (44):  7066-7070.  doi: 10.3969/j.issn.2095-4344.2014.44.003
    Abstract ( 366 )   PDF (289KB) ( 396 )   Save

    BACKGROUND: Reinfusion of autologous drainage blood could reduce allogeneic blood demand after total hip replacement. The application of anticoagulant could ensure the safety of peri-operation period after total hip replacement.

    OBJECTIVE: To investigate the application effect of reinfusion of autologous drainage blood after total hip replacement in patients taking anticoagulant.
    METHODS: 100 patients underwent initial unilateral total hip replacement in the Weifang People’s Hospital in China from January 2012 to January 2014. According to reinfusion of autologous drainage blood, the patients were divided into observation group and control group (n=50).
    RESULTS AND CONCLUSION: After replacement, total blood volume and the maximum mid-thigh circumference change were significantly larger in the observation group than in the control group (P < 0.05). No significant difference in hidden blood loss was detected between the two groups (P > 0.05). Results indicated that under the application of anticoagulant, reinfusion of autologous drainage blood in patients undergoing total hip replacement does not affect hidden blood loss, but can cause an increase in limb swelling.

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    Correlation of periprosthetic stress and bone mineral density after total knee arthroplasty
    Zang Xue-hui, Sun Hui, Gao Li-hua, Ding Hui-xia, Miao Gui-qiang
    2014, 18 (44):  7071-7076.  doi: 10.3969/j.issn.2095-4344.2014.44.004
    Abstract ( 349 )   PDF (307KB) ( 668 )   Save

    BACKGROUND: At present, the incidence rates of knee joint diseases such as knee osteoarthritis, knee joint degenerative are high. The major clinical treatment is total knee replacement in the clinic, so it is necessary to evaluate the changes in stress and bone mineral density of the regions surrounding the prosthesis after replacement.
    OBJECTIVE: To explore periprosthetic stress and bone mineral density and to analyze their correlation after total knee arthroplasty.
    METHODS: A total of 20 cases undergoing total knee arthroplasty were chosen.The hospital for special surgery scores were used to evaluate patients’ functional recovery at 12 months after total knee arthroplasty. The periprosthetic femur was divided into four regions of interest (ROI), respectively ROI 1-4; periprosthetic tibia was divided into three regions of interest, respectively ROI 5-7. Stress surrounding the prosthesis was analyzed using three-dimensional finite element analysis at 1, 3, 6 months, 1, 2, 3 years after replacement. Simultaneously, bone mineral density surrounding the prosthesis was measured using dual-energy X-ray absorptiometry.
    RESULTS AND CONCLUSION: No patients affected infection or loosening of the prosthesis. At 12 months after  replacement, the score of hospital for special surgery was (90.23±2.37), which showed significant differences as compared with before replacement (39.68±1.31) (P < 0.05). The level of stress shielding was highest in ROI 5 and lowest in ROI 3. Stress shielding rate of ROI increased with statistical difference at 6 months after operation (P < 0.05). At 1, 2, 3 years after operation, shielding rate in periprosthetic femoral stress in ROI 1 decreased. Compared with 1 month after operation, the difference was statistically significant (P < 0.05). However, shielding rate of tibial periprosthetic stress in ROI 6 increased. Compared with 1 month after operation, the difference was statistically significant (P < 0.05). Bone mineral density after 1 month after operation had no significant decrease (P > 0.05). At 3 months after operation, bone mineral density began to decline significantly (P < 0.01). The decrease was most obviously in ROI 5 and the change was least in ROI 3. After 1 year of operation, bone mineral density did not change significantly. These data indicated that changes in bone mineral density were correlated with stress shielding after total knee arthroplasty. Monitoring two variations can provide theoretical data for preventing bone loss, which provides references for clinical rehabilitation guidance.


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    Hypotoxicity infection with sinus formation after tibial plateau and ankle fracture fixation: effects of orally taking rifampicin and ciprofloxacin with transfer of skin flap
    Zhang Bo, Zhao Jin-long, Ouyang Zhen, Yu Yang, Wu Tao, Song Yong-cai, Li Wu-jian, Liu Ji-chao, Yin Wei, Yang Li-feng, Liu Feng-hu, Yang Bin-hui
    2014, 18 (44):  7077-7082.  doi: 10.3969/j.issn.2095-4344.2014.44.05
    Abstract ( 409 )   PDF (688KB) ( 620 )   Save

    BACKGROUND: Recently, there are many documents all over the world reporting hypotoxicity infection after fracture internal fixation surgery, but reports are different on whether it is necessary for chronic hypotoxicity infection internal fixation removal post surgery. There are no fixed judgment criteria of curative effects, which leads to inexact conclusion of treatment method.    
    OBJECTIVE: To observe the curative effects of taking rifampicin and ciprofloxacin with transfer of skin flap in the treatment of chronic hypotoxicity infection with sinus formation after fracture surgery on tibial plateau and ankle.
    METHODS: A total of 56 cases of chronic hypotoxicity infection after fracture surgery of tibial plateau and ankle were collected from September 2005 to December 2012. 30 cases in the therapy group were treated with levofloxacin and rifampicin with transfer of skin flap. 26 cases in the control group were treated with conventional  intravenous antibiotics with local debridement to remove internal fixation. In both groups, the course of disease was 3 to 6 months. The erythrocyte sedimentation rate, kidney function and radiographic indices were reviewed every 1 to 3 months, and curative effects were evaluated.
    RESULTS AND CONCLUSION: During the follow-up visit of 6-24 months, no recurrence happened to the cured and improved patients. In the therapy group, 24 cases were cured, 4 cases were improved, and 2 cases were invalid, with a total effective rate of 93%. In the control group, 11 cases were cured, 6 cases were improved and 9 cases were invalid with the total effective rate of 65%.χ2 test showed that therapeutic effects were significantly better in the therapy group than in the control group (P < 0.05). These data indicated that rifampicin and ciprofloxacin with transfer of skin flap for chronic hypotoxicity infection with sinus formation after fracture surgery of tibial plateau and ankle showed good curative effects.


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    Single level artificial disc replacement versus anterior cervical fusion: range of motion and stability of cervical vertebra
    Wang Wei, Wang Li-min, Wang Wei-dong, Tan Hong-yu, Liu Yi-lin, Zhang Shu-hao
    2014, 18 (44):  7083-7087.  doi: 10.3969/j.issn.2095-4344.2014.44.006
    Abstract ( 404 )   PDF (271KB) ( 428 )   Save

    BACKGROUND: Fusion treatment for single segment cervical spondylosis can induce complications such as abnormal enlargement of range of motion in adjacent segments and degenerative manifestations. Recently, scholars began to explore and to use non-fusion technique to replace traditional fusion therapy. Cervical artificial disc replacement as a new anterior non-fusion program has been greatly used in the clinic, not only obtained good clinical therapeutic effects, but also made cervical vertebrae near physiological stability, delayed adjacent segment degeneration and reduced complications.
    OBJECTIVE: To compare the clinical effects of the single level artificial disc replacement and the anterior cervical decompression and fusion for cervical spondylosis.
    METHODS: A total of 59 patients with single segment cervical spondylosis, whose clinical signs and symptoms were accorded, were enrolled from the First Affiliated Hospital of Zhengzhou University, China from May 2011 to May 2013. Imaging revealed that single segment of cervical disc degeneration compressed spinal cord or nerve root. Owing to different surgeries, these patients were divided into artificial disc replacement group (replacement group; n=32) and anterior cervical decompression and fusion group (fusion group; n=27). They were followed up at 5 days, 3, 6 and 12 months after treatment. Japanese Orthopaedic Association scores, neck pain, upper extremity pain visual analog scale scores were measured. The range of motion of the replacement segment and its effects on adjacent segments were observed.
    RESULTS AND CONCLUSION: The postoperative Japanese Orthopaedic Association Scores were improved compared with preoperative scores (P < 0.05), while Japanese Orthopaedic Association Scores were decreased compared with preoperative scores (P < 0.05). There were no significant differences between two groups (P > 0.05). Range of motion of the replacement segment after treatment was (11.6±3.0)° in the replacement group, showing no significant differences as compared with before surgery (8.8±2.7)° (P > 0.05). No significant activity was found at 3 months after treatment in the fusion group. During follow-up, the range of motion in the adjacent segments was smaller in the replacement group than in the fusion group (P < 0.05). No significant difference in the range of motion in the adjacent segments was detected before and after treatment in the replacement group (P > 0.05), but significant differences in the range of motion were detected before and after treatment in the fusion group (P < 0.05). The range of motion was apparently increased after treatment. These findings indicated that compared with the anterior cervical decompression and fusion, cervical artificial disc replacement can not only improve the clinical symptoms, restore nerve function, but also can keep the range of motion and stability of the cervical replacement segment. Moreover, it does not have impacts on the range of motion in the segments near to the surgical wound, and can effectively maintain cervical curvature.


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    Short segment pedicle screw fixation without bone fusion for the repair of thoracolumbar burst fracture: mid-term follow-up
    Ma Jing-xin, Wang Xiang-yan, Xu Guo-xing
    2014, 18 (44):  7088-7093.  doi: 10.3969/j.issn.2095-4344.2014.44.007
    Abstract ( 327 )   PDF (374KB) ( 499 )   Save

    BACKGROUND: Many present studies have reported the early clinical therapeutic effects of short-segment non-fusion fixation for the repair of thoracolumbar burst fracture. The results are satisfactory. However, the mid- and long-term follow-up results of this scheme for treating thoracolumbar burst fracture are seldom reported.
    OBJECTIVE: To evaluate the mid-term results of short segment pedicle screw fixation without bone fusion for unstable thoracolumbar burst fracture.
    METHODS: Data of 12 patients with unstable thoracolumbar burst fractures undergoing short segment pedicle screw fixation without bone fusion were retrospectively analyzed. All patients experienced severe intraspinal occupying and neurological dysfunction, and all of them affected single segment thoracolumbar injuries. The surgical procedure included postural reduction for 2 days and screw fixations at one level above, one level below 
    and at the fractured level itself. The patients underwent removal of implants at 12 months after the initial operation. Imaging and clinical findings, including canal encroachment, percentage of vertebral body height loss, Cobb angle, American Spinal Injury Association motor score, Frankel grade and adjacent segment degenemtion, were evaluated.
    RESULTS AND CONCLUSION: All patients were followed up for at least 5 years. Significant differences in canal encroachment, percentage of vertebral body height loss and Cobb angle were detectable between post-fixation and pre-fixation (P < 0.05). Evaluation results were significantly better after fixation than that before fixation, but no significant difference in evaluation results after fixation was detected (P > 0.05). After implantation and removal of fixator, none cases affected aggravated symptoms of neurological impairment. American Spinal Injury Association motor score was 34.2±6.3 before fixation, and 47.7±9.5 during the final follow-up, showing significant differences (t=-4.103, P=0.000). During the final follow-up, adjacent segments in damage levels did not suffer from degeneration in all patients. Neurological function showed the recovery of Frankel grades 1 or 2. These data indicated that a good mid-term result of short segment pedicle screw fixation without bone fusion for unstable thoracolumbar burst fracture with neurological deficit can be achieved. The improved saggital alignment was effectively constructed and maintained. Adjacent segment degeneration was not found at the injury level.


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    Minimally invasive percutaneous pedicle screw fixation versus open surgery for thoracolumbar fracture: Cobb’s angle and vertebral height
    Nie Feng-feng, Zhang Ying-hua, Huang Shou-guo, Ju Liang, Chen Bo
    2014, 18 (44):  7094-7099.  doi: 10.3969/j.issn.2095-4344.2014.44.008
    Abstract ( 389 )   PDF (345KB) ( 525 )   Save

    BACKGROUND: Open reduction and internal fixation cause big trauma and many complications. With the progression of minimally invasive concept, percutaneous pedicle screw fixation gradually showed its obvious superiority.
    OBJECTIVE: To compare clinical outcomes of minimally invasive percutaneous pedicle screw fixation versus open surgery in the treatment of thoracolumbar fracture.
    METHODS: From October 2012 to January 2014, 50 cases of thoracolumbar fractures, including 25 cases in the minimally invasive percutaneous pedicle screw fixation group and 25 cases in the open surgery group, were retrospectively analyzed. The differences in length of skin incision, intraoperative blood loss, operation time, postoperation hospital stay, and visual analog scale scores were compared. Serum creatine kinase activity and 
    C-reactive protein levels were measured before surgery and at 24 and 48 hours after operation. Imaging results were used to observe vertebral height and kyphosis Cobb’s angle changes.
    RESULTS AND CONCLUSION: Compared with the open surgery group, the length of skin incision was smaller and intraoperative blood loss was less, operation time, bed time and hospital stay were shorter, and pain of the wound was lighter in the minimally invasive group. No significant difference was found in serum creatine kinase activity and C-reactive protein levels between the two groups. Serum creatine kinase activity and C-reactive protein levels were higher at 24 and 48 hours after treatment compared with before treatment in both groups. Serum creatine kinase activity and C-reactive protein levels were higher in the open surgery group than in the minimally invasive group at 24 and 48 hours. There were significant differences in vertebral height and kyphosis Cobb’s angle in both groups after treatment compared with before treatment (P < 0.01). No significant difference in vertebral height and kyphosis Cobb’s angle was detected between the two groups after treatment (P > 0.05). Results indicated that minimally invasive percutaneous pedicle screw fixation and open surgery in repair of thoracolumbar fractures had similar outcomes. However, the trauma of minimally invasive percutaneous pedicle screw fixation was apparently less than open surgery.


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    Short pedicle screw segment with bone graft through unilateral pedicle channel and pedicle screw fixation for thoracolumbar burst fractures by posterior operation
    Ding Lei, Ding Wei-wei,Yan Sheng-liang, Jiao Wen-yong, Wang Ling-jiang, Xu Jian, Tang Guo-jun, Shi Guang-mei
    2014, 18 (44):  7100-7105.  doi: 10.3969/j.issn.2095-4344.2014.44.009
    Abstract ( 405 )   PDF (457KB) ( 471 )   Save

    BACKGROUND: Short-segment pedicle screw technology has been extensively used in the treatment and repair of thoracolumbar burst fractures in the clinic. However, it requires further investigations whether bone graft through unilateral pedicle channel has superiority.
    OBJECTIVE: To observe the perioperative effects on thoracolumbar burst fractures posterior by bone graft through unilateral pedicle channel with short pedicle screw segment fixation.
    METHODS: Clinical data of 57 cases of thoracolumbar burst fractures without neurological symptoms treated by short segment pedicle screw internal fixation therapeutic method at the Department of Orthopedics, The First  People’s Hospital of Yinchuan City from January 2009 to December 2013 were retrospectively analyzed. According to therapeutic methods, they were divided into three groups: pedicle screw fixation through injured vertebrae (n=21), unilateral pedicle screw fixation with vertebrae pedicle screw (n=19), and the short segment pedicle screw fixation with unilateral pedicle screw fixation and bone graft through pedicle channel (n=17). We observed the changes in operation time, the blood loss volume in operation, postoperative drainage blood (at the period of removing the drainage tube), injured vertebrae height’s ratio, the Cobb’s angel of injured vertebrae sagittal plane, vertebral canal encroachment rate and visual analog scale.
    RESULTS AND CONCLUSION: (1) The unilateral pedicle screw fixation and bone graft by pedicle channel could prolong operation time and increase postoperative drainage blood volume (P < 0.05). (2) Three operation methods improved vertebral body height. (3)There were no significant differences in Cobb’s angle postoperation among the three groups (P > 0.05). These data suggested that the bone graft through pedicle channel was not the factors to improve the spine kyphosis. (4) Bone graft by pedical channel improved vertebrae channel value. (5) Bone graft through pedicle channel combined with screw implantation could improve pain after treatment. These findings indicated that the therapeutic technology of short pedicle screw fixation on thoracolumbar vertebral burst fracture with unilateral pedicle fixation and bone graft through pedicle channel is a safe reliable operation method.


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    Short segmental pedicle screw fixation in repair of thoracolumbar burst fractures: 1-year follow-up of vertebral stability
    Wang Lai-jie
    2014, 18 (44):  7106-7110.  doi: 10.3969/j.issn.2095-4344.2014.44.010
    Abstract ( 344 )   PDF (377KB) ( 552 )   Save

    BACKGROUND: Pedicle screw system has been extensively used in treatment of thoracolumbar fractures. The effects of pedicle screw system in restoring vertebral height in patients and indirect spinal decompression are affirmative. However, fixator bending, loosing or nail breakage, rod breakage and vertebral height loss and kyphosis are common problems in the clinic.
    OBJECTIVE: To retrospectively analyze the clinical effects of short segmental pedicle internal fixation in the treatment of severe thoracolumbar burst fractures. METHODS: Clinical data of 51 cases of thoracolumbar burst fractures, who were treated with short segmental pedicle internal fixation in Department of Orthopedics of Hongze County People’s Hospital from February 2009 to January 2014, were retrospectively analyzed. Vertebral height, changes in kyphosis Cobb angle and spinal nerve symptoms before and after fixation were observed during follow up. Complications after fixation were recorded.
    RESULTS AND CONCLUSION: A total of 51 patients were successfully treated with internal fixation. After fixation, no secondary infection was observed in the wound. Frankel nerve function grading results showed that spinal nerve symptoms were relieved. Operation time was between 45 and 70 minutes, mean (60.9±3.7) minutes. The amount of intraoperative blood loss was between 150 and 700 mL, mean (330±130) mL. After fixation, follow-up time was more than 12 months. After 6 months of follow-up, neural function grade A symptom was not obviously improved in two cases. GradesⅠto Ⅲ was restored to different degrees in the remaining patients. At 
    12 months of follow-up, low back pain visual analogue scale scores were between 2 and 5. Dynamic radiographs revealed that no abnormal activities were visible in the fixed segment. Simultaneously, no screw loosening or breakage was detected. Results suggested that thoracolumbar burst fractures treated with short segment pedicle screw fixation can achieve ideal clinical curative effect. This is an effective method gathering decompression, reduction and internal fixation completed once, can significantly improve the quality of life of patients, but due to large surgical trauma, we should be strictly grasp the surgical indications. 


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    Dynamic lumbar pedicle fixation in repair of lumbar degenerative disease: K-Rod elastic rod, universal elastic rod and Dynesys system
    Liu Tao, Wang Zhen-jiang, Chen Fan, Zhang Da-peng, Guo Ning-guo, Ma Fang-nan, Feng Ji-chuan, Qiang Xiao-jun
    2014, 18 (44):  7111-7116.  doi: 10.3969/j.issn.2095-4344.2014.44.011
    Abstract ( 531 )   PDF (655KB) ( 458 )   Save

    BACKGROUND: Discectomy and pedicle fixation fusion are golden standard to repair lumbar degenerative disease, but the treatment would induce other complications such as degeneration of adjacent segments or severer pre-existing spinal degeneration. For the problem of lumbar fusion and fixation, lumbar elastic fixation has recently been a hot focus.

    OBJECTIVE: To evaluate the short-term effectiveness of dynamic lumbar pedicle fixation in repair of lumbar spinal stenosis and lumbar disc herniation.
    METHODS: From December 2010 to December 2012, 62 cases of lumbar spinal stenosis and lumbar disc  herniation treated with lumbar dynamic system were included. The involved segments included: 5 cases at L3/4, 20 cases at L4/5, 20 cases at L5 S1, 6 cases at double segment L3/4 and L4/5, 8 cases at double segment L4/5, L5 S1, 3 cases at L3/4 and L5 S1. There were 34 males and 28 females with an average age of 50.8 years (range 32 to 72 years). According to different fixation systems, they were assigned to three groups: general dynamic lumbar fixation system in 17 cases, K-Rod posterior dynamic stabilization system in 28 cases, and Dynesys system in 17 cases. The follow-up time was from 24 to 48 months. Evaluation indexes included visual analogue scale, Oswestry disability index, imaging analysis and excellent and good rate of curative effects.
    RESULTS AND CONCLUSION: Compared with before treatment, visual analogue scale score and Oswestry disability index were significantly improved at 6 months after treatment and final follow-up (P < 0.01). No apparent changes were detected in the length of inserted segments and adjacent segments before treatment and during final follow-up. There were no significant differences in the excellent and good rate in each group after treatment (P > 0.05). These data indicated that the lumbar dynamic system was an effective option for lumbar disc herniation and spinal stenosis. Although there are some differences in the structure of three kinds of flexible fixation, no obvious difference in early therapeutic effects was detected. Long-term effects deserve further investigations.

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    Dynesys dynamic stabilization system versus posterior lumbar interbody fusion in treatment of lumbar degenerative disease
    Peng Chao, He Zhi-yong, Mu Jian-song, Lan Hai, Li Kai-nan
    2014, 18 (44):  7117-7121.  doi: 10.3969/j.issn.2095-4344.2014.44.012
    Abstract ( 600 )   PDF (592KB) ( 674 )   Save

    BACKGROUND: Posterior lumbar interbody fusion is a typical therapeutic method of lumbar degenerative disease. Present studies suggested that adjacent segment degeneration occurs after fusion. Recently, more and more scholars paid attention to the development of non-fusion of the spine.

    OBJECTIVE: To compare clinical effects of Dynesys dynamic stabilization system fixation and posterior lumbar interbody fusion in treatment of lumbar degenerative disease.
    METHODS: From July 2009 to July 2011, clinical data of 56 patients with lumbar degenerative disease were retrospectively analyzed. There were 28 cases of Dynesys dynamic stabilization system fixation, and 28 cases of posterior lumbar interbody fusion. Operation time, bleeding volume, and postoperative hospitalization time were compared in both groups. Visual analog scale was used to assess pain. Oswestry disability index was utilized to evaluate clinical effects.
    RESULTS AND CONCLUSION: A total of 56 patients were followed up for 18-24 months. Visual analog scale and Oswestry disability index scores were significantly improved at 12 months after treatment in both groups   (P < 0.01). Significant differences in operation time, bleeding volume, and postoperative hospitalization time were

     

    detected between both groups (P < 0.01). Dynesys dynamic stabilization system group was better than posterior lumbar interbody fusion group. Range of motion was better in the Dynesys dynamic stabilization system group than in the posterior lumbar interbody fusion group (P < 0.01). During follow-up, nail rope system and polyester sleeve loose were not detectable in the Dynesys dynamic stabilization system group. These results verified that compared with posterior lumbar interbody fusion, Dynesys dynamic stabilization system for lumbar degenerative diseases has a high safety and small trauma, and can keep advantages of a fixed segment, and exert a certain effect on degeneration of intervertebral disc in the adjacent segment.

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    Intervertebral fusion cage combined with pedicle screw systems for the treatment of lumbar isthmic spondylolisthesis: evaluation of the intervertebral space height
    Mi Dong, Yang Ming-kun, Zhang Xu, Wu Ji-sheng, Liu Chuan, Li Zhou, Wang Jie
    2014, 18 (44):  7122-7126.  doi: 10.3969/j.issn.2095-4344.2014.44.013
    Abstract ( 399 )   PDF (420KB) ( 410 )   Save

    BACKGROUND: The main treatment of lumbar isthmic spondylolisthesis is the surgery, in a broader attempt to decompression, reduction, fixation and fusion of the lesioned segments. The golden standard of the treatment is biological fusion, while internal fixation is a reliable assistance for fusion therapy.
    OBJECTIVE: To discuss the clinical value and curative effect of intervertebral fusion cage combined with pedicle screw systems for the treatment of lumbar isthmic spondylolisthesis.
    METHODS: From March 2010 to March 2013, 21 cases of isthmic spondylolisthesis were treated with intervertebral fusion cage combined with pedicle screw systems, including 18 cases of spondylolisthesis of degree II and 3 cases of spondylolisthesis of degree III. All patients were followed up regularly, taking JOA lumbago score and visual analog scale score as the objective evaluation criteria of pain in postoperative follow-ups. The curative effect was assessed by Macrab standard, and the functional recovery was evaluated based on indicators such as Prolo, and the spinal fusion rate was assessed according to Lenke criteria. Changes of slippage rate, slippage angle, sacral inclination angle and intervertebral space post height in preoperative and postoperative periods were evaluated by iconography data.
    RESULTS AND CONCLUSION: All the 21 patients with isthmic spondylolisthesis were followed up for 12-16 months. JOA lumbago score and vasual analog scale score of all patients were improved after treatment, and the  difference was statistically significant compared with before treatment (P=0.000). According to Macrab evaluation criteria, there were 17 excellent cases and 4 good cases. Each indicator evaluated by preoperative Prolo activities and symptom grading showed significant differences in preoperative and postoperative periods (P=0.003). Postoperative lumbar spondylolisthesis was basically reset, the slippage angle was significantly reduced, the sacral inclination angle was increased, and the height of the intervertebral space was recovered basically. Intervertebral fusion cage combined with pedicle screw systems was one of the effective strategies to treat lumbar isthmic spondylolisthesis.


    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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    Primary curative effect of anterior cervical cage ROI-C in cervical fixation
    Song Sheng, Sun Zhen-zhong, Jiang Wei-min, Yin Qu-dong, Liu Xue-guang, Liu Jun
    2014, 18 (44):  7127-7132.  doi: 10.3969/j.issn.2095-4344.2014.44.014
    Abstract ( 492 )   PDF (1447KB) ( 632 )   Save

    BACKGROUND: With the extensive application of anterior titanium plate, postoperative complications such as dysphagia, titanium loose, screw exit and disc degeneration of neighboring segments induced more and more attention of researchers. However, the application of anterior cervical cage is expected to avoid these complications.
    OBJECTIVE: To observe primary curative effect of anterior cervical cage ROI-C in anterior cervical spine surgery.
    METHODS: A total of 32 patients with cervical spondylosis were treated with anterior cervical cage ROI-C in the Wuxi Ninth Hospital Affiliated to Soochow University from April to December 2013. The cage was implanted to promote interbody fusion. Of 32 cases, 23 cases affected cervical spondylotic myelopathy, 2 cases affected nerve root type cervical spondylosis, 3 cases affected cervical hyperextension injury, 1 case affected cervical disc herniation, 2 cases affected cervical instability and 1 case affected segmental cervical ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association and NDI scores were determined to assess neurological symptoms and functional improvement before internal fixation and during final follow-up. Simultaneously, adverse reactions were recorded.
    RESULTS AND CONCLUSION: A total of 32 patients finished the regular follow-up for 4 to 8 months. Clinical 
    symptoms and spinal cord function of all patients were obviously improved. No ROI-C loosing or displacement or secondary surgery was found. The average fusion time was 4.2 months (3 to 5 months). Mean score of Japanese Orthopaedic Association was increased from 9.2 points pre-surgery to 13.8 points post-surgery. Japanese Orthopaedic Association and NDI scores were higher during final follow-up than before fixation (P < 0.05). These data indicated that ROI-C effectively restored intervertebral height in anterior cervical spine surgery, stably reconstructed cervical vertebra, obtained interbody fusion, effectively avoided related surgical complications induced by plate implantation, improved neurological symptoms and function, and showed good short-term effects.


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    Effect of percutaneous vertebroplasty and percutaneous kyphoplasty on adjacent intervertebral disc degeneration and mechanism
    Tian Li, Meng Chun-yang, Xu Xiao-meng
    2014, 18 (44):  7133-7137.  doi: 10.3969/j.issn.2095-4344.2014.44.015
    Abstract ( 322 )   PDF (340KB) ( 472 )   Save

    BACKGROUND: Compared with conservative treatment, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) can rapidly relieve the pain caused by the compression of osteoporotic vertebral body. However, the perfusion of bone cement can not only restore the rigidity of fractured vertebrae, but also theoretically alter the stress distribution of fractured vertebrae and increase the stress load of adjacent vertebrae, thus causing adjacent intervertebral disc degeneration.
    OBJECTIVE: To observe the effects of PVP and PKP on the adjacent intervertebral disc degeneration and explore the possible mechanism.
    METHODS: A total of 85 patients with osteoporotic vertebral compression fracture were divided into three groups: conservative treatment group (n=23), PVP group (n=42) and PKP group (n=23). ODI scores, DHI, MRII, and peripheral interleukin-1β, interleukin-6, tumor necrosis factor-α levels were collected and analyzed at different time points.
    RESULTS AND CONCLUSION: The results showed that, PVP group and PKP group relieved pain effectively, reduced the time in bed, and had a better treatment satisfaction, but there were no significant differences in the  scores of ODI scores between PVP group and PKP group at 24 months after discharge (P > 0.05). At 24 months after discharge, MRII in the PVP group and PKP group were lower than that in conservative treatment group and before treatment (P < 0.05), while peripheral interleukin-1, interleukin-6, tumor necrosis factor-α levels were higher (P < 0.05), there were significant differences between PVP group and PKP group (P < 0.05). The disc degeneration adjacent to the fractured vertebral body can be accelerated by PVP and PKP procedures, and the latter is more serious. Interleukin-1, interleukin-6, tumor necrosis factor-α levels are closely related to the degree of intervertebral disc degeneration.


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    Analysis of internal fixation failure after cannulated screws for adult femoral neck fracture
    Zhao Qi, Liu Shi-qing, Ming Jiang-hua, Zhou Yan, Liao Qi, Zhang Chun, Yang Yue
    2014, 18 (44):  7138-7145.  doi: 10.3969/j.issn.2095-4344.2014.44.016
    Abstract ( 594 )   PDF (800KB) ( 574 )   Save

    BACKGROUND: Since cannulated screw has been applied to femoral neck fracture, it is not uncommon that the screw wear penetrates or refunds. What factors affect the stability of cannulated screw for treatment of femoral neck fractures in adults remains unclear.
    OBJECTIVE: To explore factors related to internal fixation failure by cannulated screws in treatment of adult femoral neck fracture and improve the stability of the adult femoral neck fracture by cannulated screws.
    METHODS: A total of 92 adult patients of femoral neck fracture were treated by cannulated screws in our department between June 2007 and June 2011. Their data were retrospectively analyzed. According to clinical information and follow-ups, we selected factors such as age, gender, Garden type of fracture, preoperative skeletal traction, timing of surgery, Garden index, standards of pedicle screws, pedicle screw shapes, partial weight bearing time and postoperative complications, which may affect the success rate of cannulated screws for 
    treating femoral neck fracture. The selected factors were then grouped and assigned, after unrelated factors were excluded by one-way χ2 analysis, multiariable Logistic regression analysis was performed.
    RESULTS AND CONCLUSION: The involved 92 patients were followed up for 18-72 months. According to Harris assessment criteria, hip function was excellent in 28 cases, good in 25 cases, fair in 17 cases, and poor in 22 cases at the final follow-up, the excellent and good rate was 58%. Radiographic results showed that, the patients were divided into two groups according to the presence of the displacement, GardenⅠ (n=22) and GardenⅡ (n=29) as a group, and Garden Ⅲ (n=25) and Garden Ⅳ (n=16) as the other group, the fixation failure rate was 12% and 39%, respectively. In normol and abnormal Garden Index groups, the fixation failure rate was 16% and 59%, respectively. In nail position standards and non-attainment standards groups, the fixation failure rate was 19% and 70%, respectively. In the complication and non-complication groups, the fixation failure rate was 14% and 55%, respectively. These factor groups showed significant differences (P < 0.05). Multiariable Logistic regression analysis showed that, Garden type of fracture, Garden index, standards of pedicle screws, and postoperative complications are the risk factors for internal fixation failure using cannulated screws in treatment of the adult femoral neck fracture.


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    Proximal femoral nail versus dynamic hip screw fixation for intertrochanteric fracture in the elderly: complication rate in 12-month follow-up
    Shen Hong-jiang, Guo Liang
    2014, 18 (44):  7146-7150.  doi: 10.3969/j.issn.2095-4344.2014.44.017
    Abstract ( 411 )   PDF (272KB) ( 525 )   Save

    BACKGROUND: Internal fixation has been shown to decrease intertrochanteric fracture complications in the clinic and to improve quality of life of patients. The major method widely used in the clinic is the fixation of proximal femoral nail and dynamic hip screw.

    OBJECTIVE: To observe the clinical effects of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture in the elderly.

    METHODS: A total of 60 patients with intertrochanteric fracture were randomly divided into proximal femoral nail and dynamic hip screw groups (n=30), and they respectively received proximal femoral nail and dynamic hip screw fixation.

    RESULTS AND CONCLUSION: Compared with the dynamic hip screw group, operative time, blood loss, the incidence of complications one year after repair, fracture healing time and complications were lower in the proximal femoral nail group (P < 0.05). After repair, the excellent and good rate of Harris hip scores was higher  (P < 0.05). No significant difference was detected in healing time of wound between the two groups (P > 0.05). Results verified that compared with the dynamic hip screw fixation, the clinical effects of proximal femoral nail fixation were better, more safe and reliable in the treatment of intertrochanteric fracture in the elderly.


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    Percutaneous closed reduction locking compression plate, percutaneous closed reduction interlocking intramedullary nail and open reduction plate in the treatment of tibial fracture: comparison of biostability
    Chen Gang, Qian Ming-quan, Zhu Guo-xing, Shi Ke-qin
    2014, 18 (44):  7151-7156.  doi: 10.3969/j.issn.2095-4344.2014.44.018
    Abstract ( 460 )   PDF (765KB) ( 643 )   Save

    BACKGROUND: The distal tibia shaft fracture is prone to be comminuted after trauma due to the absence of muscle covering and the thin soft tissue, and intraoperative reduction and fixation are difficult. Clinical efficacy is closely related to the type of fracture, degree of soft tissue injury, choice of therapy and internal fixation. Internal fixation is the main treatment for the distal tibia shaft fracture, and a microinvasive, strong fixation is the focus of tibial fracture treatment although many methods for internal fixation are present.
    OBJECTIVE: To explore clinical efficacy of the treatment of distal tibia shaft fracture using percutaneous locking compression plate, interlocking intramedullary nail and open reduction with internal fixation.
    METHODS: A total of 180 patients with distal tibia shaft fracture were randomized into three groups, receiving internal fixation treatment using percutaneous locking compression plate, interlocking intramedullary nail or open reduction. All patients were followed up for 12-24 months. The clinical outcomes of the treated patients in three 
    groups were compared through the observations of incision length, operation time, intraoperative fluoroscopy time, intraoperative blood loss, complications after fixation.
    RESULTS AND CONCLUSION: After excluding the loss of follow-up, 56 cases receiving percutaneous locking compression plate, 52 cases receiving interlocking intramedullary nail and 48 cases receiving open reduction were involved in the final analysis. The incision length and intraoperative blood loss in the groups of percutaneous locking compression plate and interlocking intramedullary nail were significantly better than that of open reduction (P < 0.05). Intraoperative fluoroscopy time in the group of percutaneous locking compression plate was significantly longer than that in other two groups (P < 0.05). The operation time showed no significant differences among three groups. The rate of complications was 11% in the group of percutaneous locking compression plate, and 27% in the groups of interlocking intramedullary nail and open reduction with internal fixation. Percutaneous locking compression plate is a good choice for the distal tibia shaft fracture due to small injury, good biomechanical stability, and no influence on blood supply at fracture end; interlocking intramedullary nail is also a useful technique due to simple operations. Open reduction with internal fixation should be chosen carefully due to great dissection, great influence on blood supply and high complication rate.


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    Application of external fixator combined with vacuum sealing drainage for limbs’ open fracture with severe soft tissue injuries
    Liu Shen-peng, Wan Guang, Liang Qiu-dong, Duan Yong-zhuang, Xu Hai-bin
    2014, 18 (44):  7157-7161.  doi: 10.3969/j.issn.2095-4344.2014.44.019
    Abstract ( 499 )   PDF (617KB) ( 533 )   Save

    BACKGROUND: The treatment of limbs’ open fracture with severe soft tissue injury is very complicated. There are many wound exudates, high frequency of dressing change, and high infection rate. How to deal with the contradiction between wound treatment and fracture fixation is the considerable problem in clinical therapy.
    OBJECTIVE: To explore the effect of external fixator combined with vacuum sealing drainage on limbs’ open fracture with severe soft tissue injuries.
    METHODS: A total of 34 patients with limbs’ open fracture with severe soft tissue injuries were enrolled in the First Affiliated Hospital, Xinxiang Medical College from December 2009 to December 2010. There were 20 males and 14 females, with an average age of 36.6 years old. There were 10 cases of upper limb fracture and 24 cases of lower limb fracture. After debridement, cutaneous deficiency accounted for 1% to 6% of surface area. On the basis of external fixation, the wound received vacuum sealing drainage (treatment group; n=17) and conventional dressing (control group; n=17). According to limb swelling and granulation growth, delayed suture, skin graft or flap to cover the wound were used. After treatment, infection rate of the wound and growth of granulation were observed. In accordance with wound healing and growth of granulation, curative effects were evaluated.
    RESULTS AND CONCLUSION: In the treatment group, there were 11 cases of healing, 5 cases of effective effects, and 1 case of ineffective effect, with a total effective rate of 94% and the infection rate of about 15%. In  the control group, there were 7 cases of healing, 6 cases of effective effects, and 4 cases of ineffective effects, with a total effective rate of 76% and the infection rate of about 40%. Significant differences in healing rate, total effective rate and infection rate were detected between the two groups (P < 0.05). The healing time of wound was 8.66-16.23 days in the treatment group and 15.68-22.36 days in the control group. The healing time was significantly shorter in the treatment group than in the control group (P < 0.05). It is thus clear that vacuum sealing drainage has obvious advantages in repair of limbs’ open fracture with severe soft tissue injury compared with the conventional dressing.


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    Ilizarov external fixation combined with vacuum sealing drainage for the repair of limb fractures with osteofascial compartment syndrome
    Cheng Jian-wen, Su Wei, Tan Zhen, Liu Wei
    2014, 18 (44):  7162-7166.  doi: 10.3969/j.issn.2095-4344.2014.44.020
    Abstract ( 363 )   PDF (686KB) ( 519 )   Save

    BACKGROUND: Osteofascial compartment syndrome is usually due to application of external fixation for fracture treatment. Vaseline gauze is used to cover and compress the wound. Frequent dressing change induces infection and is harmful to wound drainage and tissue granulation, finally causing prolonged time of hospitalization and bad results.
    OBJECTIVE: To investigate the clinical efficacy of Ilizarov external fixation combined with vacuum sealing drainage treatment for limb fractures with osteofascial compartment syndrome.
    METHODS: A total of 32 patients with limb fractures with osteofascial compartment syndrome were randomly divided into two groups. All patients adopted the same fasciotomy and drug treatment. In treatment group, the fracture was fixed with Ilizarov external fixation and the wound was covered with the vacuum sealing drainage dressing. In control group, the fractures were treated by unilateral external fixation and the wound was covered with the vaseline gauze. The fracture healing, clinical effects, hospitalization duration and costs between two groups were compared.
    RESULTS AND CONCLUSION: In the treatment group, there were 10 cases of healing well, 4 cases of muscle contracture and 2 cases of amputation. In the control group, there were 7 cases of healing well, 6 cases of muscle contracture and 3 cases of amputation. No significant difference in clinical outcome measures was detected between the two groups. Fracture healing rate and costs were higher in the treatment group than in the control 
    group (P < 0.05), but hospitalization duration, skin grafts and the incidence of infection were lower in the treatment group than in the control group (P < 0.05). Results suggested that on the basis of timely fasciotomy and decompression, Ilizarov external fixation combined with vacuum sealing drainage treatment for limb fractures with osteofascial compartment syndrome has a high limb salvage rate, which can effectively treat fractures, elevate the healing rate of fractures, reduce infection rate and skin grafting rate, shorten hospital stays. However, the hospitalization expense is higher.


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    Vacuum sealing drainage combined with external fixator in the treatment of post-traumatic osteomyelitis
    Deng Liang, He Fei, Wu Xiao-hui, He Jian-ying, Dong Xie-ping
    2014, 18 (44):  7167-7171.  doi: 10.3969/j.issn.2095-4344.2014.44.021
    Abstract ( 318 )   PDF (688KB) ( 573 )   Save

    BACKGROUND: Posttraumatic osteomyelitis is bone infection after surgery of open fractures or other joint, which leads to more secretions in antrum or bone exposed wounds, long treatment cycle, delayed healing of fracture, even disunion. The key link in the treatment is complete debridement, adequate drainage, and the use of external fixators with low interference and far away from lesions.
    OBJECTIVE: To observe the clinical efficacy of external fixator combined vacuum sealing drainage (VSD) in the treatment of post-traumatic osteomyelitis, and compared with conventional catheter drainage.
    METHODS: Since June 2010 to June 2013, 21 patients of post-traumatic chronic osteomyelitis were included in this study and divided into VSD group (n=11) and conventional catheter drainage group (n=10). All patients in VSD groups underwent debridement and VSD was used to fill dead space, then the wounds were sutured. Cases appeared nonhealing fractures underwent external fixation, 10 cases using external fixators and 1 case retained original external fixator. All patients achieved the closed wounds at the second phase, 9 cases were directly sutured, and 2 cases received skin flap transplantation. Among them, 1 case received autologous bone graft at the third phase because of bone defects. In the conventional catheter drainage group, all patients underwent debridement and conventional catheter drainage to rinse the wounds after surgery, 3 cases failing to close the wounds changed to receive ordinary dressing and skin flap transplantation at the second phase. Cases appeared nonhealing fractures underwent external fixation. Local swelling, pain and fever were observed after treatment. The time of total hospitalization stay and fracture healing was recorded.
    RESULTS AND CONCLUSION: The VSD group quickly controlled preoperative symptoms such as swelling and pain and fever than the conventional catheter group (P < 0.05). The length of hospital stay showed no significant difference between the two groups (P > 0.05). All patients were obtained through clinic service and followed up for 24-36 months. The healing time in the VSD group was shorter than that in conventional catheter group (P < 0.05). Until the end of follow-up, no patients in the VSD group appeared infection recurrence, and two cases in the conventional catheter group had recurrent infection. The results suggest that VSD combined with external fixator can repair post-traumatic chronic osteomyelitis due to rapid control of infection, easy care, shortened treatment time, and reduced rate of postoperative recurrence. In addition, external fixator can be used as the final fixation for post-traumatic chronic osteomyelitis.


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    Computer-aided design of digital plate in the treatment of hip dislocations associated with posterior wall acetabular fracture
    Xu Run-bing, Ding Liang-hua, He Shuang-hua
    2014, 18 (44):  7172-7177.  doi: 10.3969/j.issn.2095-4344.2014.44.022
    Abstract ( 348 )   PDF (431KB) ( 410 )   Save

    BACKGROUND: Modern imaging technology, computer-aided design and processing, rapid prototyping technology and other digital technology have enabled a new era of orthopedic field. Digitalization, individualization, minimal invasion, precision and intelligence are the potential topics in future orthopedics.
    OBJECTIVE: To investigate clinical efficacy of computer-aided design of digital plate in the treatment of hip dislocations associated with posterior wall acetabular fracture.
    METHODS: Sixteen patients of posterior wall acetabular fractures associated with hip dislocations were repaired with customized digital plate fixation. According to Thompson-Epstein fracture type: there were 7 cases with type Ⅱ, 5 cases with type Ⅲ, 2 cases with type Ⅳ, and 2 cases with type Ⅴ. Radiographic examination showed the presence of 2-5 mm displacement on the acetabular articular surface, average 3 mm. The time from the injury to hospitalization was 6 hours to 2 weeks, average 1.5 days. After admission, patients underwent femoral condyle bone traction, 12 cases achieved a reduction and three cases of femoral head entrapment were reset during surgery. At 4-10 days after admission, all patients received computer-aided design of digital plate fixation for acetabular fractures.
    RESULTS AND CONCLUSION: Postoperative fracture quality was assessed according to Matta standards,   15 cases had anatomical reduction (displacement < 1 mm) and 1 case had poor reduction (displacement 2-3 mm). The findings indicate that, computer-aided design of digital customized plate has achieved individualized and  precise outcomes, as well as firm fixation in the treatment of hip dislocations associated with posterior wall acetabular fracture. It avoids intraoperative repeated shaping, effectively restores the integrity of posterior wall, allows early functional exercise, and provides alternative internal fixation for hip dislocations associated with posterior wall acetabular fracture.


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    Computer-assisted design of scaphoid reconstruction: individualized percutaneous cannulated screw fixation
    Lin Xu, Zeng Jun, Guo Yong, Tan Lun
    2014, 18 (44):  7178-7182.  doi: 10.3969/j.issn.2095-4344.2014.44.023
    Abstract ( 384 )   PDF (678KB) ( 660 )   Save

    BACKGROUND: Individualized percutaneous cannulated screws fixation with the help of computer-assisted design and cast immobilization are common methods for treating nondisplaced wrist scaphoid fracture. However their clinical outcomes are still unclear.
    OBJECTIVE: To compare the clinical results of individualized percutaneous cannulated screws fixation with the help of computer-assisted design and cast immobilization for treatment of Herbert type Ib scaphoid fracture. 
    METHODS: A total of 36 patients with fresh Herbert type Ib scaphoid fracture were divided into two groups, individualized percutaneous cannulated screws fixation with the help of computer-assisted design group (screw group, 20 cases) and cast immobilization group (cast group, 16 cases). In the screw group, cannulated screws were inserted using 0.8 mm kirschner wires from scaphoid tuberosity based on the preoperative individualization fixation parameters. The direction of the wires was guided under C-arms and Herbert screws were percutaneously immobilized after fluoroscopy. In the cast group, radial deviation and palmar flexion plaster casts were immobilized for 3 months. The time of bone union, rate of bone nonunion, time return to work, wrist motion were recorded and compared in the follow-up.
    RESULTS AND CONCLUSION: All cases were followed for 10-24 months. All patients in the screw fixation group and 13 out of 16 patients in the cast group achieved bone union. The average time of bone union of the two groups was 6 weeks and 14 weeks respectively (P < 0.001). The time of returning to work was 7.6 weeks and 16.8 weeks respectively, with significant differences between the two groups (P < 0.001). The range of motion of screw fixation group at the final follow-up was 96.4°-114.4°, average 104.4°, which was significantly higher than that in the cast group (66.4°-104.2°, average 94.2°; P < 0.001). Individualized percutaneous cannulated screws fixation with the help of computer-assisted design can provide mini-invasion, high accuracy and good reproducibility, has better results than cast immobilization in the treatment of Herbert typeⅠscaphoid fractures.


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    RNAIII inhibiting peptide suppresses the adhesion of staphylococcus epidermis on the Hela cells
    Xing Qing-chang, Hao Li-bo, Wang Ji-fang
    2014, 18 (44):  7183-7187.  doi: 10.3969/j.issn.2095-4344.2014.44.024
    Abstract ( 293 )   PDF (338KB) ( 424 )   Save

    BACKGROUND: Staphylococcal infections and its biofilm formation can occur when orthopedic implants or wound is healing, and are regulated by bacterial population sensing mechanism. RNAIII inhibiting peptide intervenes the quorum-sensing system of staphylococcal and blocks the signal transduction among staphylococcal cells, and inhibits staphylococcal biofilm formation, and then prevents staphylococcal infections.
    OBJECTIVE: To investigate the influence of RNAIII inhibiting peptide on the adhesion of staphylococcus epidermis to the Hela cells.
    METHODS: The Hela cells were cultured in vitro. There were four groups in this study. In the blank group, saline with dimethyl sulfoxide was added in each well. In the RNAIII inhibiting peptide group, dimethyl sulfoxide solution containing RNAIII inhibiting peptide was added. In the levofloxacin group, levofloxacin was added. In the combination group, the dose was in accordance with above methods. Using intergroup control method, the adhesion of staphylococcus epidermis to the Hela cells was compared under the effects of saline, RNAIII inhibiting peptide and levofloxacin and their combination.
    RESULTS AND CONCLUSION: In the blank group, abundant bacterial adhered to Hela cells. The number of adhered bacteria was significantly lower in each medicine group than in the blank group (P < 0.001). The spot count was significantly lower in the levofloxacin group than in the RNAIII inhibiting peptide group (P < 0.05). In the combination group, the number of bacteria adhered to Hela cells was decreased (P < 0.01). Results verified that  RNAIII inhibiting peptide effectively suppressed the adhesion of staphylococcus epidermis to the host cells, and showed synergistic effects on antibiotics.


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    Perioperative analgesia in total knee replacement: multimodal analgesia schemes and optimal pain management

    Sun Yang, Yang Ming-min, Li Yi-mei
    2014, 18 (44):  7188-7193.  doi: 10.3969/j.issn.2095-4344.2014.44.025
    Abstract ( 452 )   PDF (410KB) ( 565 )   Save

    BACKGROUND: Positive treatment of perioperative analgesia after total knee arthroplasty can accelerate recovery of joint function, reduce complications after replacement, and improve overall technical evaluation of total knee arthroplasty.
    OBJECTIVE: To summarize commonly used analgesic drugs and analgesia method of total knee arthroplasty.
    METHODS: A computer-based online research of Wanfang database and PubMed database was performed to collect articles published between 1994 and 2014 with the keywords of “total knee replacement, epidural analgesia, peripheral nerve block, joint local analgesia, patient controlled analgesia, cold treatment” in Chinese and English.
    RESULTS AND CONCLUSION: There were 986 articles after the initial survey. Finally, 55 articles were included according to the inclusion and exclusion criteria. As the technology for total knee arthroplasty, early functional rehabilitation and replacement of pain control has been widely concerned, a large number of literatures about analgesic drugs and analgesic programs emerge. Analgesic drugs include opioids, non-steroidal anti-inflammatory drugs, local anesthetics and N-methyl-aspartate receptor blockers. Analgesic program includes epidural analgesia, peripheral nerve blockage, joint local analgesia, patient-controlled analgesia and cold therapy. These analgesic drugs and methods have their advantages and disadvantages. At present, multimodal analgesia schemes have been recognized, but the optimal pain management scheme remains controversial. Increasing considerations should be paid on the choice of analgesic methods, depending on individual characteristics and existing technology.


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    Acetabular lateral reconstruction after total hip arthroplasty: understanding and application of core technology
    Zhang Wen-xian, Fan You-fu, Wang Xiao-yan, Lv Jiang-hong
    2014, 18 (44):  7194-7198.  doi: 10.3969/j.issn.2095-4344.2014.44.026
    Abstract ( 351 )   PDF (313KB) ( 402 )   Save

    BACKGROUND: After the initial hip replacement, aseptic or infective loosening and subsidence of the prosthesis, acetabular wear, pain, osteolysis and other factors may lead to the loss of prosthesis stability and loss of joint function, which are the common cause of hip arthroplasty. Among the hip arthroplasty, acetabular lateral reconstruction is essential and largely determines the success or failure of revision surgery.
    OBJECTIVE: To explore the present situation of reconstructing acetabulum after total hip arthroplasty.
    METHODS: A computer-based online search of PubMed database (http://www.ncbi.nlm.nih.gov/PubMed) between January 1998 and March 2014, and CNKI database (http://www.cnki.net/) from January 2003 to March 2014 was undertaken for the articles about reconstructing acetabulum after total hip arthroplasty. The key words were “artificial joint, reconstruction, acetabular lateral reconstruction, current situation” in Chinese and “reconstructed acetabulum, total hip arthroplasty” in English. Article about hip reconstruction, acetabyular reconstruction, bone defect reconstruction, prosthesis choice and reconstruction, and soft tissue balance were also selected. Repetitive researches were excluded.
    RESULTS AND CONCLUSION: According to inclusion criteria, 26 articles were involved in this study. A perfect acetabular revision should achieve the following goals: stabilize acetabular prosthesis after acetabular revision; recover hip rotation center and biomechanical properties; repair acetabular bone defects and increase hip bone. Adequate preparation before surgery is an important prerequisite for the success of surgery and good results, aseptic and septic loosening or subsidence of the prosthesis, as well as acetabular wear and tear are common causes of hip revision. Intraoperative reconstruction of acetabular anteversion and camber angles, acetabular rotation center reconstruction, reconstruction of acetabular bone defects, selection of reconstruction of acetabular prosthesis, and reconstruction of soft tissue balance are the core technologies of reconstructing acetabulum after total hip 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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    Bennett fracture repair: implant option and treatment progress
    Sun Lei, Xu Jun, Tian Jun
    2014, 18 (44):  7199-7204.  doi: 10.3969/j.issn.2095-4344.2014.44.027
    Abstract ( 563 )   PDF (357KB) ( 584 )   Save

    BACKGROUND: Bennett fracture repair is one of the problems for orthopedic surgeons, although there are a variety of clinical treatment for Bennett fracture, no treatment strategy is widely accepted.

    OBJECTIVE: This study aims to provide evidence for developing an effective treatment strategy for Bennett fracture.
    METHODS: A computer-based retrieval of PubMeb database (http://www.ncbi.nlm.nih.gov/PubMed), CNKI China Journal Full-Text database (http://www.cnki.net/) and Wanfang database (http://g.wanfangdata.com.cn/) between January 2004 and July 2014 was performed by the first author. Meantime, Campbell’s Operative Orthopaedics, Shiyong Guke Xue and other orthopedic monographs were manually retrieved, to analyze research progress about Bennett fracture.
    RESULTS AND CONCLUSION: A total of 37 literatures associated with Bennett fracture were involved in this study. Conventional closed reduction plaster or Kirschner wire fixation is characterized by low cost and easy operation, but it fails to achieve anatomical reduction. AO principle for fracture treatment has been widely accepted in recent years, the application of AO screw and AO plate is increasing in treatment of Bennett fracture, it can not only repair bone fracture but also repair and reconstruct the damaged ligament, but the cost is very high and secondary surgery is needed to remove the implant. Traditional Chinese orthopedics and integrated traditional and western medicine are experienced methods for treatments of Bennett fracture, and Chinese herbs have obvious symptomatic treatment effect and effectively improve the symptoms of patients. As the thumbs play a crucial role in the hand movement, the optimal treatment strategy for Bennett fractures has important clinical significance.

    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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     Change of paravertebral muscle in patients with lumbar degenerative disease
    Qiao Pei-liu, Tayier•Abuduhadeer
    2014, 18 (44):  7205-7210.  doi: 10.3969/j.issn.2095-4344.2014.44.028
    Abstract ( 423 )   PDF (304KB) ( 495 )   Save

    BACKGROUND: Lumbar paravertebral muscles play an important role for lumbar spinal stability. Increasing studies emphasize on the change of paravertebral muscles in patients with lumbar degenerative disease and therefore have important clinical significance for the rehabilitation training of paravertebral muscle in patients with lumbar degenerative disease.
    OBJECTIVE: To review the research progress of the change of paravertebral muscle in patients with lumbar degenerative disease and to look into the future development prospects.
    METHODS: A computer-based online search of PubMed and WANFANG DATA between 1986 and 2014 was performed with the key words “lumbar vertebra, paravertebral muscle, psoas major, multifidus muscle, cross sectional area, muscle atrophy, fatty infiltration, muscle biopsy, MRI, electromyography” in English and Chinese, respectively. The clinical and experimental studies addressing the changes of paravertebral muscle in patients with lumbar degenerative disease were included. According to the inclusion and exclusion criteria, 48 literatures were included into the final analysis, 8 Chinese and 40 English.
    RESULTS AND CONCLUSION: The change of paravertebral muscle in patients with lumbar degenerative disease includes muscle atrophy and fatty infiltration. The changes of paravertebral muscles are often detected with B-ultrasound, CT, MRI, EMG and muscle biopsy. Due to the differences of sample size, age and study method, there are different results, even conflicting. So some limitations of sample size, age and study method are needed to obtain accurate results. In addition, further studies will focus on the verification of which nerve specifically dominants lumbar paravertebral muscles.


    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 Tuina manipulation for lumbar disc herniation: literature analysis in recent 10 years

    Li Ju-bao, Xiong Qi-liang, Qu Shang-ke, He Jing-zhe, Deng Ying, Jia Tao, Li Yan, Yi Hong-chi
    2014, 18 (44):  7211-7216.  doi: 10.3969/j.issn.2095-4344.2014.44.029
    Abstract ( 500 )   PDF (376KB) ( 1349 )   Save

    BACKGROUND: The currently published literatures about Tuina manipulation for lumbar disc herniation include clinical observations, retrospective study and summary of clinical experience, which have shortcomings in the study design, choice of cases and outcome measures. Reviews may enroll randomized and intended references, and has no analysis or evaluation on the quality of involved literatures, leading to the bias and subjective views.
    OBJECTIVE: To research the application laws of Tuina manipulation for treating lumbar disc herniation through literature analysis within 10 years.
    METHODS: The key words of “lumbar disc herniation, traditional Chinese medicine, Tuina, manipulation, massage, rehabilitation, poking channels, point pressing, palpating pressing, and finger pressing” in Chinese were used to search the literature about Tuina manipulation in treatment of lumbar disc herniation within recent 10 years published in the Wanfang database, Vip database and CNKI database. The top 20 manipulations of Tuina for lumbar disc herniation were and statistical analyzed with hierarchical clustering statistical method.
    RESULTS AND CONCLUSION: The hierarchical clustering analysis results showed that, Tuina manipulations for lumbar disc herniation are as follows: (1) manipulations acted on soft tissue, including rolling, holding, pushing and pressing; (2) manipulations acted on acupuncture point, including Urinary Bladder Meridian of Foot-Taiyang acupuncture points (Shengshu, Dachangshu, Guanyuanshu, Zhibian, Chengfu, Weizhong, Chengshan and Kunlun), Gall Bladder Meridian of Foot-Shaoyang acupuncture points (Huantiao and Yanglingquan), Yaoyangguan point in Du Meridian, Zusanli point in Stomach Meridian of Foot-Yangming, and tender points; (3) manipulations acted on human bones and joints, including waist inclined pull method, waist back-stretching method, pelvic traction method and straight-leg raising method. The findings indicate that the potential application laws of Tuina manipulation for treating lumbar disc herniation are given priority to pressing acupuncture points (Urinary Bladder Meridian of Foot-Taiyang acupuncture point, Gall Bladder Meridian of Foot-Shaoyang acupuncture point, Du Meridian, Stomach Meridian of Foot-Yangming acupuncture point and tender points), at the same time companied with manipulations acted on soft tissue (rolling, holding, pushing spinal method), and bones and joints (waist inclined pull method, waist back-stretching method, pelvic traction method and straight-leg raising method).


    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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