ObjectiveTo study the difference of femoral condylar twist angle (CTA) measurement in three dimensional (3-D) reconstruction digital models of human knee joint based on the two dimensional (2-D) images of MRI and CT so as to provide a reference for selecting the best method of CTA measurement in preoperative design for the femoral prosthesis rotational position. MethodsThe CTA of 10 human cadaveric knee joint was measured in 3-D digital models based on MRI (group A), in 3-D digital models based on CT (group B), in the cadaveric knee joint with cartilage (group C), and in the cadaveric knee joint without cartilage (group D), respectively. The statistical analysis of the differences was made among the measurements of the CTA. ResultsThe CTA values measured in 3-D digital models were (6.43±0.53)° in group A and (3.31±1.07)° in group B, showing significant difference (t=10.235, P=0.000). The CTA values measured in the cadaveric knee joint were (5.21±1.28)° in group C and (3.33±1.12)° in group D, showing significant difference (t=5.770, P=0.000). There was significant difference in the CTA values between group B and group C (t=5.779, P=0.000), but no significant difference was found between group A and group C (t=3.219, P=0.110). ConclusionThe CTA values measured in the 3-D digital models based on MRI are closer to the actual values measured in the knee joint with cartilage, and benefit for preoperative plan.
Objectives To assess the clinical effectiveness of non-penetrating trabecular surgery versus trabeculectomy for open angle glaucoma. Methods We searched the Cochrane Central Register of Controlled Trials (issue 2, 2007), MEDLINE (1966 to May 2008), EMbase (1980 to May 2008), and CMB-disk (1979 to May 2008). We also hand searched relevant journals and conference proceedings. Data were extracted by two reviewers independently using an extraction form. The Cochrane Collaboration’s RevMan 5.0 software was used for statistical analysis. Results Three RCTs involving 127 participants (144 eyes) with previously untreated open angle glaucoma were included. Meta-analysis showed that compared with non-penetrating trabecular surgery, trabeculectomy increased the proportion of patients with reduced postoperative intraocular pressure (WMD2.78, 95%CI 1.41 to 4.15), improved the operation success rate (RR 0.53, 95%CI 0.37 to 0.77), and reduced the use of postoperative antiglaucoma medication (WMD 0.96, 95%CI 0.84 to 1.08). Non-penetrating trabecular surgery reduced the incidence of postoperative complications (RR 17.00, 95%CI 8.36 to 26.00). Conclusion Since the sample sizes of the included trials are relatively small, and the two procedures are also related to progressive visual field loss and optic disk damage, more well-designed large-scale RCTs are required.
Objective To investigate the relation of spinal ventricular septal angle (SVSA) measured by computer tomographic pulmonary angiography (CTPA) and pulmonary vascular resistance (PVR) measured by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension (CTEPH) .Methods Eighty-nine patients with CTEPH (male 57, female 32; 53.08 ±12.43 years) were recruited as a CTEPH group, and 89 patients without pulmonary artery hypertension and pulmonary embolismwere recruited as a control group. The CTEPH patients received CTPA before right-heart catheterization and pulmonary angiography. SVSA and pulmonary artery obstruction indexes including Qanadli Index and Mastora index were evaluated by two radiologists.Results SVSA was 65.13°±12.26°and 39.69°±5.84°in the CTEPH group and the control group respectively, with significant difference between two groups ( t =14.479, P = 0.000) . Qanadli index of the CTEPH patients was( 42.50 ±17.67) % , which had no correlation with SVSA ( r= 0.094, P = 0.552) . Mastora index was ( 30.02 ±15.53) % , which also had no correlation with SVSA ( r=0.025, P =0.873) . SVSA had a moderate positive correlation with PVR ( r =0.529, P =0.000) and a weak positive correlation with right atriumpressure ( r =0.270, P =0.010) . Area under ROC was 0.764 and sensitivity, specificity for PVR≥1000 dyne· s· cm- 5 was 0.714 and 0.778 respectively when SVSA≥67.55°. Conclusion SVSA measured by CTPA can be used as a better predictor for evaluating PVR in CTEPH patients.
Objective To study the correlation between the cervical posture in the cervical disc replacement (CDR) and the cervical curve restoration in neutral position after surgery. Methods Between January 2008 and August 2010, 51 patients underwent single segmental PRESTIGE LP replacement, and the clinical data were retrospectively analyzed. During the surgery, the patient was supinely placed and the lordosis of the cervical spine was mantained with a pillow placed beneath the neck. Of them, 28 were male and 23 were female, aged 30-64 years (mean, 45 years); 32 were diagnosed as having cervical spondylotic myelopathy, 7 having radiculopathy, and 12 having myelopathy and radiculopathy. The disease duration was 3-48 months (mean, 15 months). CDR was performed at C4, 5 in 5 cases, at C5, 6 in 42 cases, and at C6, 7 in 4 cases. The Cobb angles of the cervical alignment, targeted functional spinal unit (FSU), and targeted disc were measured by sagittal X-ray film of the cervical spine in neutral position before and after surgery, as well as the intraoperative C-arm fluroscopy of the cervical spine. Linear correlation and regression were performed to analyze the relation between cervical Cobb angle difference at intraoperation and improvement of the Cobb angles at 3 months after operation. Results The cervical Cobb angles at intraoperation and 3 months after operation were larger than those at preoperation (P lt; 0.05). The difference of the Cobb angle between intra- and pre-operation was (6.72 ± 9.13)° on cervical alignment, (2.10 ± 5.12)° on targeted FSU, and (3.33 ± 3.75)° on targeted disc. At 3 months after operation, the Cobb angle improvement of the cervical alignment, targeted FSU, and targeted disc was (6.30 ± 7.28), (3.99 ± 5.37), and (4.29 ± 5.36)°, respectively. There was no significant difference in the Cobb angle improvement between the targeted FSU and the targeted disc (t= — 0.391, P=0.698), and between the targeted disc and the cervical alignment (t= — 1.917, P=0.061), but significant difference was found between the targeted FSU and the cervical alignment (t= — 2.623, P=0.012). The linear correlation between the Cobb angle difference and the Cobb angle improvement of the cervical spine was observed (P lt; 0.05). Conclusion A slightly lordotic cervical posture during CDR is an important factor to maintaining normal physiological lordosis of the cervical spine after surgery.
Objective To summarize the surgical technique and the effectiveness of Becker V-shaped lateral rotation osteotomy in total hip arthroplasty (THA) for Crowe type IV development dislocation of the hip (DDH). Methods Between January 2000 and December 2009, 18 patients (22 hips) with Crowe type IV DDH underwent THA. There were 3 males and 15 females with an average age of 54 years (range, 41-75 years). The unilateral hip was involved in 14 cases and bilateral hips in 4 cases. All patients had over anteversion of the femoral neck, with the acetabular anteversion angle of (21.28 ± 4.87)°, the femoral neck anteversion angle of (59.06 ± 1.44)°, and combined anteversion angle of (80.33 ± 1.55)°. All the patients had limb-length discrepancy, ranged from 1.0 to 3.5 cm (mean, 2.5 cm). Before operation, gluteus medius muscle strength was grade 2 in 17 hips and grade 3 in 5 hips; severe or moderate claudication was observed in 13 and 5 patients, respectively. Trendelenburg sign was positive in all patients. Preoperative Harris score was 30.00 ± 6.32. Cementless prosthesis was used. Becker V-shaped lateral rotation osteotomy and subtrochanteric shortening with overlapping femoral resection were performed, and proximal femoral shaft splitting was performed on 21 hips having narrow bone marrow cavity. Results All the cases achieved primary healing of incision. No complication of anterior dislocation, deep infection, nerve traction injury, or femoral uncontrolled fracture occurred. All the cases were followed up 3-12 years (mean, 8 years). Postoperative X-ray films showed that the initial fixation result of femoral prosthesis was excellent in 18 hips and good in 4 hips. Bone healing of osteotomy stump was obtained at 3-6 months (mean, 5 months) after operation. Affected limb prolonged for 2.5-3.5 cm (mean, 3.0 cm ) at 1 year after operation; limb-length discrepancy was 0.5-1.5 cm (mean, 1.0 cm). The gluteus medius muscle strength was restored to grade 4 in 5 hips and grade 5 in 17 hips. At last follow-up, 13 patients had no claudication, and 5 patients had mild claudication; Trendelenburg sign was negative in 15 cases and was positive in 3 cases; the Harris score was significantly improved to 91.89 ± 3.22; all showing significant difference when compared with preoperative ones (P lt; 0.05). At last follow-up, the acetabular anteversion angle, the femoral neck anteversion angle, and combined anteversion angle were (19.33 ± 4.49), (13.33 ± 5.70), and (32.67 ± 5.35)°, respectively, all showing significant differences when compared with preoperative ones (P lt; 0.05). No aseptic loosening, osteolysis, or rediolucent line was found around the femoral component. No implant subsidence, stem varus, or revision occurred. Conclusion Becker V-shaped lateral rotation osteotomy is a safe and predictable method to treat type Crowe type IV DDH.
Objective By observation of the diameter, progression rate, wall thickness, and the opening angle of the abnormal aortic of abdominal aortic aneurysm (AAA) in rats, to observe the effect of saturated hydrogen saline on residual strain of AAA rats, and to investigate its inhibition effect on AAA formation. Methods Twenty healthy male Sprague Dawley rats (weighing, 200-220 g) were randomly divided into 2 groups, which was made the AAA model by infiltration of the abdominal arota with 0.5 mol/L calcium chloride. Saturated hydrogen saline (5 mL/kg) or saline (5 mL/kg) was injected intraperitoneally in the experimental group or control group respectively, every day for 28 days. At 28 days, the diameter, progression rate, wall thickness, and opening angle of the abnormal aorta were mearsured. The aortic tissue was harvested for histological examination (HE staining and aldehyde-fuchsin staining). Results At 28 days after operation, the diameter of abnormal aorta in 2 groups were significantly higher than preoperative ones (P lt; 0.05), the progression rate in experimental group (65% ± 15%) was significantly lower than that in control group (128% ± 54%) (t=3.611, P=0.005). The opening angle and the wall thickness in experimental group were (88.78 ± 29.20)° and (0.14 ± 0.03) mm respectively, had significant differences when compared with the values in control group [(44.23 ± 28.52)° and (0.36 ± 0.05) mm respectively] (P lt; 0.01). The integrity and continuity of the aortic wall in experimental group were superior to that in the control group. Compared with the control group, the injury of elastic fiber in aortic wall and the infiltration of inflammation were all reduced. Conclusion Saturated hydrogen saline can maintain good mechanical properties and reduce dilatation of the aorta by increasing residual strain and reducing the remodeling of it.
Objective To investigate the impact of difference between the medial and lateral posterior condyle cartilage thickness on osteotomy in total knee arthroplasty (TKA) by measuring the thickness of the medial and lateral femur posterior condylar cartilage and the posterior condylar angle (PCA) in osteoarthritis (OA) patients. Methods Between May and December 2011, 53 OA patients (60 knees) scheduled for TKA met the inclusion criteria (OA group). There were 12 males (14 knees) and 41 females (46 knees), aged 57-82 years (mean, 71.9 years). The tibiofemoral angle was (183.2 ± 2.6) ° . Fifteen healthy volunteers (30 knees) were taken as controls (control group); there were 6 males and 9 females, aged 59-68 years (mean, 66.3 years). MRI scan data were imported into Mimics10.01 medical image control system to measure the thickness of femur posterior condylar cartilage and the PCA with and without femur posterior condylar cartilage. Results In the control group, the thickness of the medial and lateral femur posterior condylar cartilage was (1.85 ± 0.33) mm and (1.92 ± 0.27) mm respectively, the PCA with and without femur posterior condylar cartilage was (5.0 ± 0.9)° and (5.1 ± 0.8)° respectively, all showing no significant differences (P gt; 0.05). In OA group, the thickness of the medial and lateral femur posterior condylar medial cartilage was (0.45 ± 0.40) mm and (1.78 ± 0.51) mm respectively, the PCA with and without femur posterior condylar cartilage was (3.3 ± 1.7)° and (4.8 ± 1.8)° respectively, all showing significant differences (P lt; 0.05). In OA group, the difference between lateral and medial cartilage thickness was (1.33 ± 0.45) mm, and the difference between PCA with and without femur posterior condylar cartilage was (1.5 ± 1.3)°. There was a positive correlation between the difference of cartilage thickness and the difference of PCA (r=0.75, P=0.01). Conclusion There is significant difference between medial and lateral femur posterior condylar cartilage wear, which leads to difference of PCA. The difference will impact knee function and longevity of the prosthesis, so the difference should be considered during osteotomy.
Objective To evaluate and compare the relation of the cl inical results of expansion of open-door cervical laminoplasty (EOLP), C5 nerve root palsy in hinge side, and reclose of the opened laminae with different angles in lamina opendoor.Methods Between July 2006 and January 2009, 198 patients with cervical myelopathy were treated by EOLP. Accordingto different opening angles which were measured by CT scan after operation, the patients were divided into group A (gt; 30°, 76 patients including 44 males and 32 females) and group B (15-30°, 122 patients including 71 males and 51 females). There was no significant difference in gender, age, disease duration, and segmental lesions between 2 groups (P gt; 0.05). The Japanese Orthopaedic Association (JOA) score before and after operation was used for neurological assessment and improvement rate, and the postoperative C5 nerve root palsy and reclose of the opened laminae were recorded. Results There was no significant difference in operation time, bleeding volume, and hospital ization days between 2 groups (P gt; 0.05). After 3 weeks of operation, C5 nerve root palsy in the hinge side occurred in 7 patients (9.2%) of group A, and in 2 patients (1.6%) of group B, were restored after symptomatic treatment, showing significant difference between 2 groups (χ2= 4.568, P= 0.033). All patients were followed up 24 to 48 months. Between group A and group B, no significant difference was found in JOA improvement rate at 24 months after operation (P gt; 0.05), and in JOA score at preoperation and at 24 months after operation (P gt; 0.05), but JOA score was significantly improved at 24 months after operation when compared with preoperative score in the same group (P lt; 0.05). The function of l imb l ifting restored in 9 cases of C5 nerve root palsy at 24 months after operation; CT examination revealed that no reclose occured in group A and reclose occurred in 4 cases (3.3%) of group B, but no persistent symptoms or worsen situationwere found during follow-up. Conclusion Different angles in lamina open-door have the same cl inical result; C5 nerve palsy has good prognosis. The opening angle between 15° and 30° will reduce the incidence of C5 nerve root palsy in the hinge side, but the open side should be firmly fixed to prevent further reclose of the opened laminae.
Objective To analyze the effect of the distal femoral flexion angle (DFFA) on the sagittal al ignment of femoral prosthesis and function recovery after total knee arthroplasty (TKA). Methods Between January 2007 and January 2009, 35 patients (35 knees) whose distal femoral flexion angle (DFFA) was more than 6° underwent TKA. Reference to the method by Oswald for DFFA measurement, 35 patients were divided into 2 groups: group A (n=23, 6° lt; DFFA lt; 12°, longintramedullary rod system) and group B (n=12, DFFA gt; 12°, short intramedullary rod system). Another random 30 osteoarthritis and 10 rheumatoid arthritis patients were selected as control group (group C, DFFA lt; 6°). The postoperative femoral prosthesis flexion angle (FPFA), knee society score (KSS), the femoral notch, and extension dysfunction were analyzed. Results All incisions healed by first intention. Seventy-five patients were followed up 1-3 years (mean, 2.1 years). The X-ray films showed that no signs of loosening, fracture, or infection were observed. There were significant differences in FPFA, the femoral notch, and knee extension dysfunction at 1 year after TKA between 3 groups (P lt; 0.05). The knee extension angle of group B was significantly larger than that of groups A and C (P lt; 0.05). There was no significant difference in the knee flexion angle and KSS score between 3 groups (P gt; 0.05). KSS score of postoperation was increased significantly when compared with preoperative values in 3 groups (P lt; 0.05). Conclusion Long intramedullary rod system in patients with higher DFFA usually leads to anterior femoral notch in TKA, so short intramedullary rods that can effectively avoid the notch should be selected in patients with DFFAgt; 12°. But when the femoral prosthesis would be in flexion position, extension dysfunction usually occurs.
Objective To investigate the cl inical directive significance of three-dimensional reconstruction of CT in treating mandibular angle hypertrophy. Methods Between March 2009 and January 2011, 18 patients with mandibular angle hypertrophy were treated using the three-dimensional reconstruction technology of CT. All patients were female, aged20-36 years with an average of 25 years. Eighteen patients included: 14 single mandibular angle hypertrophy, 3 mandibular angle hypertrophy with masseter hypertrophy, and 1 mandibular angle hypertrophy with bilateral asymmetry; 6 cases of ptosis of mandibular angle, 9 cases of prominent mandibular angle, and 3 cases of introversive mandibular angle. According to the types of mandibular angle hypertrophy, the surgical methods could be correctly chosen. The procedure was planned and simulated; the osteotomy l ine was marked and the osteotomy was measured on the workstations of three-dimensional reconstruction. Results No fracture of mandible occurred in the operation. Facial nerve temporary attack occurred in 1 case and recovered at 3 months after operation. All patients were followed up 6-12 months (mean, 7.6 months). After 6 months of operation, the effectiveness was satisfactory in 15 cases, basically satisfactory in 2 cases, and unsatisfactory in 1 case (bilateral asymmetry). Conclusion Based on three-dimensional reconstruction technology of CT, surgical design performed on the model will promote the accuracy of operation. Basically symmetrical appearances can be achieved with satisfactory results.