【Abstract】 Objective To investigate the protective effect of early motion on articular cartilage after joint allograft by performing a controlled trial between different post-operation strategies after joint allograft in an animal model. Methods Twenty hemi-knee joints were harvested from 10 6-month-old New Zealand white rabbits (male or female, weighing 2.5-3.0 kg); 10 hemi-knee joints by deep frozen treatment (donors) were transplanted to unilateral knee joints (recipients) of 10 6-month-old Chinchilla rabbits (male or female, weighing 2.5-3.0 kg), which were divided into early motion group (n=5) and sustained fixation group (n=5); and 10 hemi-knee joints were used as blank control (n=5) and frozen control (n=5). The articular cartilage of allogenic joints was detected by X-ray film, gross, and histology at 6 weeks after operation. Results Gross observation: no obvious limitation of joint movements was observed in early motion group, but obvious limitation in sustained fixation group. X-ray films: the bone ends between donor and recipient healed well with good paraposition and alignment on the operation day and 2 weeks after operation; at 6 weeks, angulation deformity was observed in early motion group of 3 rabbits, and paraposition and alignment were satisfactory in sustained fixation group. Histological observation: HE staining showed that the chondrocytes had normal quantity and morphology with few nuclear fragmentation and karyolysis in early motion group, but the quantity of chondrocytes sharply decreased with dissolved nuclei and numerous fibrous tissues in the cartilage matrix in sustained fixation group. The cell survival rate of the early motion group (49.66% ± 2.15%) was significantly higher than that of the sustained fixation group (20.68% ± 1.24%) (P lt; 0.05). Scanning electron microscopy observation: nuclear membrane was intact with chromatin condensation and edema of mitochondria and rough surfaced endoplasmic reticulum in early motion group, and that the membrane of chondrocyte vanished with blurring border between chondrocyte and matrix, rupture of nuclear membrane and the disappearance of chromatin and organelles could be found in sustained fixation group. Conclusion Early motion has protective effect on articular cartilage after joint allograft, but cannot completely prevent degeneration of the allogenic articular cartilage.
【Abstract】 Objective To investigate the early effectiveness of the Discover cervical artificial disc replacement in treating cervical spondylosis. Methods Qualified for the selective standard, 24 patients with cervical spondylosis were treated between March 2010 and March 2011. Of 24 patients, 13 patients underwent anterior cervical decompression and fusion (ACDF) (ACDF group, between March 2010 and September 2010) and 11 patients underwent Discover cervical artificial disc replacement (CADR group, between September 2010 and March 2011). There was no significant difference in gender, age, disease duration, lesions typing, and affected segments between 2 groups (P gt; 0.05). The operative time, blood loss, and complications were recorded. Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) scores, and Odom’s scores were used to evaluate the postoperative effectiveness. In CADR group, the cervical range of motion (ROM) in all directions, and prosthesis eccentricity were measured before and after operation. Results Symptoms disappeared and no complication occurred after operation in the patients of 2 groups. The patients were followed up 12 to 18 months (mean, 15.3 months) in ACDF group and 6 to 12 months (mean, 9.6 months) in CADR group. The NDI scores in CADR group were significantly higher than those in ACDF group at 1, 3, and 6 months (P lt; 0.05), but no significant difference was observed in JOA score improvement rate between 2 groups (P gt; 0.05). According to Odom’s score at last follow-up, the results were excellent in 6 cases, good in 4 cases, and fair in 3 cases with an excellent and good rate of 76.92% in ACDF group, and were excellent in 9 cases, good in 1 case, and poor in 1 case with an excellent and good rate of 90.91% in CADR group, showing no significant difference (χ2=3.000, P=0.223). The patients in CADR group had significant limit of cervical joint ROM in flexion and extension and right bending at 1 month (P lt; 0.05), but cervical joint ROM restored after 3 months. The ROMs of left bending at 3 months and 6 months were bigger than preoperative value (P lt; 0.05). Meanwhile, ROM in left bending were bigger than that in right bending in replaced segment and upper segment (P lt; 0.05), and the ROM difference between left bending and right bending in upper segment was 2 times higher than that in the replaced segment; a marked linear correlation (P lt; 0.05) existed between the ROM difference and prosthesis eccentricity, and prosthesis bias had bigger ROM in lateral bending. Conclusion Discover cervical artificial disc replacement for treatment of cervical spondylosis can provide a good effectiveness and cervical postoperative movement function. As a new prosthesis, it has some merits such as simple operative steps and less complications.
Objective To evaluate the incidence of heterotopic ossification (HO) after single-level Bryan cervical artificial disc replacement, and to identify the relationship between HO and the effectiveness. Methods The cl inical data of 48 patients undergoing single-level Bryan cervical artificial disc replacement between October 2005 and October 2007 were reviewedretrospectively. There were 27 males and 21 females with an average age of 40.5 years (range, 33-51 years), including 8 cases of cervical myelopathy, 27 cases of nerve root cervical spondylosis, and 13 cases of mixed cervical spondylosis with an average disease duration of 10.3 months (range, 2-14 months). The involved segments included C3, 4 in 3 cases, C4, 5 in 6 cases, C5, 6 in 30 cases, and C6, 7 in 9 cases. The outcomes were evaluated using Visual Analogue Scale (VAS) score, the neck disabil ity index (NDI), and cervical range of motion (ROM). According to patients with or without HO, 48 patients were divided into 2 groups (HO group and no HO group). VAS score, NDI, and cervical ROM were compared between 2 groups at 1, 2, 3, and 4 years after operation. Results No severe complication occurred during and after operation in all patients. Forty-eight patients were followed up 48-72 months (mean, 56.6 months). VAS score and NDI were significantly improved when compared with preoperative values at all time points (P lt; 0.05); except at 3 days after operation, no significant difference was found in cervical ROM at the other time points when compared with preoperation (P gt; 0.05). Thirteen patients (27.08%) had HO at 4 years after operation, including 8 cases of grade 1, 3 cases of grade 2, and 2 cases of grade 3. There was no significant difference in VAS score, NDI, and cervical ROM between 2 groups at 1, 2, 3, and 4 years (P gt; 0.05). Conclusion The incidence of HO after single-level Bryan cervical artificial disc replacement is relatively high. However, HO has no effect on the cervical ROM and the effectiveness.
ObjectiveTo summarize the design and the biomechanical characteristics of Sivash-range of motion femoral modular stem (S-ROM) prosthesis and mainly to introduce its clinical use in developmental dysplasia of hip (DDH) and hip revision. MethodsLiterature concerning S-ROM prosthesis was extensively reviewed and analyzed. ResultsThe S-ROM prosthesis based on the modularity feature can reach press-fit in metaphysis and diaphysis of femur concurrently. Additionaly, S-ROM prosthesis can fit for anatomic differences of the DDH femur and is capable of use in correction osteotomy and hip revision. ConclusionModular junctions of S-ROM prosthesis increase the potentials of implant fracture and metallic debris production, so further follow-up study is needed to verify the long-term effectiveness.
Objective To design an open shape memory alloy artificial vertebral body that can be used to reconstruct the vertebral body in spine diseases, such as thoracic-lumbar spine tumors, burst fracture of the vertebrae, kyphosis and scol iosis, and to evaluate the biomechanical stabil ity of lumbar functional segment unit after insertion with the shape memoryalloy artificial vertebral body. Methods The open shape memory alloy artificial vertebral body with nickel-titanium (NiTi)alloy was made. Eight fresh spine specimens (T14-L5) from normal adult porcine were used to detect the range of motion (ROM) in 4 models and were divided into 4 groups: intact vertebrae served as group A; pedicle screw fixation of T15, L1, L3, and L4 was given in group B; after total resection of L2, it was reconstructed by open shape memory alloy artificial vertebral body combined with pedicle screw fixation of T15, L1, L3, and L4 in group C; and after total resection of L2, it was reconstructed by titanium cage vertebral body combined with pedicle screw fixation of T15, L1, L3, and L4 in group D. The three-dimensional ROM of flexion, extension, left/right lateral bending, and left/right rotation in T15-L1, L1-3, and L3,4 segments were detected in turn by the spinal three-dimensional test machine MTS-858 (load 0-8 N•m). Results Compared with group A, groups B, C, and D had good stabil ity in flexion, extension, left/right lateral bending, and left/right rotation, showing significant differences (P lt; 0.05). There was no significant difference in the degree of each motion between group B and group C (P gt; 0.05). Group C had less degree of motion in T15-L1 and L3,4 segments than group D, showing significant differences (P lt; 0.05), but there was no significant difference in L1-3 segment (P gt; 0.05). Conclusion The open shape memory alloy artificial vertebral body has a reasonable structure and good biomechanical stabil ity, it can be used to stabil ize the spinal segment with pedicle screw fixation.
Objective To evaluate the cl inical outcomes and values of anterior segmental decompression and double-plate fixation (ASDDF) for treatment of ski p cervical spondylotic myelopathy (SCSM). Methods Between June 2005 and June 2008, 17 patients with SCSM were treated with ASDDF. There were 10 males and 7 females with an average age of 58.8 years (range, 41-74 years) and an average disease duration of 9.7 months (range, 6-39 months). According to JapaneseOrthopaedic Association (JOA) score system, 2 patients were rated as extreme severe condition, 7 as severe, 7 as moderate, and 1 as mild. MRI images showed 42 affected cervical disc levels, including 26 disc levels with high-intensity intramedullary lesions on T2, 4 with low-intensity intramedullary lesions on T1, and 12 with significant cord compression but no signal change; according to Nagata classification scale, there were 5 abnormal segments at class I, 21 at class II, and 16 at class III. The rate of fusion, the Cobb angle, and the range of motion (ROM) of the cervical spine were measured preoperatively and postoperatively by the X-ray examinations. The improvement of the neurological function was evaluated by the JOA score. Results The average time of follow-up was 28.6 months (range, 24-58 months). After operation, dysphagia occurred in 2 cases (symptom rel ief after 1 month), hoarseness in 1 case (symptom rel ief after 3 months of methylcobalamin treatment), and degeneration of adjacent segments without symptom in 3 cases. The X-ray films showed the fusion rate of 100% at 12 months after operation without displacement, resorption or collapse of bone graft, and without breakage or loosening of plate and screw. The Cobb angles were (13.3 ± 10.4)° preoperatively, (15.8 ± 10.8)° immediately postoperatively, and (15.4 ± 11.4)° at last follow-up; the ROM of the cervical spine were (41.3 ± 17.4)° preoperatively and (23.8 ± 18.8)° at last follow-up; and the JOA scores were 8.2 ± 2.9 preoperatively, 13.7 ± 3.0 at 12 months postoperatively, and 13.9 ± 2.8 at last follow-up. All indexes showed significant differences between before operation and after operation (P lt; 0.05). The results of JOA scores were excellent in 8 cases, good in 6, fair in 2, and poor in 1 with an average improvement rate of 66.8% (range, 14%-88%) for the neurological function. Conclusion Adequate decompression, high rate of fusion, sol id mechanical stabil ity, improvement of total cervical lordosis,and the neurological function can be achieved through ASDDF for treatment of SCSM.
【Abstract】 Objective The auto-control micro-motion intramedullary locking nail (AMLN) is designed, to reducethe incidence of delayed union and non-union of femoral shaft fractures fixed by interlocking intramedullary nails, and toobserve the cl inical effect of self-design AMLN in the treatment of femoral shaft fractures. Methods The distal and promixalnails were connected by the micro-motion locking structure, which could cause 1.0-1.5 mm axial micro-motion between fracture gaps. It could produce physical stimulus and conduction between fracture gaps in the course of fracture union. From December 2003 to May 2006, 32 cases of femoral shaft fractures were treated with AMLN, including 21 males and 11 females with the average age of 31.2 years (ranging from 20 years to 43 years). The trauma resulted from fall wounds in 3 cases, crash injuries in 1 case and car accidents in 28 cases. Twenty-nine cases were fresh fractures in different parts of the femoral shaft with transverse, obl ique, spiral and comminuted fractures of type I, II, III and IV. Three cases were old non-union fractures. The fresh fractures were treated by closed AMLN fixation, while the old fractures were treated by open AMLN nails after routine implantation of self bone. Results All the 32 cases were followed up for the average time of 11.5 months (rangeing from 8 months to 22 months). The X-ray films showed the fractures were healed 4.0 to 7.5 months after the operation, with the mean time of 5.1 months, and no break of the nail happened. One nail mildly bent in the comminuted fracture, and 2 patients felt sl ightly unwell at the needl ing point. According to the Klemm criterion for function, 26 cases were excellent, 5 good, 1 fair, and the choiceness rate was 96.88%. Conclusion With a suitable design, AMLN is easy to perform and helpful to quicken fracture union, and it is effective to treat femoral shaft fractures.
【Abstract】 Objective To determine the three-dimensional stabil ity of atlantoaxial reconstruction withanterior approach screw fixation through C2 vertebral body to C1 lateral mass and Gall ie’s technique (ASMG) for C1,2instabil ity. Methods Twenty-five human cadaveric specimens (C0-3 ) were divided randomly into 5 groups (n=5). Thethree-dimensional ranges of motion C1 relative to C2 were measured under the five different conditions：the intact state group (group A), type II odontoid fracture group (group B), posterior C1,2 transarticular screw fixation group (group C), ASM group (group D) and ASMG group (group E). The three-dimensional ranges of motions C1 relative to C2 by loading ± 1.5 Nm were measured under the six conditions of flexion/extension, left/right lateral bending, and left/right axial rotation. The obtained data was statistically analyzed. Results In each group, the three-dimensional ranges of motion C1 relative to C2 under the six conditions of flexion/extension, left/right lateral bending, and left/right axial rotation were as follows: in group A (8.10 ± 1.08), (8.49 ± 0.82), (4.79 ± 0.47), (4.93 ± 0.34), (28.20 ± 0.64), (29.30 ± 0.84)°; in group B (13.60 ± 1.25), (13.80 ± 0.77), (9.64 ± 0.53), (9.23 ± 0.41), (34.90 ± 0.93), (34.90 ± 1.30)°; in group C (1.62 ± 0.10), (1.90 ± 0.34), (1.25 ± 0.13), (1.37 ± 0.28), (0.97 ± 0.14), (1.01 ± 0.17)°; in group D (2.03 ± 0.26), (2.34 ± 0.49), (1.54 ± 0.22), (1.53 ± 0.30), (0.80 ± 0.35), (0.76 ± 0.30)°; in group E (0.35 ± 0.12), (0.56 ± 0.34), (0.44 ± 0.15), (0.55 ± 0.16), (0.43 ± 0.07), (0.29 ± 0.06)°. Under the six conditions, there were generally significant differences between group A and other four groups, and between group B and groups C, D and E (P lt; 0.001), and between group E and groups C, D in flexion/ extension and left/right lateral bending (P lt; 0.05). There was no significant difference between group E and groups C, D in left/right axial rotation (P gt; 0.05). Conclusion In vivo biomechanical studies show that ASMG operation has unique superiority in the reconstruction of the atlantoaxial stabil ity, especially in controll ing stabil ity of flexion/extension and left/right lateral bending, and thus it ensures successful fusion of the implanted bone. It is arel iable surgical choice for the treatment of the obsolete instabil ity or dislocation of C1, 2 joint.
Objective To explore the association between behavioral, emotional problems and life events among adolescents, and to determine which factors of life events correlate most highly with the behavioral, emotional problems. Method A total of 1 325 adolescents were investigated with Youth Self-Report (YSR) of Achenbach’s behavior checklist and Adolescent Self-Rating Life Events Checklist (ASLEC), and the data were analyzed with canonical correlation analysis. Results Canonical correlation was statistically significant. The correlation coefficients of the first pair of canonical variables in the male and female group were 0.631 3 and 0.621 1, respectively, and the cumulative proportion of the first two pairs of canonical variables was above 0.95. In the first pair of canonical variables, the loadings of anxious/depressed, interpersonal sensitivity and study pressure were higher, while in the second pair, withdrawal and punishment were the most important factors. Conclusions The effects of life events on emotional problems mainly contributed to interpersonal sensitivity and study pressure.