ABSTRACT
OBJECTIVE To provide a reference for the standardized treatment of chronic obstructive pulmonary disease （COPD） and the adjustment of therapeutic drugs for COPD in the national essential medicine list. METHODS Relevant clinical experts， pharmaceutical experts and medical insurance experts were invited to sort out the COPD treatment drugs involved in the domestic and foreign COPD clinical guidelines， the national essential medicine list， the WHO standard list of essential medicine， the national medical insurance catalogue， and comparatively analyzed the COPD treatment drugs. RESULTS & CONCLUSIONS Compared with domestic clinical guidelines， foreign clinical guidelines included an additional COPD triple preparation， while involving fewer types of expectorants and antioxidants； there were only 12 kinds of COPD treatment drugs included in the WHO standard list of essential medicine， while there were 18 kinds in the national essential medicine list in China， and more theophylline drugs， expectorants and antioxidants were included. In addition， 15 kinds of COPD treatment drugs were found in both the national clinical guidelines and the national medical insurance catalogue， but not in the national essential medicine list， including terbutaline， levalbuterol hydrochloride， salmeterol， formoterol， indacaterol， beclometasone， mometasone furoate， salbutamol ipratropium， glycopyrronium formoterol， umeclidinium vilanterol， indacaterol glycopyrronium， beclometasone formoterol， budesonide/glycopyrrolate/formoterol fumarate， fluticasone furoate/vilanterol/umeclidinium， and fudosteine， which were mainly long-acting beta 2-agonists and COPD triple preparations. These drugs had certain evidence-based medicine evidence， their efficacy and economy had certain advantages， and their impact on the budget of the medical insurance fund was controllable. Therefore， it is suggested that the aforementioned drugs should be included in the essential medicines list in the subsequent update.
ABSTRACT
Advances in surgical techniques and internal fixation materials have been continuously improving treatment of intertrochanteric fractures, but postoperative failure of internal fixation is inevitable and its causes are still controversial. An advanced age, female and severe osteoporosis are believed to lead to an unstable fracture and a fall more likely, increasing the risk for failure of internal fixation. Unstable intertrochanteric fractures such as comminuted fracture of medial femur, basicervical fracture, reverse intertrochanteric fracture and lateral wall fracture are more likely to lead to internal fixation failure. Non-anatomical reduction, improper insertion point and poor position of a lag screw are also prone to internal fixation failure. Extramedullary fixation for unstable fractures may increase the risk of failure. Long waiting time for surgery, late weight-bearing and infection may also increase the risk of failure. Therefore, it is still crucial for a successful treatment to clarify the specific risk factors for internal fixation failure and make corresponding countermeasures to enhance the success rate of a primary operation. This paper summarizes the risk factors for postoperative failure of internal fixation for intertrochanteric fracture so as to provide guidance for clinical treatment.
ABSTRACT
Objective:In this study, a gait acquisition and analysis system is developed to provide a cheap, easy-to-use solution for quantitative recording and analysis of patients' gaits.Methods:From April 2017 to October 2018, we collected the gait data of 19 patients with knee osteoarthritis and 19 healthy volunteers in the orthopaedic outpatient department. Among 19 patients, there were 9 males and 10 females, aged 50.1±9.4 years old. Among 19 healthy volunteers, there were 8 males and 11 females, aged 50.7±10.3 years old. Then, from the collected gait data, the static gait features such as gait speed, step length, stride, and dynamic gait features were automatically calculated, and the statistical difference analysis was finished to determine the correlation between these quantitative gait features and knee osteoarthritis.Results:Firstly, the gait data collected by the depth camera was compared with the data from the multi infrared camera-based motion analysis system (gold standard). The average angle error of the collected knee joint angle was 0.98 degrees, which proved the correctness of the gait data recorded by the depth camera. The statistical difference analysis of gait characteristics between the patient group and the healthy group showed that the gait characteristics with P<0.05 included: gait speed ( r=-0.922, P<0.001), step length ( r=-0.897, P=0.004), stride ( r=-0.914 , P<0.001), dynamic characteristics of angle of knee joint ( r=0.775, P=0.001). Conclusion:The gait acquisition and analysis system based on the depth camera can accurately record and store the gait data of the patients with knee osteoarthritis. Moreover, the extracted quantitative gait features have statistical differences between the patients and the healthy group, which is helpful for the gait analysis of bone joint.
ABSTRACT
Objective:To explore the effect of invalid reconstruction of proximal triangular structure on clinical failure of proximal femoral fractures treatment.Methods:A retrospective study of patients with femoral neck or intertrochanteric fractures postoperative failures from January 2013 to December 2018 was performed. Fifty-three patients including 26 males and 27 females (31 intertrochanteric fractures and 22 femoral neck fractures) met the inclusion criteria. The mean age of included patients was 55.13 years (range, 18-94 years). Fixation strategies included plate screws (18 cases), cannulated screws (13 cases) and intramedullary nails (22 cases). Medial side, the lateral side and the upper side were defined according to the law of mechanics based on the proximal femoral structure and statistical analysis of the failure factors of reconstruction of different sides were performed based on the imaging data of postoperative failure cases.Results:Nineteen of 53 patients were without medial side reconstruction, 4 cases without lateral side reconstruction, 21 cases without upper side reconstruction, 2 cases without medial or lateral side reconstruction and 7 cases were without medial or upper side reconstruction. Sixteen cases experienced loss of reduction, and 23 cases suffered from nonunion; excessive movement of fixation occurred in 12 cases, and fixation breakage occurred in 2 cases. Indicated by statistical analysis, it was invalid reconstruction of different sides that lead to surgical failure ( P=0.098). Revision strategy: 5 cases were treated with plate-screw fixation, 1 with steel cable binding, 11 with hip replacement, 3 with internal fixation removal, 6 with intramedullary nail replacement, 21 with triangular reconstruction fixation, and 6 cases had not been followed up successfully. Conclusion:Invalid reconstruction of any side of the proximal triangular structure will cause instability of the proximal structure which can lead to the failure of fracture fixation during the treatment of proximal femoral fractures.
ABSTRACT
Objective:To determine the gender and age differences in anatomical parameters of proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture so as to provide theoretical evidence for development of internal fixation devices.Methods:The clinical and CT data of 375 patients with intertrochanteric fracture were analyzed retrospectively who had been treated at Department of Orthopedics, The First Medical Center, General Hospital of Chinese PLA from September 2009 to March 2017. The patients were divided into 4 age groups. The middle-aged group (from 45 to 59 years old) had 22 cases, 16 males and 6 females; the early elderly group (from 60 to 74 years old) had 87 cases, 37 males and 50 females; the elderly group (from 75 to 89 years old) had 238 cases, 76 males and 162 females; the late elderly group (≥90 years old) had 28 cases, 6 males and 22 females. The anteversion angle of femoral neck, femoral neck-shaft angle, femoral head diameter, femoral neck length, femoral neck offset and femoral neck width were measured on their images. The anatomical parameters of proximal femur were compared between genders in the same age group and between groups of the same gender.Results:There were no significant differences between male and female patients with femoral intertrochanteric fracture in body mass index or AO classification, showing comparability( P>0.05). The anteversion angle of femoral neck (8.33°±5.00°) of the male middle-aged and elderly patients with intertrochanteric fracture was significantly smaller than that of the female ones (11.28°±6.15°), but their femoral head diameter, femoral neck length, femoral neck offset and femoral neck width (49.10 mm±2.48 mm, 99.70 mm±5.22 mm, 7.18 mm±2.20 mm and 39.10 mm±4.92 mm) were significantly larger than those of the female ones (43.46 mm±2.79 mm, 90.00 mm ± 4.75 mm, 6.29 mm±2.07 mm and 33.49 mm±4.87 mm) (all P<0.05). The femoral head diameter, femoral neck length and femoral neck width of the male patients in all the 4 age groups were significantly larger than those of the female ones ( P< 0.05). The anteversion angles of femoral neck of the male patients in the early elderly, elderly and late elderly groups were significantly smaller than those of the female ones ( P< 0.05). The femoral neck offset of male patients in the elderly group was significantly greater than that of female ones ( P< 0.05). There were no statistically significant differences in anteversion angle of femoral neck, femoral neck-shaft angle, femoral head diameter, femoral neck length, femoral neck offset or femoral neck width between groups of the same gender ( P>0.05). Conclusions:Compared with the middle-aged and elderly male patients with femoral intertrochanteric fracture, the middle-aged and elderly female ones have a larger anteversion angle of femoral neck, smaller offset, width and length of femoral neck, and a smaller femoral head diameter. There are no significant age differences in anatomical parameters of the proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture.
ABSTRACT
This paper analyzed the feasibility of SPOC-mixed teaching in view of bottlenecks faced by the current health statistics curriculum, and deeply analyzed the limitations of traditional classroom teaching and network teaching only, as well as the advantages of SPOC-mixed teaching mode. At the same time, the construction of SPOC-mixed teaching mode of health statistics curriculum was explored from three aspects: teaching preparation, teaching implementation and teaching evaluation. It is hoped that the traditional teaching mode of "mainly teaching' "existed in health statistics will be transformed into a student-led and learning-based mode. According to each student's learning levels, professional background and cognitive style, individualized teaching was conducted to teach students in accordance with their ability, and promote the reform on traditional education concepts and teaching modes of health statistics.
ABSTRACT
With the development of modern science and information technology,surgery has begun to enter the 4.0 era.The connotation of Surgery 4.0 is to use technology to redefine the relationship between people and information and to reshape the way people communicate.Artificial intelligence,holographic visualization,medical robotics,precision manufacturing,network transmission and cloud technology lay the technical ground for the surgical 4.0 era.Characterized by data,intelligence,precision,high-depersonalization,automation and cloud,surgery 4.0 has opened the era of technology empowering surgeons,certainly bringing fundamental changes to sciences of human health.This article is to look into to the future trends of surgery,hoping to provide references and stimulate more thinking for medical exploration in the age of surgery 4.0.
ABSTRACT
To investigate changes in the angiotensin converting enzyme 2 (ACE2) and angiotensin (1-7) [Ang (1-7)] and to explore the role of ACE2-Ang (1-7)-Mas receptor axis in hypertension with heart failure with preserved ejection fraction (HFPEF). Methods: A total of 70 patients with primary hypertension and preserved left ventricular ejection fraction (LVEF>50%) were recruited and patients were divided into a hypertension group (HBP) and a heart failure with preserved ejection fraction group (HFpEF) according to the diagnostic criteria of HFpEF. Thirty-five healthy participants were selected randomly as a control group. Enzyme linked immunosorbent assays (ELISA) method was used to detect concentration of Ang (1-7), ACE2, angiotensin II (Ang II), brain natriuretic peptide (BNP) in plasma. Male Sprague- Dawley (SD) rats was randomly divided into 2 groups: An HFpEF group (n=16) and a sham group (n=8). Rats (n=8) in the AAC group were given Ang (1-7) [0.5 mg/(kg.d), intraperitoneally] for 6 weeks, and the rest were given equal dose normal saline. Then all the rats were killed, and the hearts were taken out for hematoxylineosin (HE) staining. The protein expressions of angiotensin converting enzyme (ACE), ACE2, and Mas receptor were detected by Western blot. Results: The BNP and Ang II were significantly increased in the HBP group and the HFpEF group compared with the control group (P0.05), whereas those levels were significantly increased in the HFpEF group compared with the HBP group and control group (P0.05). Conclusion: ACE2 and Ang (1-7) are important predictive factors for the severity of heart failure and myocardial remodeling of HFpEF with hypertension; ACE2-Ang (1-7)-Mas receptor axis may play a protective role in preventing myocardial remodeling in HFpEF with hypertension.
Subject(s)
Animals , Humans , Male , Rats , Angiotensin I , Physiology , Angiotensin II , Atrial Remodeling , Physiology , Case-Control Studies , Enzyme-Linked Immunosorbent Assay , Heart Failure , Metabolism , Hypertension , Metabolism , Peptide Fragments , Physiology , Peptidyl-Dipeptidase A , Physiology , Random Allocation , Rats, Sprague-Dawley , Receptors, G-Protein-Coupled , Physiology , Stroke Volume , Ventricular Function, Left , Physiology , Ventricular Remodeling , PhysiologyABSTRACT
Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures.Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016.There were 9 males and 3 females,aged (42.7 ± 13.0) years (range,24-63 years).All patients received percutaneous minimally invasive pedicle screw fixation.The operation duration,intraoperative blood loss,length of incision,ambulation time,and time to basic life were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation.Postoperative complications and bone fracture union were observed during the followup period.Results All patients were followed up for average 22 months (range,14-36 months).All patients underwent successful surgery,with operation duration and intraoperative blood loss of (178.0 ± 60.2) min and (116.7 ± 44.2) ml respectively.No serious complications such as blood vessel or nerve injury occurred during the operation.The incision length was 1.2-1.5 cm.All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4 ± 7.3)days postoperatively.At 1,3,6 and 12 months after operation,VAS and ODI differed significantly from the preoperative detections (P ＜ 0.05).During the follow-up,bone fracture union was observed in all patients,with no nail breakage or nail loosening occurred after operation.Conclusion For AS combined with thoracolumbar fractures,minimally invasive fixation can attain satisfactory curative effect,with advantages of minor lesion,little bleeding,fast recovery and sound bone union.
ABSTRACT
Objective To investigate the effect of overexpression of miR-30b on the proliferation,cell cycle,apoptosis and invasion of gastric cancer cell line SGC-7901 and AGS,and the inhibitory effect on the tumor formation in vivo.Methods SGC-7901 and AGS cells were transfected with miR-30b mimics and miR-control,and qRT-PCR was used to detect the expression levels of miR-30b.Western blot assay was used to detect the expression of eIFSA2 protein.CCK-8 assay was used to measure the cell proliferation.Flow cytometry was used to analyze cell cycle and apoptosis.Transwell assay was used to detect cell invasion.In addition,the SGC-7901 and AGS cells transfected with miR-30b mimics and miR-control were injected into nude mice to observe the tumor formation and the expression of eIFSA2 protein in vivo.Results Results of qRT-PCR showed that the relative expression of miR-30b was significantly higher than that of miR-control group (P ＜ 0.05).Western blot assay showed that the expression of eIF5A2 protein was decreased in miR-30b mimics group.CCK-8 assay showed that cell proliferation was inhibited in miR-30b mimics group.The result of flow cytometry showed that the cell cycle decreased and the apoptosis increased in miR-30b group.Transwell assay showed that the cell invasion was significantly lower in miR-30b group than that of control group (P ＜ 0.05).Overexpression of miR-30b inhibited the formation of tumor and decreased the expression of eIF5A2 protein in vivo.Conclusion Overexpression of miR-30b inhibits the proliferation,invasion and tumor formation of gastric cancer cells,and reduces the expression of eIF5A2 protein,which provides a potential target for gastric cancer treatment.
ABSTRACT
Objective To develop a kit of time?resolved fluoroimmunoassay(TRFIA)for detection of Schistosoma japonicum protein SjP38,and evaluate its effectiveness. Methods The anti 9G7 SjP38 monoclonal antibody was used as the capture anti?body coated with 96?hole plate,and the Eu3+labeled 1A6 monoclonal antibody was used as the detection antibody to establish the TRFIA SjP38 kit. In addition,the accuracy,sensitivity,precision,stability and coincidence rate to pathogenic diagnosis of the kit were evaluated. Results This established kit possessed high accuracy,wide linear range from 2 to 1 250 ng/ml,high sensitivity with the minimum detectable concentration of 0.14 ng/ml,and good precision(the coefficient variation of the intra?and inter?assay were 3.6%to 4.6%and 5.1%to 6.7%,respectively). The stability tests showed that the reagents could be stable for six months at 4℃,7 d at 37℃. The positive and negative corresponding rates to the pathogen detection method were 95%and 100%respectively. Conclusion All the performance and detection indicators of the kit have reached the requirements of clinical test,but its clinical application still needs further validation.
ABSTRACT
Objective To evaluate the curative effects of percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones.Methods A retrospective analysis was performed of the 32 patients who had been treated using osteoperiosteal decortication combined with distraction osteogenesis from September 2011 to December 2014 for nonunion of lower-extremity fractures.They were 23 males and 9 females,with a mean age of 33.4 years (range,from 15 to 62 years).After their former internal or external fixators were removed,the 2 fracture ends were fixated by a retractile mono-lateral or circular external fixator.Under radiographic monitoring,a percutaneous incision was made with a 5 mm sharp chisel,down to the bone.Scar and ossified tissue between the fracture ends were debrided and cut along the fracture line.Mter the marrow cavity was reamed,a new irregular wound was created at sclerotic fracture ends.Scale-shaped chips (1 mm thin and 5 mm in diameter) were elevated using a chisel on surface of the cortical bone within 2 cm from the fracture ends.The external fixators were adjusted to compress the fracture sites.On the 8th day after operation,the eternal fixators were applied to distract and compress at nonunion sites to stimulate the osteogenesis.Results All the patients were followed up for an average of 12.5 months (range,from 8 to 42 months).Primary union was successfully achieved in 28 patients while delayed union occurred in 3 patients who finally achieved union after adjuvant therapies like shock wave and or local injection of bone marrow blood.The average time for union was 4.6 months(range,from 4 to 7 months).The mean time for external fixation was 6.2 months (range,from 5 to 8 months).One patient encountered nonunion of lateral tibial cortical bone 6 months after surgery but eventually achieved union by autologous ilium grafting.Joint functions in all postoperative patients were similar to those before operation.Conclusion Percutaneous osteoperiosteal decortication combined with distraction osteogenesis is a simple,minimally invasive and effective treatment for nonunion of lower-extremity bones,avoiding disadvantages brought by traditional surgery,like massive trauma and excessive bleeding.
ABSTRACT
Tibial plateau fracture,one of the most common fractures,includes simple and complicated fractures.Inappropriate treatment could result in pain and deformity,which has a bad effect on patient life.With the development of the surgical technique,a lot of methods could be selected when an orthopedist deals with these fractures.X-ray,one of the most common assistant examination,is the preferred method for tibial plateau fracture and could diagnose most of these fractures.Due to high resolution,CT scan could find these micro-fractures which X-ray cannot find and it could supplement the Schatzker type.MRI could find ligament,meniscus and arthrodial cartilage injury.Surgical approach includes anterolateral approach,medial approach,posteromedial approach,post approach,anterior approach.Anterolateral approach could be used for most of tibial plateau fractures.Posteromedial approach is used for medial plateau fracture involving post plateau fracture or post plateau fracture alone.Common plate,locking plate,dual plate and external fixation are commonly used fixation method.Dual plate is often used for complicated tibial plateau fracture.However,how to make accurate diagnosis and choose appropriate fixation is crucial for patients.We will summarize the application of X-ray,CT scan and MRI in diagnosis of tibial plateau fracture.Commonly used approaches to the proximal tibia,which together allow for the treatment of any proximal tibia fracture,will be described in this article.
ABSTRACT
Objective:To establish a reliable approach for measuring proximal femoral 3 dimensional anatomy, and to compare post-operative differences of proximal femoralanatomy in the inter-trochanter fractures with two kinds of antegrade nailings.Methods: Some computer assisted design ( CAD ) soft-wares, e.g.Mimics, were used to establish a reliable approach for measuring proximal femoral 3 dimen-sional (3D) anatomy.Intra-class correlation coefficient ( ICC) was used to test the reliability of intra-and inter-observers.The post-operative pelvic CT data of 19 cases of inter-trochanter fracture patients treated with InterTAN nailing and 21 cases of inter-trochanter fracture patients treated with proximal femo-ral nail anti-rotation ( PFNA) were retrospectively analysed and used to measure bilateral proximal femo-ral anatomical parameters, including 2D and 3D femoral neck-shaft ( NS) angle and femoral neck ante-version (NA) angle, and 2D and 3D anteversion angles of the intramedullary (IM) nailings.ICC was used to test the consistency of the NA angles in the different groups, and the paired student T-test was used to test the differences of the paired quantitative data.Results:The established measurement method hasdexcellent consistency within the intra-and inter-observers, with all the ICCs higher than 0.9.The paired student T-test showed no significant difference between the post-operative bilateral 2D or 3D NA angles.The ICCs results showed that there were no consistency between the post-operative bilateral 2D or 3D NA angles (P values were 0.099 and 0.055, respectively), but the excellent consistency between the 2D injured side NA angle and 2D IM nailing’ s NA angle, or between the 3D injured side NA angle and 3D IM nailing’s NA angle (the ICCs were 0.81 and 0.8, respectively, P values <0.001).In PF-NA group, 57%of the differences between the 2D post-operative injured side’s and intact side’s NA an-gles were higher than 15°, which was more than 15.78%in InterTAN group.The paired student T-test showed no significant difference between the post-operative injured side’ s 2D or 3D NS angles and the in-tact side’s respective 2D or 3D angles in PFNA group (P values were 0.925 and 0.367, respectively), but in InterTAN group, the post-operative injured side’s 2D or 3D NS angles were significantly smaller than the intact side’s respective angles (P values were 0.033 and 0.009, respectively).Conclusion:By analyzing and comparing bilateral proximal femoral anatomical parameters after two kinds of IM nailings procedures, the differences between the bilateral post-operative NA angles in PFNA group were significantly larger than those in InterTAN group.There was significant correlation between the NA angles of the injured sides and NA angles of IM nailings in both the groups.
ABSTRACT
Fracture nonunion is the cessation of a normal reparative process of fracture healing. With an incidence of 2.5%-4.4%, it is one of difficult problem for orthopedics surgeons. Definition, classification, treatment and causes of fracture nonunion are reviewed in this article. The therapeutic principles and methods are introduced systematically combined with causes of fracture nonunion.
Subject(s)
Humans , Fracture Healing , Fractures, Ununited , Diagnosis , TherapeuticsABSTRACT
<p><b>BACKGROUND</b>The objective of this study was to analyze the trend in the publication of systematic reviews on hip fractures through a bibliometric approach.</p><p><b>METHODS</b>Literature including systematic reviews or meta-analyses on hip fractures was searched from the ISI Web of Science citation database. The search results were analyzed in terms of geographical authorship and frequency of citation by country, institution, author, and periodical distribution.</p><p><b>RESULTS</b>A total of 654 published systematic reviews from 1995 to 2013 in 48 countries or regions were retrieved. The United States (171) was the predominant country in terms of the number of total publications, followed by the United Kingdom (149), Canada (120), Australia (76), and China (54). The number of systematic reviews significantly increased during the last 6 years, especially in China. The production ranking changed in 2012, at which time the United States and China were the leaders in the yearly production of systematic reviews on hip fractures. The amount of literature (27 publications) from China contributed almost one-quarter of the total literature (109 publications) in 2012. However, the average number of citations of each article from China was still low (6.70), while the highest number of citations of each article was from Sweden (193.36). The references were published in 239 different journals, with 15 journals contributing to 41.3% of the systematic reviews on hip fractures. The two journals that contributed the most were Osteoporosis International (10.6%) and the Cochrane Database of Systematic Reviews (7.6%). The predominant institution in terms of the number of publications was McMaster University (36) in Canada.</p><p><b>CONCLUSIONS</b>The best evidence in the field of hip fractures has attracted increasing attention. Systematic reviews on hip fractures from China have been increasingly more frequent during the past 6 years, particularly in 2012.</p>
Subject(s)
Humans , Bibliometrics , Hip Fractures , PublicationsABSTRACT
Objective To study the optimum combination of orientation parameter of total hip prosthesis and acetabular safe zone on condition that the range of motion for activities of daily living (ADL) is fulfilled.Methods A three-dimensional generic parametric and visually kinematic simulation module of THA was developed.Range of motion ( ROM ) of hip flexion ≥ 110°,internal-rotation ≥30° at 90° flexion,extension ≥30° and external rotation ≥40° were defined as the normal criteria for ADL.ROM of hip flexion ≥ 120°,internal-rotation ≥45° at 90° flexion,extension ≥30° and external rotation ≥40° were as the severe criteria.The ranges of changes in general ratios (GRs) of head-neck,femoral neck antevemion ( FNA ),operative inclination (OI) and anteversion (OA) of acetabulur components were 2.0-2.92,0°-30°,10°-60°,and 0°-70° respectively.Within the limits of the upper two activity criteria,the synchronous OA of acetabulur components was calculated with every 5°change in OI of the cup,and the collodiaphyseal angle ( CDD ) was set as 135°.The safe-zone of combination of acetabulur operative anteversion (OA) and inclination (OI) was defined as the area that fulfilled the two mentioned criteria of ROM without cup-neck impingement.All parameters were analyzed by using SAS 6.12 software.Results The safe zone of acetabdar angle rose with the increase of GRs of head-neck and the safe zone of severe criteria was smaller than that of normal criteria.When the CDD angle was 135°,the sum of average aeetabular OA and acetahular OI plus 0.816 times of the FNA equaled to 84.76° innormal criteria; and the sum of average acetabular OA and acetabular OI plus 0.873 times of the FNA equaled to 92.04° in severe criteria.Conclusions A high GR of head-neck greatly increases the size of safe-zone of acetabular angle.The higher demand of ROM of hip joint requires the smaller safe zone of acetabular angle,as can be corrected by increasing the GR of head-neck.The optimum combination between the sum of average acetabular OA and acetabular OI ( Y) plus FA (X)in the normal criteria and severe criteria can be estimated by using the following formulae:Y1 =-0.816X1 + 84.76 (R2 =0.993 ),Y2 =-0.873X2 + 92.04( R2 =0.999) respectively.
ABSTRACT
Objective To explore the feasibility of tibial nerve motor branches transfer to the deep fibular nerve in an anatomical study.Methods Twenty-three sides lower limbs from 12 adult cadavers which preserved in Formalin were used for dissection of the tibial nerve and its all motor branches,and the proximal deep and superficial fibular nerve.Experimental measurement were performed for the parameters of each branch such as length,diameter,the location of original point relative to the level of the fibular head.The diameter of proximal part of the deep fibular nerve was measured simultaneously.Finally,the length from original point of each branch to the fibular neck was also measured during simulation of nerve transfer procedure.Results The average length of motor branches to the flexor digitorum longus muscle,to the flexor hallucis longus muscle and the superficial branches to the soleus muscle were (95.70 ± 13.40)mm,(96.90± 13.60)mm and (73.60 ± 12.00)mm respectively.Their average diameter were (0.63 ± 0.16)mm,(0.65 ±0.20)mm and ( 1.56 ± 0.26)mm respectively.The average diameter of proximal deep fibular nerve was (2.54± 0.26)mm.Based on length,branches to the flexor digitorum longus muscle and flexor hallucis longus muscle were adequate for direct nerve transfer to the deep fibular nerve in all specimens without interpositional grafr.And in 22 specimens (95.7 percent),the superficial branches to the soleus muscle were long enough to directly transfer.Other branches of the tibial nerve were not adequate for direct nerve transfer Conclusion This study confirmed the anatomical feasibility of using motor branches from tibial nerve for direct transfer to restore the deep fibular nerve.The superficial branches to soleus muscle were the best donor nerve if considering the branches,length,diameter and the difficulty of surgical procedures.
ABSTRACT
ObjectiveTo study the anatomic characteristic of the attachment of medial patellofemoral ligament and its function in patellar stability. MethodsThirty adult cadaver knees were used for anatomic study, and the attachments of medial patellofemoral ligament were observed and measured. Results The femoral attachment of medial patellofemoral ligament was anchored to the bone between the medial femoral epicondyle and the adductor tubercle. The fibers here were thin and narrow, and became thick and wide to the anterior. The patellar attachment was in the superior two-thirds of the medial margin of the patella. The fiber here were the thickest and the widest. Conclusion The anatomic characteristic of the attachment of medial patellofemoral ligament was revealed, providing anatomical bases for surgery.
ABSTRACT
Objective To evaluate the accuracy of thoracic pedicle screw placement using the "funnel technique" and investigate its consistency in experimental study and clinical application.Methods The clinical data of three human cadavers and 11 patients with the installation of at least one thoracic pedicle screw at T1 -T12 from August 2006 to July 2008 were retrospectively analyzed. One junior spine surgeon lack of experience were responsible for placing these screws with the "funnel technique".The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing postoperative CT scans. Results The mean follow-up time was 23.1 months,which showed no vascular or visceral complications, or iatrogenic neurological injury. The rate of unintended cortex perforations was 14% (10/72) in cadavers and 15% (8/55) in patients, respectively.The critical perforation occurred in two screws (3%) in cadavers and one screw (2%) in patients. There was no statistical difference between the percentage of cortex perforations in cadavers and patients. Of all the 11 patients, screw violation occurred laterally in six ( 11% ), medially in one ( 2% ) and superiorly in one (2%). No violations occurred inferiorly or anteriorly. For all patients, only one screw needed revision. The perforations made by the junior spine surgeon occurred in six screws in the first cadaver, three in the second cadaver and one in the third cadaver. Conclusions The "funnel technique" is a simple,safe, accurate and cost-effective technique for pedicle screw placement. The result of the experimental study is consistent with that of the clinical application. "funnel technique" is helpful for junior spine surgeons to master the technique of thoracic pedicle screw placement.