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BACKGROUND:For the department of orthopedics, digital technology can be used for a three-dimensional reconstruction of the fracture site, and visual virtual reset. This not only can preoperatively plan the operation path, make reasonable operation plan, but also can predict the prognosis after surgery. OBJECTIVE:To discuss the feasibility and clinical effect of digital technology for three-dimensional measurement and preoperative design in intertrochanteric fracture patients undergoing proximal femoral nail antirotation. METHODS:Eighty patients of intertrochanteric fractures, who underwent proximal femoral nail antirotation in the Changyi People’s Hospital from January 2010 to January 2014, were selected in this study. According to the order of visiting, they were randomly divided into traditional treatment group and three-dimensional design group, with 40 cases in each group. Patients in the traditional treatment group received proximal femoral nail antirotation. Patients in the three-dimensional design group received preoperative CT scan to establish the digital three-dimensional model of intact femur. The analog was reset by technology. The length and diameter of medul ary cavity were measured. The appropriate specifications of intramedul ary nail were selected. On this basis, the plan of the operation and implementation of operation were made. Operation time, intraoperative bleeding volume and blood transfusion were recorded in the two groups. Hip function was evaluated by hip Harris score. RESULTS AND CONCLUSION:(1) Operations in the two groups were successful. Significant differences in operation time, intraoperative bleeding volume and blood transfusion were determined between the two groups (P0.05). (2) Al patients were fol owed up. Postoperative wound was healed. Broken nail or broken rod was not found at the end of the study. (3) At the end of the fol ow-up, the excel ent and good rate of Harris hip score was 95%in the traditional treatment group and 93%in the three-dimensional design group;no significant difference was detected between the two groups. (4) Results suggested that the application of digital department of orthopedics technology for the treatment of intertrochanteric fracture of femur in patients with preoperative three-dimensional measurement and surgical design can significantly shorten the operation time and improve hip function.
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BACKGROUND:The morphological and mechanical transfers of unstable intertrochanteric fractures were complicated, so it is difficult to analyze the biomechanical characteristicsof the common experimental methods in a comprehensive way. Moreover, the high cost, long cycle and poor repeatability of common tests limit its application in biomechanics. OBJECTIVE:To analyze the biomechanical characteristics of unstable intertrochanteric fracture in different fixation ways by three-dimensional finite element analysis. METHODS:Intertrochanteric fracture locking dynamic hip fixation model (C1), Gamma nail fixation model (C2) and proximal femoral anatomical locking plate model (C3) were established. The distal end of the femur was fixed, and subjected to the hip reaction force of 2800 N and abduction muscle strength of 1 200 N. Three-dimensional finite element analysis was used to analyze the stress distribution, stress concentration and maximum displacement of unstable intertrochanteric fracture in three different fixation ways. RESULTS AND CONCLUSION:(1) Stress: the anterolateral stress and anteromedial stress of C3 were the maximum. Posterolateral stress and posteromedial stress ofC3 were the minimum. There were significant differences among the three groups (alP< 0.05). (2) Stress of fracture space: significant differences in anterolateral stress, anteromedial stress, posterolateral stress and posteromedial stress were determined in C1, C2 and C3 (P< 0.05). Anterolateral stress of C3 was significantly less than anterolateral stresses of C1 and C2 (P< 0.05). Anteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). Posterolateral stress of C1 was significantly larger than that of C2 and C3 (P<0.05). Posteromedial stress of C1 was significantly larger than that of C2 (P< 0.05). Posteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). (3) Significant differences in bone stress around the screw top were detected among the three groups (P< 0.05). Bone stress around the screw top of C3 was significantly larger than that of C1 and C2 (P< 0.05). (4) Thus, locking dynamic hip screw, Gamma nail and proximal femoral anatomical locking plate have their advantages and disadvantages for treatment of unstable intertrochanteric fracture of the femur. The appropriate internal fixation device should be selected according to the need.
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Objective To evaluate whether low carbohydrate diet before 18F-FDG tumor imaging could reduce myocardial 18F-FDG uptake.Methods From April 2011 to January 2012,70 patients were enrolled in this study.They were randomly divided into control group (34 cases) and test group (36 cases).Patients in control group were on regular diet,while those in test group had low carbohydrate diet in the evening before imaging.Blood samples were taken before injection of 18F-FDG for the measurement of serum glucose,free fatty acid,insulin and ketone body.Whole body 18F-FDG tomography was performed with dualhead coincidence SPECT.The myocardial uptake of FDG was assessed visually and scored as 0 for no uptake,1 for uptake lower than liver,2 for uptake similar to liver,3 for uptake higher than liver,and 4 for remarkable uptake.The ratio of myocardium to liver (H/L) was calculated.Two-sample t test,Wilcoxon rank sum test and linear correlation analysis were performed.Results The myocardial uptake in test group was significantly lower than that in control group with H/L ratios of 0.94±0.57 and 1.50±1.04,respectively(t=-2.75,P＜0.05).The concentrations of serum free fatty acid and ketone body in test group were significantly higher than those in control group: (0.671±0.229) mmol/L vs (0.547±0.207) mmol/L and (0.88±0.60) mmol/L vs (0.57±0.32) mmol/L,t=2.38 and 2.67,both P＜0.05.The concentrations of glucose and insulin were (5.28±1.06) mmol/L and (35.16±33.70) pmol/L in test group,which showed no significant difference with those in control group ((5.19±0.78) mmol/L and (41.64±35.13) pmol/L,t=0.39 and-0.79,both P＞0.05).A negative correlation was found between the myocardial uptake of 18F-FDG and serum free fatty acid/ketone body concentration (r=-0.40,-0.33,both P＜0.01),respectively.There was no correlation between the myocardial uptake of 18 F-FDG and glucose/insulin (r =-0.02,0.13,both P＞0.05),respectively.Conclusion Low carbohydrate diet before 18F-FDG tumor imaging can reduce myocardial uptake,thus facilitating detection of lesions near the heart.
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OBJECTIVE@#To develop a simple screening table for primary osteoporosis (POP) in senior men and women.@*METHODS@#Questionnaires were designed to obtain the risk factors associated with osteoporosis and bone mineral density (BMD), which were measured in 146 community residents over 60. The multiple stepwise regression was used to find out the risk factors and establish the screening index. Then the cut-off point of sensitivity and specificity were obtained. Simple screening table for POP in senior people was established according to the screening index and the cut-off point. Validity and reliability of the simple screening table for POP in senior people were testified by 61 outpatients whose BMD was measured with dual energy X-ray (DEXA).@*RESULTS@#Percentage of the height loss,body weight, age, and gender were selected with multiple stepwise regression.Percentage of height loss and body weight were selected to develop the simple screening table for POP in senior people. The cut-off point was 270, sensitivity was 88.9 %, specificity was 75.7 %, the agreement rate was 75.4%,and the Kappa value was 0.489.@*CONCLUSION@#The simple screening table for POP in senior people based on the percentage of height loss and body weight is simple, economic, suitable for both men and women, and is useful in basic public health.
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Mass Screening , Methods , Osteoporosis , Surveys and Questionnaires , Reference StandardsABSTRACT
Objective To evaluate the diagnostic and therapeutic value of emergency Angiography in massive gastrointestinal hemorrhage.Methods 19 patients with massive gastrointestinal hemorrhage,failed by internal medicine or under instable condifion,were undergone emergency angiographic diagnosis with hemostatic or embolismic agent infusion at the same time,and were transfered fo surgical department for emergency surgery on time,then the findings of angiographic diagnosis were compwred with the ones of operation.Results All the patients were performed emergency angiography successfully.and the localigation diagnosis rate is 100%.Conclusion Emergency angiography established orientation goal for the emergency surgery,which is safe even if blood pressure of the patients was uncertain by internal medicine,and hemostasis treatment also makes chance for emergency surgery.