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BACKGROUND:The basic idea of artificial disc replacement is the intension to minimize the impact on adjacent segments based on the premise of stabilizing index segment, then prevent and reduce the incidence of adjacent segment degeneration. OBJECTIVE:To explore the indications and contraindications of artificial disc replacement, peri-operative economics considerations, long-term complications, as wel as the effect of artificial lumbar disc replacement combined with fusion surgery. METHODS:The PubMed database, CNKI database and SinoMed database over the past decade were searched for the related articles. The retrospective and prospective clinical trials of artificial lumbar disc replacement were included. Repetitive studies and stale perspectives were excluded. A total of 34 articles were summarized and analyzed in the end. RESULTS AND CONCLUSION:Since the first artificial lumbar disc prosthesis designed to be commercial y distributed in 1982, there have been a plenty of clinical trials on lumbar disc replacement. However, there is no answer to many problems that encountered in clinical trials. The effect of the number of replaced segment on the clinical outcomes, the effect of facet joint degeneration on the clinical outcomes, selection of the patients with the history of lumbar disc surgery, age of the patients and the rest time before disc replacement should be taken into consideration in the researches on indications and contraindications of artificial disc replacement. The intraoperative blood loss, operation time and hospital stay after replacement can be used to evaluate whether lumbar disc replacement is better than the traditional lumbar fusion surgery or not. The complications after lumbar disc replacement include heterotopic ossification, implants mechanical failure, and facet joint and adjacent segment degeneration. The combination of lumbar disc replacement and fusion surgery for the treatment of multi-segmental lumbar disc diseases can achieve complement and thus obtaining the efficacy that better than the application of one surgery alone.
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BACKGROUND:Nonunion is a common clinical problem of bone fracture. For decades, with the help of internal/external fixation materials, popularization of microsurgical technique, innovation of bone graft materials, especial y molecular biology techniques, breakthrough progress has been made in the treatment of nonunion. OBJECTIVE:To summarize the research progress of treatment in nonunion and to provide better technology theory and choices of method for the treatment of nonunion in future. METHODS:The PubMed database and CNKI database were retrieved by the first author for the articles related to reason and treatment method of nonunion published from January 1990 to May 2013. The key words were “fracture nonunion, treatment, progress”. For the articles in the same field, those published recently or in authorized journals were selected. RESULTS AND CONCLUSION:The repetitive and old articles were eliminated, and final y 48 articles were selected for further analysis. At present, two methods can be used in the treatment of nonunion, including nonsurgical method and surgical method, the surgical method is utilized more frequently and more efficiency in clinic. Fracture healing is the complex process involving various aspects, and once the nonunion occurred, different patients should be treated with different methods, and the combination of various surgical and nonsurgical methods can be used if necessary to obtain satisfactory effect. But al the treatment methods should pay attention to soft tissue protection.
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BACKGROUND:There are various methods for the treatment of osteonecrosis of femoral head, but there is no satisfactory method to promote the repair of osteonecrosis of femoral head. In recent years, bone marrow mesenchymal stem cel transplantation for the treatment of osteonecrosis of femoral head has achieved certain effect. OBJECTIVE:To review the application progress and problems of bone marrow mesenchymal stem cel transplantation for the treatment of osteonecrosis of femoral head. METHODS:A computer-based online search was performed in PubMed database, Wanfang database and CNKI database for the related articles from 1999 to 2012. The articles on the isolation, culture, differentiation, labeling and in vivo tracing of bone marrow mesenchymal stem cel s were selected, as wel as the basic and clinical researches on bone marrow mesenchymal stem cel transplantation for the treatment of osteonecrosis of femoral head. A total of 39 articles were included for review. RESUTLS AND CONCLUSION:At present, the method for the isolation of bone marrow mesenchymal stem cel s includes adherence screening method, density gradient centrifugation, flow cytometry separation and magnetic activated cel sorting method;the commonly used method for cel labeling and tracing includes isotope tracing method, antigen labeling method, antigen labeling, fluorescent labeling and MRI contrast enhancer labeling method. The method for the treatment of osteonecrosis of femoral head with bone marrow mesenchymal stem cel s includes pith dril ing decompression combined with bone marrow mesenchymal stem cel injection and transplantation, intervention plus bone marrow mesenchymal stem cel transplantation, gene transfection combined with bone marrow mesenchymal stem cel transplantation and tissue engineering technology of bone marrow mesenchymal stem cel s. Although, the research on the bone marrow mesenchymal stem cel transplantation for the treatment of osteonecrosis of femoral head has achieved great progress, there are stil problems needed to be further solved.
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BACKGROUND:Majority of patients appeared different degrees of hip joint bursitis and gradual y developed into femoral head necrosis in the early rehabilitation process of severe acute respiratory syndrome. OBJECTIVE:To analyze various causes of the severe acute respiratory syndrome sequela, and to review the treatment method of femoral head necrosis. METHODS:The PubMed database, China Journal Ful-text database (CNKI), VIP database and Wanfang database were retrieved by the first author with computer for the related articles from January 1997 to August 2012. The key words of“infectious atypical pneumonia, sequela, femoral head necrosis, bone ischemia, etiology, infectious atypical pneumonia virus, conservative treatment, operation treatment, total hip replacement”in English and Chinese were put in the title and abstract to search articles. A total of 872 articles were screened out after primary retrieval, and eventual y 56 articles were included for review. RESULTS AND CONCLUSION:Severe acute respiratory syndrome sequela, femoral head necrosis, was related with the dose and duration of hormone, patient’s sensitivity to hormone, using method, the secretion of leptin and bone calcitonin, and also infectious atypical pneumonia virus. The femoral head necrosis caused by the above factors can be treated with conservative treatment to slow down the process of femoral head necrosis and delay prosthesis replacement. Eventual y, most of the patients wil receive surgical method. For the treatment of advanced severe acute respiratory syndrome sequelae femoral head necrosis, prosthesis replacement can get the best effect.
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BACKGROUND:Changing the acetabular orientation is the best method for the treatment of acetabular dysplasia, and Bernese periacetabular osteotomy is one of the most commonly used and successful treatment methods. OBJECTIVE:To review and analyze the operation indication, surgical technique and influencing factors of Bernese periacetabular osteotomy for better clinical application. METHODS:The PubMed database, Elsevier database and Springer database were retrieved for related articles published before December 2012 with the key words of“Bernese osteotomy, Ganz osteotomy, periacetabular ostetomy”. The articles that related to the clinical application of Bernese periacetabular osteotomy in patients with acetabular dysplasia were enrol ed in this study. Repetitive studies and Meta analysis were excluded. And the analysis emphasis was put on the operation indication, surgery technique and influencing factors of Bernese periacetabular osteotomy. RESULTS AND CONCLUSION:A total of 483 articles were screened out after primary computer-based online research. And according to the exclusion criteria, 43 articles were selected for review. Bernese periacetubular osteotomy was performed through polygonous osteotomy around the acetabula by modified Smith-Peterson approach. The surgical technology was improved gradual y, but the major osteotomy procedures never changed, only the soft tissue release method was modified. The direct factors that influence the surgical effect of Bernese periacetabular osteotomy are the degree of radiographic hip degeneration and dysplasia. In the future, with the in-depth understanding of hip deformity, the operation indication and technique of Bernese periacetabular osteotomy wil also developed.
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BACKGROUND:Knee osteoarthritis is a common and frequently-occurring disease in the elderly, the incidence in the postmenopausal women is significantly higher than that in other groups. The clinical manifestation is various, mainly pain and dysfunction of the knee joint. There are many methods for the treatment of the knee osteoarthritis, and the non-operation treatment is the main and basic treatment method. OBJECTIVE:To summary the advantages and limitations of various non-operation treatment methods of knee osteoarthritis. METHODS:The VIP database, Wanfang database, CNKI database, Medline database and PubMed database were retrieved for the clinical reports and reviews on epidemiology, related factors, pathogenesis and non-operation treatment of knee osteoarthritis from January 2000 to May 2013 with the key words of“osteoarthritis, knee osteoarthritis, epidemiology, etiology, pathogenesis, treatment”in Chinese and “osteoarthritis, knee osteoarthritis, pathogenesis, therapy”in English. The reproductive researches and atypical reports were excluded. RESULTS AND CONCLUSlON:The etiology of knee osteoarthritis is unknown, and the pathogenesis may be related to various, of factors such as age, sex hormone, load conduction disturbance and genetic correlation. The clinical manifestations of knee osteoarthritis are varied, and many clinical treatment methods can be selected, but different treatment methods have different indications and the effects are not identical, and each has its own merits. Drugs are the most commonly used means for the treatment of knee osteoarthritis, such as traditional Chinese medicine, acupuncture and massage, which can significantly relieve the pain and improve the function of knee joint. Strength training and mechanical vibration are new methods of treatment, although not widely used in clinic, the effect has been gradual y confirmed, but stil need clinical exploration and experience accumulation. In addition, a large number of clinical data also showed that the oral drug in combination with life changing, exercise or muscle training therapy, its clinical effect is often better than single therapy.
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10.3969/j.issn.2095-4344.2013.26.020
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10.3969/j.issn.2095-4344.2013.26.019