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Objective The purpose of this article was to investigate the internal tunnel position during anterior cruciate ligament (ACL) reconstruction with single-bundle ACL. Methods MRI were performed in 10 knees form 10 volunteers at full extension and at 30°, 60°, 90°, and 120° flexion position. All the images obtained were exported into Mimics 10.01. Three-dimensional models were established with Mimics in a computer. All the mark points were confirmed on femur and tibia. The distance between the femoral mark point and tibial mark point was measured. The isometric point was determined as the change in the distance was shorter than 3mm during knee flexion-extension. Results Ten three-dimensional models were established successfully and the isometric points of A0-X, A15-X, A30-X, A45-X, B0-Y, B15-Y, B30-Y, B45-Y, C0-Z, C15-Z, C30-Z, C45-Z, and C60-Z were identified. Conclusion There was no absolute anatomical isometric point, whereas the physiological isometric point did exist. Therefore, determination of tibial point should be considered synthetically. B45-Y was recommended for tunnel position.
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BACKGROUND:Interlocking intramedullary nailing exhibits unique superiority in treatment of multi-segment radial fracture,bone nonunion,and osteoporotic fracture. However,distal interlocking screw placement would injury the deep branch of radial nerves. OBJECTIVE:To analyze the anatomical characteristics of the deep branch of radial nerves during radial interlocking intramedullary nailing. DESIGN,TIME AND SETTING:An observational measurement was performed at the laboratory of Department of Orthopedics,Second Affiliated Hospital of Soochow University between November and December 2002. MATERIALS:A total of 44 pieces of fresh adult cadaver forearm specimens were provided by Department of Anatomy,Soochow University,China. A vernier caliper was purchased from Henan Yuanyang Zhenhua Instrument Factory,China. METHODS:The deep branches of radial nerve of 44 fresh forearm specimens were exposed. The lateral epicondyle of humerus was joined to the Lister tubercle of radius. The line passed through 6 horizontal planes,which were as follows in sequence:0,1.0,1.5,and 2.0 cm lower than the articular surface of radial head respectively,the horizontal planes of the deep branch of radial nerve entering the supinator and winding across the radius. The crossed points were named points A,B,C,D,E,and F accordingly. MAIN OUTCOME MEASURES:The distance between the deep branch of radial nerve and fixed points B,C,and D was measured separately when the forearm was kept in pronation,neutral and supination positions. RESULTS:The distance between the deep branch of radial nerve and fixed points B,C,D became nearer and nearer in the sequence of B,C,and D. With the forearm in pronation,neutral and supination positions in sequence,each fixed point became farther and farther from the deep branch of radial nerve. CONCLUSION:When interlocking intremedullary nailing is used to fix radius,it is relatively safe to keep the forearm in neutral and flexion positions,and drilling and insertion of distal interlocking screw at 1.5 cm lower the articular surface of radial head from the posterolateral to anteromedial approach should be selected.
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BACKGROUND: With the advancements in helical CT myelography and computer image postprocessing, virtual medical imaging has acquired good outcomes in the diagnosis and treatment of complex cervical spondylosis. OBJECTIVE: To observe the effects and significance of helical CT myelography on multiplanar and three-dimensional reconstruction of virtual anatomical models of cervical spondylosis. DESIGN, TIME AND SETTING: The present computer three-dimensional reconstruction, gold standard control study was performed at the Second Hospital Affiliated to Soochow University between January 2001 and January 2006. PARTICIPANTS: Twenty patients with complex cervical spondylosis, who had received surgery, were employed for this study. METHODS: Virtual anatomical model of cervical spondylosis was established by multiplanar and three-dimensional reconstruction through the use of helical CT myelography in 20 patients. Scanning and reconstruction results were used for pre-surgery disease condition evaluation and virtual surgery. In addition, surgical intuitionistic results were considered gold standard to evaluate the accuracy and efficacy of virtual anatomical models. MAIN OUTCOME MEASURES: The accuracy and efficacy of virtual anatomical models. RESULTS: Virtual anatomical models could concurrently show bony and membranate vertebral canals. These exhibited comprehensive and minute bony anatomic structure of cervical vertebrae and anatomic information regarding dura mater, spinal cord, and nerve sleeve for pre-surgery evaluation and virtual surgery. The imaging virtual anatomic information was in accordance with practical anatomical information in patients. CONCLUSION: Virtual anatomical model can be used to comprehensively evaluate the disease condition of cervical spondylosis and simulate the surgery due to its intuitionistic, vivid, and accurate display of anatomy of cervical vertebrae.
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BACKGROUND:Insulin-like growth factor-1(IGF-1) is an important regulator in osteoblasts proliferation,differentiation and matrix synthesis,which participates in the process of fracture healing and repairing. OBJECTIVE:To investigate the potential bone regeneration effect of human bone marrow mesenchymal stem cells(MSCs) transfected into IGF-1 retroviruses vector on bone defects repairing. DESIGN,TIME AND SETTING:A controlled observation experiment was performed between March 2004 and May 2005 at the Laboratory Animal Center of Soochow University. MATERIALS:MSCs were transfected into IGF-1 retroviruses vector in vitro and combined with demineralized bone matrix(DBM) . METHODS:Fifteen BalB/C nude mice were prepared for 8 mm calvarial defects models and divided into 3 groups by number table method,with 5 animals in each group. DBM transfected with IGF-1 and DBM transfected with vector were implanted into the defect in MSCs cells transduced with IGF-1 and vector groups,respectively. There was no other intervention in the blank control group. The implants were harvested and evaluated by histological examination at 4 weeks after model preparation. MAIN OUTCOME MEASURES:①The mRNA expression of IGF-1 was analyzed by RT-PCR and Western Blot. ②The complexes of cells and DBM were analyzed by scanning electron microscope(SEM) at days 3 and 6 after co-culture. ③Gross observation of the calvarial defects models. ④Osteogenic activity of the implants was evaluated by hematoxylin-eosin staining at weeks 4 after model preparation. RESULTS:①There were mRNA and protein expression of IGF-1 in MSCs cells transduced with IGF-1 vector. ②SEM showed that there were plenty of cells adhered to surface of DBM,and grew into inner part at the 3 days after co-culture with IGF-1,which secreted much collagen fibers at days 6. The count of adherent cells and collagen fiber was smaller in the vector group at each time points. ③No obvious inflammatory reaction could be seen in each group at 4 weeks after model preparation. Compared with vector control,abundant new bone and blood vessel formation occurred in the calvarial defects treated with DBM/IGF-1,and no new bone formation in the blank control groups. ④Results of hematoxylin-eosin staining showed that grafts in the MSCs cells transduced with IGF-1 group was combined closely with calvarial defects,new bone and vessel could be found. There were few bone-like materials formation in vector group,and no defects in control group were repaired. CONCLUSION:The composites of IGF-1 transfected MSCs and DBM has good effect in repairing calvarial defects.
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[Objective]Ulnar fractures fixed by interlocking intramedullary nails or dynamic compression plates were tested to compare their biomechanical function,in order to provide the theoretical basis for clinical practice.[Method]In the experiment,12 pieces of fresh ulnars were used to produce middle-part transverse fracture models;which were fixed by interlocking intramedullary nails or six-hole 3.5 mm dynamic compression plates seperately.The diameter of intramedullary nail was 4mm,and the length was 200-230mm.The specimen was set on the MTS test machine.The rigidity and strength of ulnar fractures fixed by interlocking intramedullary nails were compared with those of ulnar fractures fixed by six-hole 3.5 mm dynamic compression plates in the anti-axial test,anti-bending test,anti-torsional test.[Result]In the anti-axial test,anti-bending test and anti-torsional test,the rigidity of ulnar fractures fixed by interlocking intramedullary nails was 450.00?38.42 N/mm,45.64?5.24 N?cm/Deg,11.42?1.21N?cm/Deg in sequence;while the rigidity fixed by dynamic compression plates was 405.40?29.26 N/mm,41.00?4.78 N.cm/Deg,10.05?1.32 N?cm/Deg accordingly.Burdened 1000N axial pressure,the displacement of interlocking intramedullay nail fixing specimen was 2.20?0.11 mm,and the compression plate fixing specimen was 2.48?0.15 mm.Given a 5 N?M bending burden,the maximum radial bending degree of interlocking intramedullay nailfixing specimen was 3.25?0.15 mm,which was 3.60?0.21 mm of compression plate fixing specimen.In the anti-torsional test,the interlocking intramedullay nail and compression plate fixing specimen could burden 2.40?0.13 N?M and 1.90?0.10 N?M respectively.The experimental data were analyzed by software SPSS.10,which came to a distinguished difference by t-test(P
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[Objective]To study the clinical results of methods of improvement of pedicle screw stability in patients of osteoporosis. [Method]Thirty-four cases of patients with osteoporosis were operated using pedicle screw and methods of improvement of pedicle screw stability were used during the operations.Of which,male 20,female 14;the mean age of 57(range 40～71).According to Jikei grading scale for osteoporosis,8 were of early stage,11 of stageⅠ,8 of stageⅡ and 7 of stageⅢ.There were 14 cases of fractures and 20 cases of osteopathy.For patients of early stage and stageⅠ(19 cases),long and large size of pedicle screws were used,meanwhile stiff connection rod system,two cross-link devices,placement of pedicle screw with large angles in horizontal and sagital planes were applied.For patients of stageⅡ and stageⅢ(15 cases) bone cement was used to fill the pedicle hole to ensure the screw stabily.[Result]There were no neurologic and vessel injuries or aggravated as well as no breakage of screw except two cases with loosening of screw during the follow-up with the mean period of 14 months(range 9～26).The loss of correction of reduction in fractures was 5%,the rate of fusion was 100% in grafting.[Conclusion]Different methods of improvement of pedicle screw stability used in osteoporosis may avoid loosening of screw and loss of correction.
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BACKGROUND: Fracture of humeral ectocondyle is a kind of articular epiphyseal fracture. It is one of the most prevalent disorder of cubital articulation. The occurrence of fracture and the mechanical mechanism of treatment is not very well cognized in clinic.OBJECTIVE: To analyze the stress distribution of the humeral ectocondyle in different postures so as to investigate the treatment mechanism of the humeral ectocondyle fracture.DESIGN: Computer simulation study on stress.SETTING: Department of Experimental Mechanics, Fuzhou University, and Department of Orthopedics, Third Affiliated Hospital of Peking University.MATERIALS: This experiment was conducted in the Fujian Experimental Mechanic Committee of Fuzhou University between January 2000 and December 2002. Humerus from a 6-year-old. corpse (Provided by the Department of Anatomy of Fujian College of Traditional Chinese Medicine). Instruments were computer, SUPER-SAP93 software, material sickle and measuring instrument and so on.METHODS: 9 kinds of loading conditions were simulated and added on three dimensional finite elemental model of humerus in SUPER-SAP93software, and then the stress distribution was filed out and analyzed.MAIN OUTCOME MEASURES: The average Mises stress of lateral condylar area and humeral trochlea area.RESULTS: At flection posture of elbow, the average Mises stress of lateral condylar area was the largest while at extension posture the stresses of nodes affected by extensor tendon were larger than those of lateral condyle.CONCLUSION: At the flection posture of elbow, the fracture of lateral condyle of humerus was resulted from c9llision occurring when radius and ulna struck humerus while at extension posture, it was chiefly due to extensor tractive force. We can use extensor tractive force to reduce the fracture of lateral condyle and avoid extensor tractive force to fix it.
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Objective To observe whether the full-thickness defects of articular cartilage at the knee joint of rabbits could be repaired by implantation of polyglycolic-acid(PGA) composites adhered with bone marrow stromal cells (BMSCs). Methods Culture-expanded rabbits’BMSCs were seeded onto porous PGA scaffolds. After a 72-hour co-culturing, the cell-adhered PGA was implanted into the articular cartilage defect at the intercondylar fossa of the femur. The rabbits were sacrificed 12 weeks later after the operation and the specimens were examined histologically for morphologic features, and stained immunohistochemically for type Ⅱcollagen. Results The specimens harvested from BMSCs-PGA composite demonstrated a hyaline cartilage formation. No obvious progressive degeneration sign was found in the newly formed tissue. The control groups showed no hyaline-like cartilage formation. Conclusion PGA composites adhered with in vitro culture-expanded autologous BMSCs can facilitate formation of hyaline-like cartilage in rabbits.
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Objective To discuss the repair methods for the cartilage defects of the knee joint. Methods The cylindrical osteochondral grafts were harvested from the non-weight-bearing area of the knee joint and then transplanted to the cartilage defects in 6 patients with cartilage defects of the knee joint. Results The clinical symptoms of all the patients followed up for 2-24 months disappeared and the joint mobility recovered to normal. A follow-up MRI showed consistent cartilage coverage and the excellent position of the cylindrical osteochondral grafts. Conclusions The osteochondral autograft is a practical surgical method because it is characterized by less trauma, simple performance and good maintenance of the curvature of the articular surface.
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<p><b>OBJECTIVE</b>To investigate appropriate ways for screw placement of pedicle of vertebral arch in the horizontal plane.</p><p><b>METHODS</b>Fifteen preserved thoracolumbar spine specimens (T(11)-L(5)) were used and divided into three groups at random. Firstly four anatomic parameters indicating screw positions in the horizontal plane were measured. Secondly the methods of Roy-camille, Magerl, and authors' segmental differences were used to place successively the screws of the pedicles with 5 mm, 6 mm, and 7 mm in diameter. Coincidences between the drilling point, drilling direction and pedicle axis, and ruptures of the pedicle as well as the length of the screw in the vertebral body were observed.</p><p><b>RESULTS</b>Four anatomic parameters at various segments showed significant differences (P<0.05). The drilling point by the Roy-camille's method deviated medial to pedicle axis in most segments, and its drilling direction did not coincide well with most E-angles of the pedicles. The drilling point by Magerl's method coincided relatively well with pedicle axis in lumbar vertebrae, but there were still some differences between its drilling direction and E-angles of the pedicles. The method of segmental differences coincided the best with the pedicle axis. The lengths of screw in the vertebra were relatively long by both Magerl and segmental difference methods. When 5 mm diametral screw was used by the three methods, the rupture rate was very low. When 6 mm and 7 mm diametral screws were placed, the rupture rate was accordingly increased. Of the three methods, Roy-camille's method showed a relatively high rupture rate, while the method of segmental differences a comparatively low rupture rate. Various degrees of rupture of the pedicle of vertebral arch were found at the juncture of the thoracic and lumbar vertebrae when 6 mm or 7 mm diametral screws was used by any screw placement method. In contrast, the rupture was seldom seen at the lower lumbar vertebrae when 7 mm diametral screws were used.</p><p><b>CONCLUSIONS</b>The segmental difference method is proved to have the anatomic safety and screw biomechanical stability. It is appropriate to choose different diametral screws, different drilling points and directions according to different segments of the vertebra.</p>
Asunto(s)
Adulto , Humanos , Tornillos Óseos , Vértebras Cervicales , Heridas y Lesiones , Vértebras Lumbares , Heridas y Lesiones , Traumatismos Vertebrales , Cirugía GeneralRESUMEN
Objective To describe the design and application of a new fork interlocking in-tramedullary nail(FLN).Methods The anti-compression,anti-bendin g,anti-torsion and rigidity of the FLN were compared with those of recta ngle nail(RN),plum blossom nail(PBN),Ender nail(EN),GK nail(GK)and 8-hole plate biomechanically an d 169case of tibial fractures treate d with the FLN from September1998to May 2001were reviewed.Results The anti-compression,anti-bendin g,anti-torsion and rigidity of the FLN were similar to those of GK and significantly stronger than those o f RN,PBN,EN and 8-hole plate.Of 169cases,147were followed up for more than 3months.Among them,97nails have been removed.The average healing period was 19.6week s(11-31weeks)and the complications include 5exte rnal rotation deformities(from 10?to 15?),4valgus deformities,2varus deform ities,6shortening-displacements,16pain at the nail-entry points,1common peroneal nerve injury(healed 3months later)and 3delayed postoperative infection(1case one month later,2cases five mo nths later).The infection rate was 1.6%.Based o n Johner and Wruhs standard,the excellent ra te was 96.5%,fair 1.3%and failure 2.2%respectively.Conclusion1)FLN is an effective and convenient im plant to treat tibial fracture.2)In severely comminuted fractures an d distal shaft fractures,the distal h ole could be inserted with two transv erse screws similar to GK,which can widen its indication.[
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Objective To study the mechanism and difference of fractured vertebral body’ s prevertebral height recovery following different methods of reduction. Methods A L 1 compressed fracture model was produced by modified Gepstein method with wet human spinal specimens(T11-L 3); the model was reduced by hyperextension, longitudinal extension and device reduction respectively. The measured parameters including the changes of prevertebral height, the changes of anterior longitudinal ligament strain and the changes of vertebral disc’ s height; segments including upward and downward of the fractured vertebral bodies were observed. Results The prevertebral height recovery platform stage happened in all the three methods of reduction. There is no significant difference between the prevertebral heights in the maximum experimental load; the prevertebral height increased first and stayed stationary later in the hyperextension reduction procedure; in the device reduction process, the prevertebral height stayed stationary at first and dereased later. Conclusion The prevertebral heights increase is not unlimited between different reduction process of L 1 fracture, and it is limited by spinal anatomy on the late phase of reduction. Knowing these features is useful for us to treat the patients and improve the devices.
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Objective Hemangioma had been recognized as one of the most common tumors; however, intramauscular hemangioma (IMH) was a kind of uncommon benign tumor in skeletal muscle. A large number of orthopaedic surgeons knew little about it's specific clinic features. This paper was to report the diagnosis and therapy of 110 IMH cases, and to review tbe causes for misdiagnosis as well. Methods From oct. 1962 to Dec. 1998, 110 patients underwent surgical therapy with the definitive histological diagnosis; the clinical feature, gender, age, value of X-ray imaging, computed tomography(CT), single photon emission computed tomography (SPECT)?magnetic resonance imaging (MRI) and ultrasonography of IMH were analysed. Surgical technique, pathological classification, postoperation effects, prognosis and recurrence reason were discussed. Measures for cmplication and recurrence prevention, differential diagnosis were put forward. Results Anatomical distribution was 11.82% in the neck, 10.91% in the trunk, 16.36% in the upper limb and 60.91% in the lower limb. The disease was characterized by localized pain within soft tissue, local mass, deep tenderness, muscular soreness and mass expansion after exercise. According to Allen's classification, three types were defined: 1) capillary type; 2) cavernous type; 3) mixed type, combination of both, which included miscellaneous types of deep soft tissue(venous,arteriovenous,epithelioid and granulation tissue type). There were capillary type (38.18%), cavernous (33.64%) and mixed type(28.18%). Forty-nine of 110 cases were followed up for an average of six years and two months, the result of 48.98% patients was excellent, 22.45% was good, and 20.41% was unsatisfactory. Only four of 49 cases had local recurrence which was susceptible to infection. Conclusion Intra muscular hemangioma is easy to be mis or under diagnosed, especialy when it is deep or small localized, and it can rarely be diagnosed radiologically unless calcified phlebolithes occurs. Usually, peripheral nerve is not invaded, but could be compressed by the tumor. MRI is most helpful to define the diagnosis, and SPECT can also provide helpful diagnostic information. Although it can be treated by various methods, surgical excision provides the best result. Recurrence can always attribute to incomplete excision. Wide excision of the lesion is the treatment of choice. Preoperative embolization of IMH can reduce intraoperative blood shedding. Embolization combined with surgery forms a new modern approach to treat IMH.
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Objective To evaluate the diagnostic value of MRI for meniscal bucket-hanle tears. Methods 21patients with bucket-handle tears and 11 patients without bucket-handle tears were put under MRI examinations with the dedicated MRI system(Artoscan 0.2T ESAOTE) and confirmed by arthroscopy.Each was accessed for the presence of (1) the double-anterior sign,(2)the double posterior cruciate ligament sign,(3)the fragment within the intercondylar notch sign and (4)the absent bow tie sign.Results Of 33 cases, the double-anterior sign were seen in 10 cases, the double posterior cruciate ligament sign were seen in 5 cases,the fragment within the intercondylar notch sign were seen in 20 cases and the absent bow tie sign were seen in 25 cases. Conclusion MRI plays an important role in the diagnosis of meniscal bucket-handle tears.The sensitivity and specificity of medial meniscal bucket-handle tears are higher than that of lateral meniscus. The fragment within the intercondylar notch sign is the most valuable sign in diagnosing meniscal bucket-handle tears.
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Objective To discuss the effective method for decreasing operative complications in acetabular fractures. Methods A retrospective analysis was done on 70 patients with acetabular fractures treated with open reduction and internal fixation from June 1998 to June 2003 so as, in combination of follow up data, to investigate cause, mechanism, and effective preventive and therapeutic methods. Results Open reduction and internal fixation were effective methods for acetabular fractures but had too many complications especially in traumatic arthritis and femoral head avascular necrosis, to which we must pay much more attention. Conclusions Operative injury lessening and anatomical reduction are keys to decrease of operative complications. Anterior screw fixation through inguinal approach may be an effective method of decreasing operative injury and complications.
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Objective To specify the diagnostic accuracy of low-field MRI on meniscal tears. Methods Meniscal lesions were examined by using 0.2 T MRI and checked arthroscopically in 171 cases. The results were recorded and compared. Results From the calculation of the arthroscopic findings and the results by MRI, we obtained the diagnostic accuracy rate of 95.91% for both the medial and lateral menisci, sensitivity of 95.60% for the medial menisci and 96.47% for the lateral menisci, and specificity of 96.25% for the medial menisci and 95.35% for the lateral menisci. Conclusions The low-field MRI can bring about high diagnostic accuracy for meniscal tears and has a good price-performance ratio.