OBJECTIVE To assess the effect of sodium hyaluronate (HA) for degenerative disorders of the temporomandibular joint (TMJ). METHODS A prospective randomized controlled clinical trial was conducted. The experimental group received injections in the upper compartments of the involved TMJs with 1% HA 6 mg, whereas the control group received prednisolone (PS) 12.5 mg once a week. Three to four injections were as one course. Before and one week after the treatment courses, clinical symptoms, amount of interleukin-6 (IL-6) and total protein of synovial fluid were measured and compared. RESULTS Sixty-seven patients were included and 4 out of them were dropped out. There were 12 males and 51 females, among them, 14 cases with synovitis, 21 with anterior disc displacement without reduction and 28 with osteoarthritis of the TMJ. Thirty-five patients allocated in HA group and 28 in PS group. Both drugs could relieve the clinical symptoms of TMJ degenerative disorders. In HA group, marked improvement rate was 51.43% and failure rate was 2.86%, whereas marked improvement rate 39.29% and failure rate 17.86% in PS group. The declined levels of IL-6 in synovial fluid was notably greater in HA group than those in PS group. CONCLUSIONIntra-articular injection of HA is effective and safe to treat TMJ degenerative disorders with mild adverse reactions, better in terms of effective rate and declined level of IL-6 than PS.
Objective To analyze the biomechanical changes of the adjacent cervical facet joints when the angled cervical prosthesis is replaced. Methods A total of 400 northwestern people were involved, with an age of 40 years or older.The cervical vertebra lateral X-ray films were taken, and the cervical angles were measured by professional computer aided design software, then the cervical intervertebral disc prosthesis with 10° angle was designed. The finite element models of C4，5and C4-6 segments with intact cervical discs were developed; the C4，5 disc was replaced by the cervical prosthesis with 0° and 10° angle respectively; and then all models were subjected to axial loading, flexion/extension, lateral bending, and torsion loading conditions; the stress effects on adjacent facet joints after replacement were observed by comparing with that of the intact model. Results The cervical angles were (9.97 ± 3.64)° in C3，4, (9.95 ± 4.34)° in C4，5, (8.59 ± 3.75)° in C5，6, and (8.49 ± 3.39)° in C6，7, showing no significant difference between C3，4 and C4，5, C5，6 and C6，7 (P gt; 0.05) and showing significant differences between the other cervical angles (P lt; 0.05). When C4，5 model was axially loaded, no significant difference in equivalent shearing stress were observed in intact, 0°, and 10° groups; at flexion/extension loading, the stress was biggest in intact group, and was smallest in 10° group; at lateral bending, the stress got the high rank in intact group, and was minimum in 10° group; at torsion loading, the stress state of 10° group approached to the intact one condition. When C4-6 model was loaded, the facet joint stress of the replaced segment (C4，5) decreased significantly at axial loading, flexion/extension, and lateral bending; while no obvious decrease was observed at torsion loading; the stress of the adjacent inferior disc (C5，6) decreased significantly at axial loadingand lateral bending condition, while less decrease was observed at torsion loading, no significant change at flexion/extension condition, it approached to that of the intact one. Conclusion The finite element analysis reveals that the biomechanical properties of 10° designed prosthesis is approximate to that of the intact cervical disc, thus the 10° designed prosthesis can meet the requirements of biomechanical function reconstruction of the cervical spine.
ObjectiveTo evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors.MethodsA clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed. There were 9 males and 8 females with an average age of 34.4 years (range, 13-64 years). Seven patients were diagnosed with chondrosarcoma, 3 with osteosarcoma, 2 with Ewing’s sarcoma, 1 with high-grade sarcoma, 1 with polymorphic dedifferentiated sarcoma, 1 with fibrosarcoma, 1 with plasmacytoma, and 1 with bone giant cell tumor. According to the surgical staging system described by Enneking et al, 1 patient was rated as stage 3, 8 as stageⅠB, 8 as stageⅡB. According to the classifications of shoulder girdle resections of Malawer et al, 11 patients were type ⅢB, 5 were type ⅣB, 1 was type ⅥB. The disease duration ranged from 0.5 to 8.0 months (mean, 3.2 months) and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm. The 1993 Musculoskeletal Tumor Society (MSTS) upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function. Tumor recurrence and metastases were monitored by radiograph.ResultsPoor superficial incision healing occurred in 1 patient, the rest incisions achieved healing by first intention. All patients were followed up 20-72 months (mean, 45.4 months). Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases; 3 patients suffered from pulmonary metastases and were alive with disease. No local recurrence occurred in all patients. The overall survival rate was 88.2% (15/17) and the disease-free survival rate was 70.6% (12/17). Rib fracture after trauma, aseptic loosening, and atrophy of the deltoid muscle occurred in 1, 1, and 1 case, respectively. The other related complication was not observed. At last follow-up, the MSTS score was 26.1±1.4, and the flexion, extension, and abduction range of motion of shoulder joint were (70.0±7.5), (31.2±11.3), and (54.4 ±12.5) °, respectively.ConclusionReconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.
It is clear that that bloody bone graft is better than tranditional nobloody bone graft. The autherdesigned the shelf oporation of gluteus minimus muscle pedicle ilinc graft in hip joint. Since 1986 , 14patients were operated. Follow-wp survey lasted 24 to 49 monthes. It was improved evidently forhip joint unsteadiness and clandicatory gait and bad complication did not hiappon. The operation wassimple and make use of materials nearby and union fastly. It didn t destroy myedynamia of ...
Traditional gait analysis systems are typically complex to operate, lack portability, and involve high equipment costs. This study aims to establish a musculoskeletal dynamics calculation process driven by Azure Kinect. Building upon the full-body model of the Anybody musculoskeletal simulation software and incorporating a foot-ground contact model, the study utilized Azure Kinect-driven skeletal data from depth videos of 10 participants. The in-depth videos were prepossessed to extract keypoint of the participants, which were then adopted as inputs for the musculoskeletal model to compute lower limb joint angles, joint contact forces, and ground reaction forces. To validate the Azure Kinect computational model, the calculated results were compared with kinematic and kinetic data obtained using the traditional Vicon system. The forces in the lower limb joints and the ground reaction forces were normalized by dividing them by the body weight. The lower limb joint angle curves showed a strong correlation with Vicon results (mean ρ values: 0.78 ~ 0.92) but with root mean square errors as high as 5.66°. For lower limb joint force prediction, the model exhibited root mean square errors ranging from 0.44 to 0.68, while ground reaction force root mean square errors ranged from 0.01 to 0.09. The established musculoskeletal dynamics model based on Azure Kinect shows good prediction capabilities for lower limb joint forces and vertical ground reaction forces, but some errors remain in predicting lower limb joint angles.
Objective To review the diagnosis, treatment method, and surgical technique of tarsometatarsal joint injury. Methods Recent l iterature concerning tarsometatarsal joint injury was reviewed and analyzed in terms of anatomy,injury mechanism, classification, diagnosis, management principle and methods, and surgical techniques. Results It could be difficult to diagnose tarsometatarsal joint injury, and subtle injury was more difficult to diagnose with a high rate of missed diagnosis. Fairly accurate diagnosis of tarsometatarsal joint injury could be made based on medical history, symptoms and signs, and necessary imaging examinations. For the patient of partial l igament rupture caused by subtle or non-displacement injury, a cast for immobil ization could be adopted; the patients of instable injury should be treated with open reduction and internal fixation. For the patients of complete dislocation and severe comminuted fractures, arthrodesis should be suggested. Conclusion The diagnosis and management of tarsometatarsal joint injury is compl icated. The treatment method of tarsometatarsal joint injury has evoked controversy. Surgeons should choose the optimal treatment method and surgical technique according to the injury type, radiological manifestation, and classification so as to obtain the best cl inical outcome.
This article introduces the basic principles of finite element analysis in biomechanics, focusing on the basic principles of a variety of finite element analysis software, and their respective characteristics. In addition, it also describes the basic stress analysis of UGNX6.0 NASTRAN analysis for artificial knee process, i.e. the choice of the type, material definition, the set of constants, finite element mesh division and the finite element results of the analysis. Finite element analysis and evaluation of the design of personalized artificial knee were carried out, so that the rationality of the geometric design of the structure of the experimental design of artificial knee has been verified.
ObjectiveTo investigate the influence of uncovertebral joint foraminal part excision on the motion response, stability and clinical outcomes after single-level cervical disc replacement. MethodsThe clinical data of 57 patients with cervical spondylotic radiculopathy, who underwent single-level Prestige LP cervical disc replacement in West China Hospital of Sichuan University from January 2012 to January 2015, were retrospectively analyzed.According to whether to have the uncovertebral joint foraminal part excision in the process of operation, two groups were divided, named excision group and non-excision group.The Japanese Orthopedic Association score (JOA), neck disability index (NDI) and visual analogue score (VAS) were used to evaluate the clinical outcomes pre-and post-operatively.The stability, overall cervical alignment, range of motion of treated levels in flexion-extension and lateral bending, and the transverse and longitudinal diameter of intervertebral foramen were measured by X-ray and CT-3D examination.The complications and reoperations were also recorded. ResultsThere were statistically significant improvement in the JOA, NDI, neck VAS and arm VAS scores in both of the two groups after the surgery (P < 0.05).The improvement of the NDI and the arm VAS scores were more obvious after the surgery in excision group.The overall cervical alignment, the range of motion of treated levels in flexion-extension and lateral bending were well maintained post-operatively (P > 0.05), and the differences between the two groups were not significant (P > 0.05).The transverse diameter of intervertebral foramen was significantly increased in excision group post-operatively (P < 0.05) while the longitudinal diameter was not (P > 0.05);both of the transverse and longitudinal diameter of intervertebral foramen didn't differ much post-operatively in the non-excision group (P > 0.05).All the prostheses showed a good stability.No prostheses shift, dislocation or unfixed prostheses were found. ConclusionUncovertebral joint foraminal part excision can be used in single-level Prestige LP cervical disc replacement, which is safe and reliable.
ObjectiveTo provide the evidence for diagnosis and treatment of the complication by describing the distribution and drug sensitivity of pathogens in patients with prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA). MethodsBetween January 2003 and June 2013,65 cases (65 knees) with PJI after primary TKA were treated.There were 28 males and 37 females with an average age of 63.2 years (range,37-80 years).The median interval between PJI and primary TKA was 2.8 years (range,2 weeks to 11 years),including 29 left knees and 36 right knees.Prosthesis loosening could be found in 27 cases by X-ray examination.The average value of C-reactive protein and erythrocyte sedimentation rate was 37.4 mg/L (range,12.5-197.0 mg/L) and 63.2 mm/1 h (range,29.3-73.8 mm/1 h) respectively.Preoperative and intraoperative synovial fluid as well as intraoperative tissue samples should be submitted for aerobic and anaerobic culture.The four types of infections were made according to the Tsukayama et al.classification standards. ResultsThe patients were all diagnosed as having PJI.There were 5(7.69%) type I infections,4(6.15%) type ⅡA,8(12.31%) type ⅡB,3(4.62%) type Ⅲ,and 45(69.23%) type IV according to the Tsukayama et al.classification standard.Bacterial culture results were negative in 12 cases and positive in 53 cases,the main pathogen was Gram-positive cocci (39/53).The most common organism identified was Coagulase-negative Staphylococcus (24/53) followed by Staphylococcus Aureus (12/53).Resistant bacterium accounted for 61.11%(22/36) of Staphylococcus.These bacterium were all sensitive to vancomycin,linezolid,meropenem,and fluconazole;and highly resistant to erythrocin,penicillin,and cefoxitin.The main pathogenic bacteria of Coagulase-negative Staphylococcus and Staphylococcus aureus had highest resistant rate to penicillin. ConclusionGram-positive cocci is the main pathogen in patients with PJI after primary TKA,which is highly resistant to penicillin and macrolides.Antibiotic treatment of this complication should be based on the result of drug sensitivity test,vancomycin and linezolid may be used before the result of drug sensitivity test.It is important to pay attention to rare and multiple resistant bacteria.
Objective To analyze the correlation between the morphology of tibial intercondylar eminence and non-contact anterior cruciate ligament (ACL) injury, and provide a theoretical basis for the prevention and risk identification of ACL injury. Methods A retrospective analysis was conducted on the knee radiographs of 401 patients admitted to the Chengdu Second People’s Hospital between January 2017 and October 2021, including 219 males and 182 females. Non-contact rupture of ACL was observed in 180 patients and confirmed by arthroscopy or surgery, while the remained 221 patients were confirmed to have normal ACL by physical examination and MRI. The heights of medial and lateral tibial intercondylar eminence and the width of tibial intercondylar eminence of the 401 patients were measured, and the risk factors of ACL injury were analyzed. Results The height of medial tibial intercondylar eminence was lower and the width of tibial intercondylar eminence was smaller in male patients with ACL fracture than those in the male control group with statistical significance (P<0.05). Logistic regression analysis showed that a narrow width of tibial intercondylar eminence was a risk factor of ACL injury in males (P<0.05). The receiver operating characteristic (ROC) curve showed that the diagnostic threshold was 11.40 mm, the area under the curve (AUC) was 0.851 [95% confidence interval (CI) (0.797, 0.896)], the sensitivity was 72.81%, and the specificity was 84.76%. The height of medial tibial intercondylar eminence was lower and the width of tibial intercondylar eminence was smaller in female patients than those in the female control group with statistical significance (P<0.05). Logistic regression analysis showed that both a low height of medial tibial intercondylar eminence and a narrow width of tibial intercondylar eminence were risk factors of ACL injury in females (P<0.05). For the width of medial tibial intercondylar eminence, the ROC curve showed that the diagnostic threshold was 8.30 mm, and the AUC was 0.684 [95%CI (0.611, 0.751)], the sensitivity and specificity were 63.64% and 72.41%, respectively; for the height of medial tibial intercondylar eminence, the diagnostic threshold was 11.30 mm, and the AUC was 0.699 [95%CI (0.627, 0.756)], the sensitivity was 89.39%, and the specificity was 47.41%. Conclusions The reduced width of tibial intercondylar eminence is a risk factor and effective predictor of non-contact ACL injury in males. Both the reduced height of the medial tibial intercondylar eminence and the reduced width of tibial intercondylar eminence are risk factors and may be predictors for non-contact ACL injury in females.