BACKGROUND:Scoliosis is a complex spinal pathology characterized as a three-dimensional spine deformity combined with vertebral rotation. The finite element analysis can replace traditional biomechanical experiment for repeated experimental analysis and for processing digital simulation. It has been widely used in the study of scoliotic biomechanics.
OBJECTIVE:To emphasize the application of finite element analysis on the brace and surgical treatment of scoliosis.
METHODS:An online search of PubMed and Wanfang database was performed by using key words of“scoliosis, finite element”in Chinese for articles published between January 1986 and May 2013. A total of 38 papers related to finite element of scoliotic treatment, published in authorized journal and considered to be a representative, were selected.
RESULTS AND CONCLUSION: How to design an individualized brace in accordance with biomechanical characteristics of scoliosis is the hot topic. By using multi-imaging technology, the rib, chest bone and pelvis are introduced into the finite element models, in a broader attempt to analyze the optimal three-dimensional orthopedic force pattern for scoliosis. The results of relative research showed that, the ideal loading pattern is given at the protruding area of scoliosis. Finite element analysis can predict and evaluate the orthopedic procedure and effect of patients, thus assisting the design of reasonable orthopedic treatment scheme. Through finite element analysis, we can simulate and analyze the stress distribution of internal fixator in spine, which contributes to prevent the complications.

ObjectiveTo summarize the experience of the operations of pancreaticoduodenal combined trauma.MethodsClinical data of pancreaticoduodenal combined trauma in 12 cases were analyzed retrospectively.Head of pancreas with duodenal combined trauma occurred in 9 cases,body-tail of pancreas with duodenal conbined trauma in 3 cases.Diferrent operative fashion were used.ResultsPostoperative pancreatic fistula in 2 cases( 16.7％ ),were cured by continuing lower pressure suction of all cases,11 cases were cured (91.7％ ) and 1 cases died (8.3％).ConclusionOperation in time and correct operative fashion were the key of successful treatment.Three-cavity twoBlakemore Tube had a certain value.

Objective To study the long term results of thoracolumbar fractures treatment with AF (atlas fixator) pedicle system. Methods The clinical results of 60 cases of thoracolumbar fractures treated with AF pedicle system from 1996 2000 were analyzed retrospectively. Results The follow ups lasted from 3 to 6 years, averaging 4 years. The neurological function improved by at least 2 ASIA grades in 27 cases and by 1 ASIA grade in 33 cases. The correction of the vertebral body height averaged 95.1%, and the correction loss averaged 19.7%. Degeneration and narrowing of the disc space next to the fractured vertebrae were common, and correction loss was most evident at the upper disc spaces. Conclusions The AF pedicle system can achieve good long term clinical results for the recovery of neurological function and the vertebral body height. But the rates of implant failure and correction loss are still high probably due to deficiency of bone grafting and delayed implant removal.

[Objective]To find out the new method to cure the intervertebral discs degeneration by way of the eletron microscope study of the degeneration of the cartilage endplate in the circumstances of the intervertebral destabilization. [Method]To choose forty-eight white macrotia rabbits of Japan,which weighed within the range of 2.5?0.2 kg,female and male was unrestricted.These rabbits were divided into 2 groups randomly,with 21 rabbits in the contrast troup,with 27 rabbits in the experimental group.First 27 rabbits of the experimental group were destabilizated by operated on L6、7.Inj Diazepam 0.25 mg/kg,Inj Ketamine 0.02 g/kg and Inj Atropine 0.125 mg/kg was one by one injected into the rabbit through the auris vein,shearing the rabbit hair of backside waist,fixing the rabbit on operation table in face lying,using 1% Povidone Ioding to degerm the operation area.Every rabbit was incised at the backside of its waist,that incisal opening is located in the center of the intervertebral space(L6、7 space) that both side iliac crest line correspond,from the meso-ordinate direction cut about 4 cm incision,cutting open skin and subcutaneous tissue,thoroughly,exposing the spinous processes the vertebral plates and the upper-inferior articular processes,entirely segregating the muscles that cohere the spinous processes the vertebral plates and the articluar process,then excising the supraspinal ligaments and interspinal ligaments,biting off two sides the inferior articular processes of L6,in order that resulting in intervertebral destabilization,using 0.9% Inj.Sodium Chloride to washout the incisal opening,in order sewing up each layer tissues.After operation rabbits can freely move in the cages.To draw the materials from all groups after two months,four months and six months orderly.Using transmission electron microscope to observe the structure the cartilage endplate,the author should judge the degenerative course and mechanism of the cartilage endplate synthetically.[Result]The intervertebral destabilization can cause the collagen fibers degenerates from the regular and compact structure to the disorder and loose structure.[Conclusion]The intervertebral destabilization can distinctly lead to the degeneration of the cartilage endplate.

[Objective] To discuss the operation and clinical results about surgical treatment of scoliosis of thoracic hemivertebra and diastematomyelia of adolescent.[Methods]From Jan 2001 to June 2007,15 patients were treated with one-stage posterior hemivertebrae and osseous divide resection combined with transpedicular instrumentation and bone graft.There were 6 males and 9 females with an average age of 21.2 years(range 16 to 24 years).All cases were segmented hemivertebrae.Hemivertebrae were located at T11(n=3)and T12(n=12).The status of the spinal fusion,correction rate and instrumentation were evaluated after surgery.[Results]All cases were followed up for 19 to 45 months with an average of 34 months.Cobb's angles of the main curve were 52.3??3.8?before surgery,10.2??1.4? after surgery.At the final follow-up there was 1.6? loss of correction.The mean height was increased by 3.76 cm.The district of bone graft showed good bone fusion.The time of vertebra fusion was 3 to 5 months(mean 3.6 months).No instrumentation,spinal fusion failure or other severe complications were noted.[Conclusion]One-stage posterior hemivertebrae and osseous divide resection combined with transpedicular instrumentation and bone graft can achieve a satisfactory result for the treatment of scoliosis of thoracic hemivertebra and diastematomyelia of adolescent.It can be recommended in clinical practice because of a good stability of fixation and fine spinal fusion.

BACKGROUND:The structure surrounding upper thoracic spine is complicated. Transverse diameter of pedicle was relatively smal . There were important organs in front of the vertebral body. Screws deviated from axis or screws were too long. The safety and effectiveness of screw implantation were not implemented. It is necessary to understand the key structure of surroundings. OBJECTIVE:To analyze the relationship of anatomic position between the axis of screw of pedicle of upper thoracic spine and key adjacent structure of the vertebral body. METHODS:A total of 30 healthy adult volunteers received T 1-T 4 pedicle axis paral el to CT scans. The positions of esophagus, trachea position, aortic arch, carotid and vertebral arteries were observed when the pedicle screw was implanted along the pedicle axis. The shortest distance on both sides of a vertebral pedicle axis from these structures was measured. Paired t-test was utilized for analysis. RESULTS AND CONCLUSION:240 measurement parameters were analyzed. The distance from the left pedicle axis on T 1-3 to esophagus was smal , and the left pedicle on T 2 was minimal. The distance from the right pedicle axis on T 2-4 to trachea was smal . The distance from right pedicle axis on T 3 , T 4 to right main bronchus was smal . Carotid and vertebral artery did not show the risk of injury. 62%of the patients were in the aortic arch on T 4 plane, and no risk of damage was found. These results indicated that the left pedicle screws were easy to damage the esophagus, and the right pedicle screw was easy to damage trachea. Carotid artery, vertebral artery and aortic arch were not easy to be damaged. The anatomic position of easily damaged structure could be identified by careful analysis of CT data before screw implantation in the pedicle of upper thoracic spine.

Objective To evaluate the expression and clinical significance of matrix metalloproteinase 14(MMP-14) in osteoar-thritis(OA) patients in synovium and synovial fluid of knee joint .Methods Semi-quantitative RT-PCR were used to detect the ex-pression of MMP-14 mRNA in 32 case of OA (experimental group)and 26 non-OA patients(control group)synovium ;protein level expression of MMP-14 in synovial fluid were analyzed by ELISA .Results The expression of MMP-14 mRNA in experimental group synovium of knee joint was significantly increased compared with control group (P<0 .05);but the protein level of MMP-14 was low in experimental group synovial fluid compared with control group (P<0 .05) .Conclusion The expression of MMP-14 is increased in OA patients synovium and maybe promote the progress of OA directly ;the protein level of MMP-14 is decreased in OA synovial fluid ,indicated the function of MMP-14 in OA synoviocyte indirectly .

Objective To investigate the expression and significance of MMP-3 in knee joint synovium of different stage in osteoarthritis (OA) patients. Methods MMP-3 protein were detected by immunohistochemical method in knee synovial tissues from 90 OA patients (the OA group) and OA group was divided into 3 subgroups according to Kellgren and LawrenceX-ray diagnosing standards: the gradeⅠ(n = 30), gradeⅡ (n = 30) and grade Ⅲ subgroups (n = 30). 30 patients were enrolled as control group. Immunohistochemistry was used to detect the expression of MMP-3 protein in the tissue. Results The expression level of MMP-3 protein in OA group was significantly higher that in the normal synovium (P < 0.05). There existed significant difference in the expression of MMP-3 protein between the grade Ⅲ subgroup and the gradeⅠ, or Ⅱsubgroups (P < 0.05). The expression of MMP-3 protein related positively to the severity of OA (r = 0.912, P < 0.05). Conclusion The expression of MMP-3 protein related closely to the pathogenic mechanism of OA. It may serve as an important indicator of early diagnosis and the activity of OA.

Astract:Objective To assess the anatomical and functional significance of the bladder and urethra in female SUI by dynamic MRI and urodynamic. Methods The clinical data were retrospectively analysed on 60 cases of female stress urinary incontinence from Feb 2011 to Nov 2013. All the women received pelvic floor dynamic MRI and Urodynamic study. Measured the urethral angle,the distance of the H line, M line and the descent of the bladder,cervical,anorectal junction from the PCL in the mid-sagittal dynamic MR image of the pelvic. Pearson 's correlation coefficient was used to examine the association among the distance of the H line,M line and the urethral angle,the descent of the bladder,cervical,anorectal junction from the PCL and the Urodynamic data. Results The distance of the H line,M line were significantly and positively associated with urethral angle and the descent of the bladder,cervical,anorectal junction from the PCL. The distance of the H line,M line were significantly and negatively associated with functional profile length, maximum urethral closure pressure,VLPP and detrusor opening pressure. Conclusion Pelvic floor dynamic MRI combined with Urodynamic study is useful for assessing the anatomical and func-tional significance of the bladder and urethra in female SUI.

BACKGROUND:The conditions of teenager and adult skeletons have great differences. Thus, it is dangerous to place screw on teenagers using the methods for adults.
OBJECTIVE:To observe the anatomical features of teenagers’ upper-middle thoracic vertebra images, and to provide experimental basis for pedicle nailing and pedicle-rib head unit nailing in teenagers’ upper-middle thoracic vertebrae.
METHODS:We chose 30 teenagers (13 to 18 years old) without spine lesions, and then they were scanned (0.625-1.25 mm) from T 1 to T 12 segments using CT. The original data were loaded into a three dimensional software in DICOM format for measuring related indicators. At last, we analyzed the data according to different segments.
RESULTS AND CONCLUSION:The trend between the width of pedicle and pedicle-head unit was similar, showing a“V”shape. The minimum of width was located in the T 4 , and there were significant differences between the corresponding vertebral bodies (P<0.05). The trend between pedicle nail road length and pedicle-rib head unit nail road length was similar, and the trend between them was gradual y increasing. The minimum of length was located in T 1 , and the maximum of length was located at T 10 , and there were significant differences between the corresponding vertebral bodies (P<0.05). The trend between the pedicle transverse angle and pedicle rib-head unit transverse angle was similar. The trend from T1 to T10 was on a decline, and there were significant differences in corresponding vertebrae (P<0.05). The trend of curves between pedicle sagittal angle and pedicle rib-head unit sagittal angle was similar, showing a wavy shape, and there were significant differences in corresponding vertebrae (P<0.05). These results confirmed that the same segmental pedicle rib-head unit can provide a safer nailing place than the pedicle relatively.