Objective To compare clinical outcomes of double-bundle and single-bundle in individualized arthroscopic anatomical reconstruction of anterior cruciate ligament (ACL) . Methods The clinical data of 117 patients were reviewed who had received double-bundle or single-bundle arthroscopic ACL reconstruction from March 2007 through September 2009 in our hospital and had undergone complete follow-up. Of them, 35 cases had single-bundle ACL reconstruction and 82 double-bundle reconstruction. In the single-bundle group(group A), there were 31 men and 4 women, aged 28. 6 ±5. 1 years. In the double-bundle group(group B), there were 73 men and 9 women, aged 27. 6 ±5. 4 years. The 2 groups were comparable in the preoperative demographic data ( P > 0. 05). To evaluate the outcomes, Lachman and Pivot Shift exams , KT-2000, Lysholm and IKDC (International Knee Documentation Committee) scores, were adopted. Results The 117 patients received a mean follow-up of 15 months (from 11 to 25 months). The Lachman test showed 88. 6% (31/35) were normal in group A and 95. 1% (78/82) were normal in group B.The pivot-shift test showed 88. 6%(31/35) were normal in group A and 96. 3% (79/82) were normal in group B. Group A had a mean Lysholm score of 93. 4 ± 8. 2 and group B a mean Lysholm score of 93. 7 ±7. 0. There were no significant differences between the 2 groups in the above indexes ( P > 0. 05). By IKDC score, 71. 4% (25/135) were normal in group A and 93. 9% (77/82) were normal in group B. The KT-2000 test showed a mean of 1. 4 ± 0. 6 mm in group A and a mean of 1. 1 ± 0. 5 mm in group B. These 2 values were significantly different between the 2 groups ( P < 0. 05). Conclusions The individualized arthroscopic double-bundle anatomical reconstruction of ACL can maximally restore the anteroposterior and rotational stability. Arrangement of the ACL insertion site on the femoral and tibial side, three-portal technique and ruler application are keys for individualized anatomical double-bundle ACL reconstruction.

Objective To explore a new way to improve the repairing effect of tendon allograft by pretreatment with ethyldimethylaminopropyl carbodiimide (EDC) cross-linking. Methods Rabbits' tendon allografts were obtained by lyopyilization.The allografts were then cross-linked and heparinized by EDC and N-hydroxy-succinimide (NHS) respectively.The degradation rate,cytotoxicity and histocompatibility of the cross-linked allografts were detected and compared with those of untreated at different time points.The injured anterior cruciate ligaments (ACL) were repaired by tendon allografts with and without cross-linking pretreatment in rabbits.The tendon-bone healing was observed and compared by light microscopy and scanning electron microscopy (SEM) at 1,3,6 months. Results The degradation rate of the pretreated tendon allografts [(6.26 ± 3.16)％] was significantly lower than that of the unpretreated [(30.70 ± 10.24)％]( t = 14.200,P = 0.025 ).The pretreated tendon allografts were atoxigenic and produced significantly lower inflammatory reaction ( P ＜ 0.05 ).The pretreated tendon allografts also showed more powerful capability of repairing ACL injury and shorter time of tendon-bone healing. Conclusion Tendon allografts cross-linked and heparinized by EDC/NHS may promote tendon-bone healing with improved stability,degradation and biocompatibility.

Objective To compare clinical outcomes of minimally invasive plating osteosynthesis (MIPO) and intramedullary nail stabilization in treatment of acute humeral shaft fractures. Methods From March 2007 to January 2009, 52 patients were treated in our department for acute fractures of middle and lower humeral shaft. Twenty-seven were treated with MIPO technique (group A) and 25 with intramedullary nail (group B) . In group A, there were 15 men and 12 women, aged from 18 to 65 years (average, 36. 7 years); in group B, there were 16 men and 9 women, aged from 25 to 63 years (average,39. 4 years). Operation time, amount of blood transfusion, hospital stay, time for union, complications, Mayo scores of the elbow and Constant scores of the shoulder were recorded in both groups and compared statistically. Results The mean follow-up time was 17. 8 months (range, 16 to 36 months) . There were no significant differences between the 2 groups in operation time, amount of blood transfusion, hospital stay, time for union, and Mayo scores of the elbow ( P > 0. 05) . There was no case of postoperative iatrogenic radial nerve palsy or non-union in group A, but there were 4 cases of non-union, 2 cases of iatrogenic radial nerve palsy and one case of varus malunion in group B. Compared with group B, group A showed significant advantages in rate of postoperative non-union and Constant scores of the shoulder functional recovery ( P < 0. 05) . Conclusion In treatment of humeral shaft fractures, MIPO technique has advantages of less operative invasion, quick bone union, satisfactory shoulder functional recovery and low risk of postoperative palsy of the iatrogenic radial nerve.

Objective To investigate clinical characteristics and treatment of Hoffa fractures.Methods Twenty patients with Hoffa fracture (24 condyles) were treated from January 2002 to April 2009.They were 14 men (18 condyles) and 6 women (6 condyles), aged from 20 to 70 years (average, 43. 3 years).There were 15 fractures of medial femoral condyle and 9 ones of lateral femoral condyle. Two rare cases were fractures of unilateral bi-condyles and one rare case fractures of unilateral bi-condyles plus contralateral single condyle. Four fractured condyles were old due to implant failure and 20 were fresh. According to the modified Letenneur's classification, there were 6 condyles of type Ⅰ, 4 condyles of type Ⅱ and 14 condyles of type Ⅲ.Fifteen condyles were fixed anteroposteriorly with 2 to 4 cancellous or canulated screws, 8 condyles were fixed posteroanteriorly with 2 to 4 screws, and one condyle was fixed with K wires. Five condyles were fixed with screws plus lateral supporting plates, and 3 condyles with screws plus posterior anti-sliding plates. Results All the patients were followed up for an average of 14. 4 months (6 to 84 months) . All the 24 condyles obtained bony union after an average of 18. 6 weeks (from 12 to 44 weeks). There was no infection, implant failure, nonunion or bone necrosis. According to Letenneur's functional assessment system, 16 condyles were excellent, 6 good and 2 poor, with a good-to-excellent rate of 91. 7%. Conclusions All Hoffa fractures should be treated with screws. Screw diameter, fixation direction and surgical incision should depend on facture type and size of fracture block. Unstable Hoffa fractures should be treated with screws combined with lateral supporting plates or posterior anti-sliding plates.

Objective To assess the accuracy and safety of inserting K-wires by a spinal minimally invoive robot system into cattle spines. Methods With a program shown on the screen of a C-arm fluoroscopy system,194 nails were placed ino 17 cattle spines by a spinal minimal invasive robot system which had been developed jointly by Shenyang Institute of Autmation Chinese Academy of Sciences and our institute.Radiation frequency,radiation exposure time,operation time and deviation of drills were recorded and analyzed. Results The mean deviation in the lateral projections by the spinal minimally invasivc robot system was smaller than in the anteroposterior projections.In lateral projection,the deviations within 1 mm,2 mm and 3 mm accounted respectively for 91.6％,99.5％ and 100％.In anteroposterior projection.the deviations within 1 mm,2 mm and 3 mm accounted respecrvely for 71.1％,89.6％ and 94.8％.The mean drilling time,the mean radiation frequency and the mean radiation time per hole by the robot system were respectively 420 seconds (from 330 to 577 seconds),13 times (from 8 to 21 times) and 9 seconds (from 8 to19 seconds).There was a learning curve in mastering the system.Training for a period of time made the accuracy within 2 mm in both lateral and anteropsterior films 95.6％ of the deviations in lateral films and 92.1％ of the deviations in anteroposterior films were less than one mm. Conclusions Operators of the spinal minimally invasive robot system can avoid intraoperative X-ray radiation.The flexibility and accuracy of the system can completely satisfy the clinical needs of spinal surgeons,but there must be a learning curve.

Objective To establish a 3D atlas of Letournel-Judet classifications of acetabular fractures which provides remote access on the web through hypertext markup language (HTML) and virtual reality modeling language (VRML) for efficient remote diagnosis. Methods Firstly,different Letournel-Judet classifications of acetabular fracture were simulated based on 3D reconstruction models of healthy volunteers via Mimics software.The files of VRML format were exported after geometry modeling.Secondly,The.wrl files were edited by adding nodes of Sensor,Route,and Script to the files to make the static scene respond to users' interaction.Finally,the homepage of 3D atlas was established with the Dreamweaver software.Results The 3D atlas of Letournel-Judet classifications of acetabular fractures was established which can be accessed online.These virtual worlds can be browsed via the Internet and hyperlinked with the World Wide Web. Conclusion The 3D atlas of Letournel-Judet classifications of acetabular fractures can be easily and convenicntly used by surgeons for consultation in clinical diagnosis of an acetabular fracture.

Objective To evaluate the clinical efficacy of Achillon,a novel guide for Achilles tendon suture produced by Newdeal Ltd in France,in the mini-invasive surgical treatment of acute Achilles tendon rupture. Methods Between December 2010 and March 2011,7 patients(7 feet) with acute Achilles tendon rupture were treated in our department.They were 5 males (5 feet) and 2 females (2 feet),with an average age of 34.2 years (range,21 to 53 years).The interval between injury and operation ranged from 1 to 11 days(3.8 days on average).A longitudinal incision approximately 2.0-3.5 cm in length was made around the ruptured Achilles tendon for minimally invasive repair after insertion of the Achillon.Postoperative rehabilitation was carried out. Results All the wounds healed at the first stage.All patients were followed up for 5 to 11 months, with an average of 7.2 months. All patients regained normal weight-bearing walking 3 months after operation without any re-rupture. According to the ankle-hindfoot scoring system of American Orthopaedic Foot and Ankle Society (AOFAS),they scored 93.2 points.By the visual analogue scale(VAS),they scored 1.2 points at the operation site. Conclusion The surgical treatment of acute Achilles tendon rupture with Achillon has advantages of mini-invasion,a low rate of incision problems and quick function recovery.

Objective To investigate the value of femoral neck fracture(FNF) typing by digital subtraction angiography(DSA) in prognostic prediction of the fracture healing. Methods From June 2005 to June 2008,45 patients were admitted to our hospital for treatment of single femoral neck fracture.They were 26 males and 19 females,aged from 26 to 60 years(average,45.4 years).Their fractures were all typed according to DSA results.Type Ⅰ ( 15 patients) were DSA pictures which showed 3 to 6 supporting band vascular images crossing the fracture line.Type Ⅱ(14 patients) were DSA pictures which showed one to 2 supporting band vascular images crossing the fracture line.Type Ⅲ(16 patients) were DSA pictures which showed no supporting band vascular images crossing the fracture line.All cases underwent close reduction and internal fixation with cannulated screws under C-arm fluoroscopy.The prognoses of all the patients were evaluated according to their symptoms and imaging examinations in terms of avascular necrosis of femoral head (ANFH) and fracture healing. Results All the patients obtained an average follow-up of 36.7 months (from 24 to 60 months).In patients of DSA type Ⅰ,the ANFH rate and nonunion rate were respectively 0 and 13.3％ (2/15).In patients of DSA type Ⅱ,the ANFH rate and nonunion rate were respectively 7.1％ (1/14) and7.1％(1/14).In patients of DSA type Ⅲ,the ANFH rate and nonunion rate were respectively 100％ (16/16) and 0.The ANFH rate following FNF treatment was negatively related to age and the vascular number showed by DSA.The nonunion ratewas positively related to age but not significantly associated with the vascular number showed by DSA. Conclusion DSA has a significant value in predicting the prognosis for patients with femoral neck fracture.

Objective To investigate clinicopathologic characteristics of obsolete Bennett fractures and their surgical treatment and prognosis. Methods From August 2008 to April 2010,13 patients with obsolete Bennett fracture were admitted to our department.They were 12 men and one woman,with an average age of 34.3 years (from 17 to 42 years).They had a fracture history of over 4 weeks to as long as 12 weeks (average,7.9 weeks).In all patients,after X-ray examinations,the radio-dorsal ligament complex of the first carpometacarpal joint was properly released,fracture gaps were cleared up,fracture fragments were anatomically reduced and fixed with a Kirschner wire,and at last the first metacarpal joint was fixed with the Kirschner wire crossing the joint Postoperatively all patients were immobilized with cast plaster for 4 weeks before the Kirschner wires acrross the joint were removed.Gradual rehabilitation was conducted.The X-rays were taken every month. Results The patients were followed for 6 to 24 months(average,14 months).The fractures healed in all the patients,with an average healing time of 3 months.No dislocation of the joints occurred.Injury to articular cartilage of the trapezium bone occurred in one patient,and no apparent pain was experienced in the other 12 patients.According to the Total Active Motion assessment,the thumb function was rated as excellent in 9 cases,good in 2,moderate in one and poor in one,with a good to excellent rate of 84.6％.Conclusions In obsolete Bennett fractures,the radio-dorsal ligament complex of the first carpometacarpal joint will have cicatricial contracture,preventing reduction of the fragments of the radio-dorsal joint.Therefore it is important to properly release the radio-dorsal ligament complex to achieve anatomical reduction of the radio-dorsal joint.An injury history of over 3 months and complicated injury to the trapezium bone cartilage may be significant factors affecting the prognosis of obsolete Bennett factures.

Objective To investigate the effect of insulin-like growth factor-1(IGF-1 ) on the osteogenic phenotype of fibroblasts. Methods Fibroblasts (Fbs) were derived from an adult New Zealand white rabbit through isolation,purification and cultivation.The experiment was conducted in 3 groups.In the control group,Fbs were cultured in conventional medium without any intervention factors.In the osteogenic induction group,the osteogenic induction medium was composed of conventional medium plus dexamethasone at concentration of 1 × 10-8 mol/L plus vitamin C at 50 mg/L plus sodium glycerophosphate-β at 10 mmol/L.In the experimental group,Fbs were cultured in osteogenic induction medium plus IGF-1 at the final concentration of50 ng/mL.Proliferation of Fbs in each group was detected by methyl thiazolyl tetrazolium (MTT)colorimetric assay.Alkaline phosphatase(ALP) activiiy was detected,osteocalcin 6 days after culture was determined,and the ability of osteogenic differentiation 2 weeks after culture was evaluated by calcium-cobalt staining. Results MTT showed that the cells grew significantly faster in the experimental group than in the other 2 groups( P ＜ 0.05),but there was no significant difference between the control group and the osteogenic induction group in this respect (P ＞ 0.05).The ALP expression in the experimental group was insignificantly higher than in the osteogenic induction group( P ＜ 0.05),but significantly higher than in the control group ( P ＜ 0.05).In osteocalcin secretory activity,the experimental group was significantly superior to the other 2 groups and the osteogenic induction group was significantly superior to the control group ( P ＜0.05).The experimental group had significantly more calcified nodules than the other 2 groups and there were few calcified nodules in the control group 2 weeks after culture. Conclusion IGF-1 can advance proliferation and osteogenic phenotype expression of the Fb stimulated.