Objectiv e To evaluate the mid-term and long-term clinical outcome of total hip re-pl ace ment in patients with hip congenital dislocation.Methods From June198 3to Decem ber1998,36hips in32patients di agnosed as congenital disloca tion of hip(CDH),aged22to69years old(with the mean of 48.5years), were treated with total hip replacement (THR).Thirty-one hips of 28patient s were fol lowed-up with the duration of 9.5years(3.5to18years).Ac c ording to our system,the congen ital dys-pla sia of hip was divid ed into th ree degrees:the first degree was subluxation in15hips,the second degree was in termedi ate dislo cation in11hips,and the third degree was high dislocatio n in5hips.The fixation of the prosthetic compo nents was as follows :10cup s and12stems with cement,21cups and19stems with un-cement.In acetab ula r preparation,most of the patients with subluxation(13hips)underwent deep ening of the acetabu lum and were installed with larger cups;deepening of the acetabulum,smaller cup and auto femoral grafting on the su perior lip fixed w ith screws were performed in2hips with subluxation and all of hips with interm e di ate and high dislocation.Results The complications included intra operativ e lesser trochanter fracture in1case,deep vein thrombosis and thromboembolism of femoral artery in1case re spec-tively,limb discrepancy in3cases,asepti c loosening in4cases(1with trochanteric nonunion and migration,1with stem l oosening and2with both stem and cup loosening).The Harrisscore was85in th e other27hips(48scores before surgery).Con clusion Total hip replacement in patients with congenital dislocation of hip could be some what difficult be cause of the liability to complications.The techni cal difficulties en coun-t ered during surgery in cluded the correction of the length of bilateral lower extremi ty,the balance of the abductor muscles,the re lease of the soft tis sue,the dealing of the su perior segmental defect of acetabulum and selectio n of the compo nents.

Objective To observe the expansion of transverse width of post screw-implantation in the pedicle and assess the effect of the relative diameter and BMD on the expansive rate. Methods There were 48 vertebral bodies, and 96 pedicles, obtained from 4 human cadaveric T2～L1 specimens (the mean age of 41 years). The BMD(A), pedicle width (B) and height were measured respectively. According to groups of BMD(A1:0.44～0.52 g/cm2;A2:0.52～0.70 g/cm2;A3:0.70～0.92 g/cm2 and the relative diameter(screw/pedicle)(B1:40%～55%;B2:55%～70%;B3:70%～85%), the tests were classified into 9 groups (A1B1?A1B2 ?A1B3?A2B1?A2B2?A2B3?A3B1?A3B2 and A3B3). The implantation procedure was carried out under the uniform standard. Results The number of valuable date was 85, while 11 dates were excluded, including 4 burst pedicles in A3B3 group. According to the statistical analysis, the pedicle width was expanded after implantation. The expansive rate of pedicle width was influenced significantly by the relative diameter and BMD(P

Objective To define the role of melatonin in the pathogenesis of chickens scoliosis following pinealectomy and constant light irradiation. Methods Ten white leghorn chickens in the control group were kept in light-dark (12h:12h) cycle, 500 lx in daytime and 0-5 lx in nighttime after birth. Pinealectomy was performed in 20 white leghorn chickens when 3-day-old and then kept in light-dark cycle as the control group. Constant light (500 lx) irradiation was used to reduce the secretion of melatonin in 20 chickens after their births. Radiologic examinations were performed on all chicken spines for scoliosis monthly. When the chickens were 3-month-old, their mid-day and mid-night serum samples were collected and analyzed with ELISA kit for melatonin. Results There was no scoliosis in the control group and constant light group when the chickens were 3-month-old. In the pinealectomy group, 4 chickens had obvious scoliosis in the first month when X-ray examination was taken. The curved deformity progressed and became serious when the chickens grew up. There were 7 chickens with severe curved deformity in the second month. When the chickens were 3-month-old, there were totally 11 chickens with scoliosis, Cobb' angle 11?-85?, average 30.63?. The level of melatonin in control group was low in daytime (10.6 pg/ml) and high in nighttime (110.4 pg/ml) alternately. The melatonin level was much lower, daytime 8.4 pg/ml and nighttime 6.9 pg/ml in pinealectomy group and 10.8 pg/ml in constant light group. There was no statistical significance in the serum melatonin between the pinealectomy group and constant light group. Both groups remained low level of serum melatonin. Conclusion Pinealectomy can reduce the secretion of melatonin and induce scoliosis in chickens. Although constant light could suppress the secretion of melatonin in chicken serum, it did not induce scoliosis. The pathogenesis of chickens scoliosis might not be mediated by low-level melatonin.

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.

Objective To explore the clinical value of 3-dimensional CT angiographic (3D-CTA) imaging of vertebral artery. Methods Volume rendering (VR) and shaded surface display (SSD) of 3D-CTA were adopted to examine 67 patients whose primary clinical diagnosis was vertebral artery insufficiency. Among them, 7 were examined with selective vertebral artery angiography.Results One hundred and thirty-three vertebral arteries (52 normal ones and 81 with lesions) were displayed and the rest one was not displayed due to complete occlusion. The lesions consisted of congenital abnormities, compression or displacements caused by traction, rough vascular surface, calcification, lumen stenosis, partial occlusion etc.. The vertebral arteries with developmental abnormities could be complicated with various other lesions, also the lesions might occur on multiple sections of a single vertebral artery; the description was as follows: there were 31 vertebral arteries with congenital abnormities (17 with developmental thinness and 14 with abnormally extended courses); 11 with lesions on initial sections (V1) (10 with roughened vascular surfaces and thin diameter, among which 3 were twisted in an anglular shape and 1 was calcified ); 30 with lesions (13 with the displacements caused by hyperosteogeny compression, 7 with internal displacements caused by traction, 10 with local lesions) on cervical vertebrae sections (V2) and atlanto-occipital section (V3); 55 with lesions (52 with beaded shapes and coarse walls, among which 2 had calcification and 3 partially blocked ) on intracranial sections (V4). Thirteen lesions on 8 abnormal blood vessels out of the 14 blood vessels of 7 patients, who were examined with the selective vertebral artery angiography, had lesions including stenoses displayed as significant by 3D-CTA but displayed as mild by DSA on 2 intracranial sections, and the examining results of 3D-CTA conform to those of DSA for lesions on other 11 sections. Conclusion 3D-CTA can distinctly display the whole course of the vertebral arteries and show its anatomical relationships with vertebrae. 3D-CTA is superior to other angiographic method to display congenital abnormalities and/or calcification of the vertebral arteries and assess the status of vertebral bones. It provides important information for diagnosis of vertebral artery disease.

Objective To explore the clinical value of helical CT surface shaded display (SSD) and multiplanar reconstruction (MPR) images in diagnosing the acetabular fractures. Methods According to the anatomical basis of "Y" type cartilage in children acetabulum, adult acetabulum was divided into "two columns" the anterior and posterior column and "four walls"the anterior, posterior, medial and roof walls, so as to define the localization, type, interface and union of fractures accurately. Results From 1999 to 2001, 68 cases of acetabluar fractures were reviewed. Of 68 cases, 28 cases were diagnosed as complex double columns and three walls (anterior, posterior and interior wall respectively) fracture, 7 cases as complex single column (anterior column) and three walls (anterior, posterior and interior wall) fracture, 5 as complex single column (anterior column) and two walls (anterior and interior wall) fracture, 21 as simple posterior wall fracture, 7 as simple anterior wall. In this group, 21 complex double columns and three walls fractures, 7 complex single column and three walls fractures, 5 complex single column and two walls fractures, 15 simple posterior wall fractures, 3 simple anterior wall fractures had reduction and internal fixed with plates or absorbable screws; another 7 complex double columns and three walls fractures, 6 simple posterior wall fractures, 4 simple anterior wall fractures were treated with traction reduction because the separation and displacement of their fragments were not significant. Using ?2 statistical analysis,there was a significant difference between the X-ray film and SSD and MPR in demonstrating the numbers and types. Conclusion SSD and MPR reconstruction imagines are of instructive importance in sufficient evaluation, operative preparation and appropriate instrumentation of internal fixation. In the management of acbtabular fracture, plates are needed to stabilize the fracture involved the anterior or posterior column, while the fragments of anterior or posterior wall are only fixed with screws, small fragments could be removed in order to avoid forming loose body. Therefore, SSD and MPR are the regular and important method in preoperative examination of complex acetabular fracture and dislocation.

Objective To evaluated the surgical techniques and results of open reduction and internal fixation performed for ankle fracture. Methods Eighty-two patients with ankle fracture were treated with open reduction and internal fixation from March 1995 to June 1999. Fifty-eight patients with complete clinical data were analyzed. The patient group consisted of 36 males and 22 females. According to Weber-AO classification, the group was made up of 30 Weber B cases,28 Weber C cases. All patients were evaluated with modified Baird and Jackson scoring system. The relationship between final result and fracture pattern, fixation methods, the time of exercise initiation after operation were analyzed respectively. Results The followed-up period varied from 2 months to 52 months, with an average of 17 months. The number of patients whose results was excellent, good, fair and poor was respectively 31, 18, 6 and 3. The total percentage of good to excellent clinical results was 84.5%. Fifty-four ankles were completely pain free and the remainders had only slight pain after long time walking. Conclusion Operative treatment may provide satisfactory fracture reduction and clinical results for ankle fracture. Correct fracture pattern estimation and proper internal fixation is of importance to achieve and maitain reduction, and then, to gain better long term results.

Objective To investigate the characteristics of looped ankle injury caused by cord strangulation, seek proper treatment to decrease amputation rate, and restore limb function as much as possible. Methods Among the nine patients with looped strangulation ankle injury, 7 had both their anterior and posterior tibia arteries involved, while the other 2 patients had only their posterior tibial artery involved. There were 4 patinets suffered from combined open tibia and fibula fractures, 2 patients from close tibia and fibula fractures; and another 2 patients from external malleolus fracture. The interval from injury to treatment varied from 6 to 27 hours(average 12 hours). All patients were treated with surgical procedures as soon as possible, blood vesseles and nerve injuries were detected and anastomosis had been done if necessary. All fractures were fixed externally. Results The limbs of all 9 patients were salvaged successfully. Most function of the injured limbs were restored. Only one external malleolus fracture malunited and was treated successfully by subsequent osteotomy. Conclusion Emergent intervention is of great importance to looped ankle injury caused by cord strangulation. Once blood vessel or nerve injuries are suspected, surgical detection or anstomosis if neccessary, should be done as soon as possible. All the associated fractures should better be fixed externally, and in order to avoid "tourniquet effect"the injured skin should be incised as early as well. With proper limb salvage procedure, good or excellent result may be achieved even in the patient with a delayed diagnosis.

Objective To summarize the techniques and results of midfoot amputation and discuss the role of the tendon balance in this operation.Methods Twenty-six traumatic midfoot amputions were performed from 1990 to 1999. The amputation level ranged from the base of metatarsal to the Lisfranc's joint. The bone stump should be smooth, round and arc featured, the amputation line needn't pass the joints, four extensor longus tendons were divided into two groups and the groups were weaved each other. Bone stump were drilled a hole through which extensor tendon stumps were re-attached to the bone stump. Anterior tibial tendon could also be re-attached to the front aspect of the bone stump with the above mentioned procedure. In case the navicular could not be preserved, midfoot amputation should be given up. Results Among the group, 15 cases were followed-up 2 to 10 years after operation. No case had equinovarus deformity, all cases could flex ankle dorsally to 0? or more, but 4 cases had painful callus on the stump, and 1 case slight ulceration. The other cases in the group got satisfactory outcomes. Conclusion In terms of midfoot amputation, different amputation level leads to different tendon imbalance. Proper tendon balance and appropriate stump repairing is of importance to reconstruct balanced plantar biomechanics,and then, to achieve good long term result.

Objective To investigate the result of McBride operation for treatment of hallux valgus with more than 5 years follow-up. Methods There were totally fifity patients who underwent McBride operation in this study. The follow-up period varied from 5 years to 10 years and 2 months (average 7 years and 1 month). The symptoms and deformity before and after operation were compared statisticly. Results The angle between first phalanx and metatarsal is strongly correlated with the angle between first and second metatarsal.The coefficience of pre- and post-operation is 0.84 and 0.71 respectively.There were 64 feet whose symptoms were eliminated and the deformity were corrected basically. The effective rate was 71.1% according to the assessment criteria discribed by doctor ZHU Lihua. The common complications were pain residue, local numbness, hallux valgus recurrence, hallux varus and claw toes. The measurment showed the angle between first phalanx and metatarsal significantly decreased after operation and the angle between first and second metatarsal also decreased following the hallux valgus correction. Conclusion McBride operation is a good and reliable method to treat young patients with mild to moderate hallux valgus. Complications are related to congenital foot deformity, severe valgus deformity and normal structure injuries during the operation.