Progress has been made in the treatment of long bone shaft fra ctures in recent years with its therapeutic focus on the mechanical priorities o f the disorder shifting to the biological ones. ‘Biological internal fixation’ is a new concept. ‘Flexible fixation’ has been recommended to promote forma tion of callus, and precise indirect reduction to reduce operative lesion. Inspi ring results have been achieved in the internal fixation systems and external fi xator which resulted from the clinical application of the new concept. The inter nal fixation systems include interlocking intramedllary nail, point contact fixa tor(PC-Fix), limited contact-dynamic compression plate(LC-DCP), bridging plat e(BP), Less Invasive Stabilization System(LISS), locking compression plate(LCP), and so on.

Spine surgery,one of the most important ramifications in orthopedics,has stemmed from modern medicine,in vivo implantation and biomechanics.Its continuous perfe ction and development have been goin g side by side with advancement of medical s cience,close affiliation of new materials and engineering,and unceasing invention of new techniques.The Chinese Spine Surgery Group of the Chinese Medical Association Orthopedic Society was es-tablished in 1985.Since then great progress has been made in both basic th eory and clinical practice.Chinese surg eons have done a marvelous job in almo st every field of spine surgery,such as treatment and basic research of spin al fracture and dislocation and /or com bined with the spinal cord injury,sp inal infection and neoplasm,and degenerative spine diseases.They have also de-veloped many new techniques and meth ods independently.With increasing communication with both domestic an d international scholars,spine sur gery in China has reached a new level and caught up with the most advanced in the world in some fields.This paper reviews the brief history of Chinese spin e surgery with special reference to th e Chinese Spine Surgery Group,surge ry ap-proaches,internal fixation techni ques,minimally invasive surgery an d basic research. [

Objective To investigate the characteristics of histopathological changes of osteoarthritic cartilage. Methods The specimens of patellar articular cartilages from 31 knees of 29 patients with osteoarthritis and 2 knees of 2 young adults were studied under transmission electron microscope (TEM) and immunohistochemistry. The ultramicroscopic changes of patellar cartilage and the expression of type Ⅱ collagen in the extracellular matrix were analyzed. Results In Stage Ⅰ, the immunohistochemical staining of type Ⅱcollagen enhanced in all layers of articular cartilage, especially in the superficial layer, the staining was positive, particularly at the peripheral area of chondrocytes. TEM showed broken collagen fibrous networks, more lipid droplets, glycogen and vacuoles in cytoplasm, organelles swelling and increasing. In Stage Ⅱ, the immunohistochemical staining of type Ⅱcollagen increased in the superficial and middle layer of articular cartilage, especially in the chondrocytes around fissures; it was also positive in extracellular matrix, besides, there was irregular nucleus, chromatin concentration and organelles decreasing. In StageⅡ, severe disordered arrangement of collagen fibers, macrolipid droplets and a great number of vacuoles appearing in cytoplasm. In Stage Ⅲ the nuclear pycnosis, cells breaking into numerous fatty debris and forming a micro-scar or an empty lacuna. Index of staining of the immunohistochemical characteristics of type Ⅳ collagen from StageⅠ-Ⅳ were 48.43?11.96, 53.36?10.12, 8.01?3.89, 4.34?2.39 respectively, while in comparison with the normal cartilages, there were significant difference in all stages (P

Objective To analyze the fracture characteristics, operative indicators, complications and treatment results of intertrochanteric fractures of femur in over 80 years old cases. Methods A total of 87 cases (90 hips) of intertrochanteric fractures with mean age over 80 years treated with operative methods from October 1996 to October 2004 were reviewed upon fracture types, preoperative primary diseases, operative methods and postoperative complications. Results The average age was 83.5 years. Of all, 74 cases had different physical diseases included cardiovascular, cerebrovascular, respiratory, digestive system and others (average 2.4 diseases per person). Treatment methods included DHS and intramedullary interlocking nail such as Gamma nail, PFN and reconstructive nails. A follow up for six months in 63 cases showed that excellence rate of functional evaluation was 84%(53/63). Conclusions The full evaluation and treatment of preoperative diseases are the prerequisite for the intertrochanteric fractures in the elderly, for the intertrochanteric fractures in the elderly have high incidence and many preoperative diseases and severe complications.

It is generally known that postoperative pain can cause many adverse clinical effects on the patients of orthopaedic surgery such as lack of exercises of the involved limb,atrophy of the related muscles,anchylosis,osteoparosis,et al,which will ultimately affect the patient's final recovery and living quality.This paper introduces some recent advanced theories about the orthopaedic postoperative pain diagnosis,evaluation and various kinds of treatments hoping to achieve more effective perioperative analgesia in orthopaedic surgery.

China ; Forecasting ; Orthopedic Procedures ; trends ; Orthopedics

[Objective]A prospective comparative evaluation of fulcrum bending radiographs(fulcrum)to determine curve flexibility and predict surgical correction in adolescent idiopathic scoliosis(AIS).[Method]A total of 64 consecutive patients with AlS according to inclusion and exclusion criterias who underwent surgical treatment were studied.All curve types were single-curve and the PUMC classification were Ia/Ib/Ic.All patients were divided into 4 groups according to the magnitude of Cobbs angle in preoperative standing anteroposterior radiograph:moderate thoracic curve(20 cases,40?60?),moderate lumbar curve(21cases,35?60?).The Cobbs angles were measured and the flexibility ratio was determined on fulcrum radiograph.The amount of correction obtained by fulcrum radiograph was compared with the amount of surgical correction by evaluating the differences from surgery as absolute values.The correlation of Cobbs angles between postoperative standing anteroposterior radiograph and fulcrum radiograph were analyzed.[Result]For the moderate thoracic curves,curve flexibility provided by fulcrum radiograph has no significant difference(P=0.141)from surgical curve correction,there was no significant difference(P=0.094)between the mean Cobbs angle on fulcrum bending and that on postoperative standing anteroposterior radiograph.The postoperative Cobbs angle was positively correlated with the preoperative Cobbs angle on fulcrum radiograph and the correlation degree in the moderate lumbar curve was relatively weak.[Conclusion]Fulcrum radiograph can only be used to assess the flexibility and correction of moderate thoracic curves in AIS.Pedicle screw instrumentation provides even more correction.

Objective To investigate the surgical management of scoliosis in neurofibromatosis Ⅰ type. Methods Since 1983, the results of surgical intervention of 31 consecutive patients for scoliosis in neurofibromatosis were reviewed. There were 19 males and 12 females. The mean age of the patients was 15.4 years (range, 5 to 25 years). The type of curve in scoliosis included thoracic curve in 23 patients, lumbar curve in 3 and thoracolumbar curve in 5. There were 6 cases of thoracic curves associated with kyphosis. The mean Cobb angle of scoliosis was 85.9? ranging from 45? to 145?, and the mean Cobb angle of kyphosis was 81.3? ranging from 43? to 120? before operation. The surgical methods included posterior operation in 17 patients, anterior operation in 2, and combination of anterior and posterior in 12. The instrumentation used for internal fixation included Harrington rod in 7 patients,Luque rod in 3, combination of Harrington and Luque rod in 5 patients, CD in 4 patients, CDH in 3 patients,TSRH in 7, and PRSS in 2, 10 cases of whom only single rod fixation were used. Results The patients were followed up for an average of 9.4 years (range, 1-18 years). The correction rate of Cobb angle in scoliosis was 33.4% in scoliosis, and 39.6% in kyphosis postoperatively. The complications of the group consisted of Luque rod breakage in 1 patient, Harrington rod breakage in 1, Harrington rod and Luque wire breakage in 1,nonunion of bone graft and pseudarthrosis in 4, curve aggravation in 1. One patient underwent revision for three times because of recurrent hook dislodgement. Conclusion Scoliosis in neurofibromatosis should be operated early, sufficient bone graft and the solid instrumentation for internal fixation are required.

Objective The study was to probe into the causes and strategies of decompensation after operation in adolescent idiopathic scoliosis in order to reduce the operative mistakes and be aware of pitfalls in scoliosis surgery.Methods From July1997to December2001,174patients underwent the operation of three-dimensional correction of adolescent idiopathic scoliosis,ten of them developed postoperative decom-pensation.Other four patients with postoperative decompensation were referred to our hospital,who received the primary operation for idiopathic scoliosis at the local hospital.In all,fourteen patients with decompensa-tion were retrospectively reviewed including3male and11female cases aging from12to23years(range,15.7years).The criteria of postoperative decompensation was defined as trunk shift more than2mm,shoul-der tilting,aggravated distal lumbar rotation in coronal plane,the plumb line of center of C 7 deviating the from the posterior edge of S 1 and kyphosis of thoracic-lumbar junction more than10degree in sagittal plane.Results The analysis was made depending on preoperative and postoperative X-ray films,the causes of de-compensation after surgery included classification error,inappropriate fusion level,over correction for tho-racic curve and insufficient knowledge of lumbosacral hemicurve in this group.According to the patientssubjective symptoms and decompensation conditions,ten of the patients were treated surgically,which in-cluded re-fusion and fixation for3patients,fusion level extension for6patients and fusion of the upper tho-racic curve after removing major thoracic curve instrumentation for one patient.The other four patients re-ceived conservative therapy with brace.The patients were followed up from1to3years(average,18.9months),except one case followed up to6months.Twelve patients regained spinal balance;two patients re-mained more than20mm trunk shift.Conclusion Although operative treatment is frequently used for idio-pathic scoliosis,it is important to recognize the necessity for operative intervention,indication for surgery.The adolescent idiopathic scoliosis should be operated according to the curve type and flexibility,the appro-priate fusion level and operative procedures can contribute to lessen the postoperative decompensation.If postoperative decompensation occurs,therapeutic decision should be made according to subjective symptoms and the decompensation type of the patients.

Objective To determine the best method of revision for failed pedicle screw by investigating the change in maximum insertional torque and axial pullout strength after placing a larger diameter and/or longer screw or augmenting the failed hole with bone shims or PMMA. Methods Six fresh male adult cadaveric spines from T10-L5 were harvested. These specimens, aging from 23 to 51 years with an average of 36.7 years, were divided into six groups: 1)Using a larger diameter screw; 2)Using a longer screw; 3)Using a larger and longer screw; 4)Augmenting with bone shims; 5)Augmenting with PMMA; and 6)Reinsertion after being backed out. The first three groups were subdivided into two groups. Maximum insertional torque and axial pullout strength of each original screw were recorded as control data. Change of maximum insertional torque and axial pullout strength between original and corresponding revision screws were noted. Measurements were analyzed using one-way ANOVA statistically by SPSS10.0. Insertional torque change after simply removing and replacing a 5.0 mm?40 mm screw was also measured. Results Among the changes in pedicle dimensions, the greatest improvement in peak insertional torque and axial pullout strength occurred when using a 2 mm larger and 10 mm longer screw, with an increase of 37.06% and 18.22%; a 2 mm larger screw increased peak insertional torque and axial pullout strength by 20.15% and 19.99% respectively, while a 1 mm larger and 5 mm longer screw increased by 19.23% and 10.07% respectively; use of a 5 mm or 10 mm longer screw decreased peak insertional torque by 32.80% and 14.02% respectively, with axial pullout strength down by 27.36% and up by 43.25% respectively. Use of bone shims caused a decrease of the insertional torque and axial pullout strength by 14.99% and 29.34% respectively. Hole augmentation with PMMA lead to a significant increase in insertional torque but a decrease in axial pullout strength by 37.40%. Simply removing and replacing an original screw resulted in a decrease in insertional torque by 34.22%. Conclusion Revision for pedicle screw is most effective when using a 2 mm larger diameter screw, next by using a 1 mm larger diameter and 5 mm longer screw. Use of a bone shim should be avoided. The efficacy of hole augmentation with PMMA need to be further investigated.