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. [

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.

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.

BACKGROUND:Cybex NORMTM isokinetic dynamometer exhibits precise measurement,but the operation is too complex and the cost is too high to apply on routine examination.OBJECTIVE:To compare orthopedics tool measurement apparatus(OTMA)and Cybex NORMTM dynamometer in evaluating the range of motion after the treatment of shoulder.hip and knee joint diseases,and to verify tlle practical value of OTMA as a scientitic patent achievement.DESIGN,TIME AND SETTING:Clinical randomized control trial was carried out in the Rcsearch Center for Orthopaedics and Artificial Joint.Peking Union Medical College Hospital from October 2004 to March 2005.PARTICIPANTS:A total of 121 patients were randomly divided into two groups.OTMA group comprised 22 patients with shoulder periarthritis(22 shoulders).1 5 patients with avascular necrosis of the femoral head(21 hips),and 24 patients with knee osteoarthritis(33 knees).Cybex group comprised 21 patients with shoulder periarthritis(21 shoulders),16 patients with avascular necrosis of the femoral head(21 hips),and 23 patients with knee osteoarthritis(33 knees).METHODS:Two groups patients were treated with OTMA or Cybex NORMTM dynamometer,respectively,the range of motion was measured before treatment and 3 months,1 year after treatment.The Hospital for Special Surgery(HSS)knee rating scale,Karisson evaluation criterion of shoulder function and Harris hip score were applied to evaluate the patients,Visual analog scale(VAS)pain scale and short-form health survey(SF-36)were also used in this study.MAIN OUTCOME MEASURES:The range of motion in shoulder,hip and knee;Karlsson,Harris and HSS scores;VAS pain score and SF-36 score.RESULTS:OTMA measurement had a coincidence with Cybex NORMTM dynamometer measurement as 98.3%.All patients accepted and completed the measurement.The range of motion Was associated with HSS.Karlsson and Harris scores (P=0.002).CONCLUSION:According to three-dimensional space measurement,the digital OTMA may obtain the outcomes similarly with Cybex NORMTM dynamometer,it is also near to the practical value of joint angles.

Objective To evaluate the clinical results and safety of pedicle screw fixation for the treatment of spinal disorders. Methods From January 1988 to December 1999, 475 patients (216 males amd 259 females) with an average age of 49.1 years old in the male and an average age of 48.7 years old in the female, underwent pedicle screw fixation for spinal disorders. Diagnoses included 217 cases of spondylolisthesis, 76 lumbar stenosis, 32 degenerative lumbar spine instability, 72 thoracic or lumbar spine fractures, 60 scoliosis, and 18 others. The instrumentations were as follows: Dick 55 cases, Steffee 79 cases, CD 54 cases, RF 82 cases, DRFS 59 cases, TSRH 29 cases, USS 19 cases, SOCON 44 cases, Dynalock 24 cases, Diapson 22 cases, Tenor 5 cases, and CDH 3 cases. The fusion ranges involved one segment in 310 cases, two segments in 96 cases, and three segments in 9 cases. Hooks were applied in 60 cases. Results Four hundreds and twenty eight patients(90.l%) were followed up for (6.0?3.7)years. In the patients of degenerative spondylolisthesis, spondylolysis, lumbar stenosis, degenerative lumbar instability and thoracolumbar fracture, the amelioration of nerve function was 79.9%, 87.9%, 77.0%, 89.3%and 62.7%; the improvement of spinal motion was 90.5%, 90.9%, 83.6%, 92.9%and 52.5%; the amelioration of low back pain was 89.9%, 87.9%, 85.2%, 89.3%and 84.8%; and the amelioration of leg pain was 93.9%, 90.9%, 93.4%, 92.9%and 79.7%respectively. The mean reduction rate of degenerative spondylolisthesis, spondylolysis and spinal fracture was 90.5%, 87.9%and 91.5%respectively. The SOCON technique showed the highest reduction rate of an average of 92.3%, followed by RF of 90.8%, and Dick, Steffee and DRFS of 81.2%, while other instrumentations showed no satisfactory result in reduction. Complications occurred in 90 cases, in which 26 cases occurred during operation with the incidence of 6.1%, while 64 occurred after operation with the incidence of 15.0%. Conclusion Pedicle screws provide fixation of short segments with satisfactory clinical results and relatively high fusion rate. Perfect surgical technique is the key to reduce the incidence of complications.

Obiective To evaluate the value of allograft bone for acetab ular and femoral reconstruction in THA revision surgery. Methods A total of 19 p atients underwent reconstruction of acetabular and proximal femoral bone defects from June 1996 to December 2000 were reviewed. Eleven of the patients were men and 8 women with a mean age of 66.5 years and 63.2 years respectively at the t ime of resision surgery. According to AAOS system, the acetabular bone defects w ere classified into type I in 2 hips, type II 10 hips and type III 4 hips, and o n the femoral side, there were type I in 3 hips, type II 11 hips and type III 2 hips respectively. The reconstruction of bone defect of acetabulum included stru ctural allograft in 3 hips, impacted morselized allograft in 3 hips, and metal w ire mesh with morselized allograft in 3 hips. In all 3 of femoral segemental def ects, the reconstructions of the proximal femoral bone defects were done with st ructural allografts. Metalwire mesh with morselized allograft for femoral bone d efects were performed in 2 cases and morselized allogratts alone for femoral bon e defects in 4 cases; both acetabular and femoral bone defects were reconstruct ed with impacted morselized allografts in 6 cases (7 hips), and 4 patients with no bone grafts; Harris score system and radiograph were used for the final eva luation. Results Ninteen patients were followed up for an average period of 46 m onths (ranges, 6 to 68 months), Harris score improved from 42.7 points pre rev ision to 82.7 points at final follow up, the incorporation of allografts bone in 15 patients (16 hips) were noticed radiographically in all but one hip was fo und reabsorption of the structural allograft and radiolucents were found in the other 3 patients. No infection was encountered in this series. Conclusion If th e different types of bone defects were properly identified and suitable allogrft s adopted, reconstruction of bone defects with allografts during the THA revisi on surgery is a useful and reliable method. [

Objective To evaluate the standing bending, traction and fulcrum bending radiographies in the prediction of scoliosis correction. Methods 27 patients with thoracic scoliosis with an average of 16.4 years old were selected for the evaluation. All the patients were treated with the posterior correction and bone grafting fusion, and fixed with the third generation system of the segmental vertebral fixation, such as TSRH, CD, or CD+Horizon. Measurement of the Cobbs angle was carried out in the preoperative posterior anterior radiographies with the natural position, standing bending, traction and fulcrum bending and in the postoperative posterior anterior radiographies. Results Mean of Cobbs angle at the thoracic curve after operation was 31 degrees, which decreased significantly in comparison with the preoperative data. Average correction rate was 51.6%. The postoperative Cobbs angle at the thoracic curve was positively correlated with the preoperative Cobbs angle in the standing bending, traction and fulcrum bending radiographies. It was significantly different from the preoperative Cobbs angle in the standing bending and traction radiographies, while no difference was seen with the fulcrum bending radiography. Conclusion The fulcrum radiography can be used to evaluate the flexibility of the thoracic scoliosis, and is better than the standing bending and traction radiographies. The three methods should be used together for the analysis of the scoliosis to predict the result of the scoliosis correction.

Objective To investigate the expression of the basic fibroblast growth factor (bFGF) in normal and degenerated human intervertebral discs in order to determine whether bFGF is related to degeneration of the intervertebral disc. Methods The specimens of the intervertebral discs from 11 male and 19 female patients undergone lumbar disc herniation surgery (observation group) and 6 patients with scoliosis following anterior release (control group) were harvested. The tissues were histologically observed to confirm their degenerated or normal status and then conducted for the expression of bFGF and its mRNA with immunohistochemistry and in situ hybridization. Results In the observation group, all the samples were found to be degenerated disc tissue, and the positive rate of the expression of bFGF was 90% (27/30) with immunohistochemistry and 20% (6/30) with in situ hybridization. In the control group, all the samples were shown to be normal disc tissues, and had negative expression of bFGF with immunohistochemistry and in situ hybridization. The positive rate of the expression of bFGF showed significant difference between the two groups. Conclusion The expression of bFGF showed significant difference between the degenerated and normal intervertebral discs, which indicated that the bFGF might promote proliferation of chondrocyte and synthesis of extracellular matrix in the degenerated discs as a proliferation stimulating factor.