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. [

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.

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: How to evaluate the cervical curvature correctly has been a greatly concern of spine surgeons. In recent studies, cervical curvature index(CCI) and cervical spine angle(C2-7) were often used by foreign researchers.OBJECTIVE: Ishihara method and spine angle(C2-7) method were applied to measure the cervical curvature, and the correlation between the two methods was compared as well.DESIGN: An observational controlled trial based on the patients.SETTING: Department of Orthopaedics of Peking Union Medical College Hospital.PARTICIPANIS: Totally 63 cases including 34 male and 29 female patients with cervical spondylopathy were involved in the Department of Orthopaedics of Peking Union Medical Clooefe Hospital from July 2002 to July 2003.METHODS: The 63 cervical spondylopathy patients' cervical spine lateral X-ray films were evaluated.MAIN OUTCOME MEASURES: Main outcomes: ① The patients' CCI and the cervical spine angle; ② Relationship between their CCI and the cervical spine angle. Secondary outcomes: ① Regressive equation derived from their CCI and the cervical spine angle; ② Comparison of CCI and the cervical spine angle between male and female. RESULTS: The CCI(Ishihara method) was averaged 10. 1 (SD, 11.6), and the cervical spine angle(C2 -7) 17. 5 °(SD, 13.5). A highly significant correlation was found between the two indexes( P＜0.01). Sex and age factors were found to be irrelevant to them.CONCLUSION: The CCI (Ishihara method) and the cervical spine angle (C2-7) are significantly correlated with each other.

China ; Forecasting ; Orthopedic Procedures ; trends ; Orthopedics

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.

Objective To evaluate the clinical manifestation and operative treatment for the scolio-sis of Marfan syndrome, and analyze its clinical outcomes as well. Methods The retrospective study cov-ered 10 patients including 8 females and 2 males with an average age of 12.9 years (9 to 16 years), who had undergone operations from January 1990 to December 2002. The Cobb's angle in the coronal and sagittal plane, the trunk shift, the apex rotation and shift were evaluated both before and after operation respectively. In the group, there were four cases with family history. Of the 10 cases, the classification of scoliosis was single curve in two cases, double curves in six cases and three curves in two cases. Results All the pa-tients were followed up for a mean time of 15 months, ranged from 4 months to 3 years. The trunk shift changed from the mean distance of 2.17 cm to 1.41 cm. The apex rotation decreased about 1?. The apex shift changed from the mean distance of 4.57 cm to 2.14 cm. The mean Cobb's angle in the coronal plane changed from 88? to 42?. The correction rate was about 46.38% (18.18% to 81.54%). The Cobb's angle on the final follow-up was 46?( 11? to 96?), and the mean lost angle was 4?. The mean Cobb's angle of the thoracic kyphosis was 20?(-10? to 52?) preoperatively and 23?(0? to 35?)postoperatively, and 24?( 0? to 35?) on the final follow-up. The Cobb's angles of the thoracolumbar kyphosis of 5 cases improved from 85? to 10? after operations, and there was no angle loss on the follow-up. Conclusion The three dimensional corrective instrumentation can be used effectively for the correction of the scoliosis of Marfan syndrome. The critical points for the successful operation are the simultaneous correction of the coronal and sagittal plane deformities, prevention of the dural expansion in the lumbar or lumbosacral canal, rigid and multi-segmental internal fixation, extensive and ample bone fusion, and correct external fixation after operation.