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: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.

BACKGROUND: Measurement is frequently performed in diagnosis of orthopedics, and involved in various correction andtreatment of congenital and acquired deformity. The perioperative measurement of affected knees of patients undergoing totalknee replacement (TKR) is significant.OBJECTIVE: To clinically evaluate and validate 4 domains of a self-designed simple medical orthopedics tool measurementapparatus (OTMA) according to the results of Cybex Norm measurement system, an international standard measurementapparatus, for osteoarthritis patients during TKR.DESIGN, TIME AND SETTING: Stratified, randomized, Controlled experiment. The study was performed at the Department ofOrthopedics, Peking Union Medical College Hospital between October 2004 and March 2006.PARTICIPANTS: A total of 47 patients (66 knees) with osteoarthritis of knee, undergoing TKR, were selected and randomlydivided into 2 groups: OTMA group (n=24, 33 knees) and Cybex group (n=23, 33 knees).METHODS: Range of motion (ROM) of two groups was measured respectively using OTMA and Cybex Norm, before and 3months after treatment as well as the final time of 1-year follow up. The ROM results were evaluated by Hospital for SpecialSurgery Knee Score (HSS) scale for knee joint. The visual analog scale and MOS 36-item Short Form Health Survey (SF-36)scale were filled to verify the applicability and reproducibility of OTMA. The correlation of measurement results and subjectivescale evaluation was analyzed to verify the evaluation efficiency of OTMA.MAIN OUTCOME MEASURES: Coincidence of ROM of two groups at different time points; correlation of scale scores and ROM.RESULTS: All patients were followed up. The coincidence rate of measurements between OTMA and Cybex Norm was 98.3%,HSS scale scores were increased with increasing ROM in both groups (P < 0.01). Correlation analysis showed that ROM washighly correlated with scale results, consistent with the clinical manifestation of patients.CONCLUSION: The measurement process was accepted by all patients, and could be performed repetitively. OTMA displaysprecise measurement, which could reflect clinical symptoms of patients and assist clinical diagnosis.

0.05). In Group 2, the mean maximum pull out strength of the GSS screws was 127% of that of the CCD control screws, while the mean maximum pull out strength of the TSRH screws was 64% of that of the CCD control screws. The mean maximum pull out strength of the GSS screws was significantly higher than that of the TSRH screws (P0.05). Conclusion GSS screws offer better anchoring in revision surgery than most of the currently used screws do.

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.