BACKGROUND:Closed reduction and internal fixation are mostly used to treat fracture dislocation of tarsometatarsal joint, but cannot obtain satisfactory repair effect. Redisplacement easily appeared after local sweling subsidence. Therefore, open reduction and internal fixation are actively used in the clinic to treat fracture dislocation of tarsometatarsal joint so as to restore foot function and to elevate quality of life. OBJECTIVE:To explore the clinical effect of open reduction and cannulated screw and Kirschner wire fixation for fracture dislocation of tarsometatarsal joint. METHODS:A total of 42 patients with fracture dislocation of tarsometatarsal joint in the 88 Hospital of Chinese PLA from September 2012 to September 2013 were selected and were given open reduction and cannulated screw and Kirschner wire fixation. After treatment, the recovery of patients was observed, and ankle hindfoot function was assessed with American Orthopaedic Foot and Ankle Society ankle hindfoot score. RESULTS AND CONCLUSION:A total of 42 patients were folowed up for 1-12 months. American Orthopaedic Foot and Ankle Society ankle hindfoot score results showed that there were excelent in 30 cases, good in 10 cases, and poor in 2 cases, and the 2 patients were subjected to high energy soft tissue injury. 37 patients in 4-6 months after operation started weight-bearing walking. Three patients had mild pain, a certain functional limitation, but could maintain normal walking gait. The remaining two patients complicated with traumatic arthritis, and were unable to do normal weight-bearing walking. These results show that open reduction and cannulated screw and Kirschner wire fixation can achieve good effect of anatomical reduction of fracture dislocation of tarsometatarsal joint, and improve patient’s ankle function.

Objective To investigate the expression of matrix metalloproteinases and tissue inhibitor of metalloproteinases in active Mooren's ulcer corneas.Methods An indirect immunofluorescent technique was used to visualize the presence of matrix metalloproteinase-1,2,3,9 and tissue inhibitor of metalloproteinase-1,2 in active Mooren's ulcer corneas from 6 patients and normal human corneas from 4 corpses.The results were further analyzed by an image-processing system.Results Only TIMP1,2 were detected in normal corneal epithelium while MMP-1,2,3,9,and TIMP-1,2 all were found in Mooren's ulcer corneas.MMP-2,TIMP-2 expressed in epithelium,MMP-3 expressed in stroma,MMP-1,9,and TIMP-1 expressed in both epithelium and stroma.Conclusion In active Mooren's ulcer cases,corneal lesion and corneal wound healing coexist,but the destructive reaction is greater than wound healing.Over-expression of MMP-9 and unbalanced regulation of MMPs/TIMPs may play an important role in the Mooren's ulcer of this stage.

[Objective] To discuss the clinical manifestations,treatment,and therapeutic efficacy of lumbar disc herniation complicated by lumbar spinal stenosis in elderly patients.[Method]Thirty-six elderly patients with lumbar disc herniation complicated by lumbar spinal stenosis were treated with surgical treatment,including multi-segment fenestration,laminectomy,resection of nucleus pulposus,and internal fixation of pedicle screws.The therapeutic efficacy was retrospectively assessed.[Result]All patients were followed up with an average time of 3 years and 6 months.The good to excellence results was 83%.[Conclusion]In elderly patients with lumbar spinal stenosis,there are patients have special clinical manifestations.Different operations should be adopted for different patients.There are several important factors that affect the efficacy of operation,including operation modes,sufficient decompression,restotation of spinal instability,and postoperative exercises of lumbodorsal muscles.

[Objective]To analyze and evaluate the relevant factors of recurrent lumbar disc herniation for providing strategy of prevention of this syndrome.[Method]Sixteen cases of recurrent lumbar disc herniation were analyzed according to medical history,physical examination and image examination before re-operation and the primary operation,and all the patients received exploration during operation.[Result]The relevant factors of recurrent lumbar disc herniation were as follows:the extent of disc degeneration,the stability of lumbar spine,the time of getting out of bed after primary operation and the weight of the patients.[Conclusion]Besides iatrogenic factors,there are several factors related to recurrent lumbar disc herniation,including the characteristics of disc and lumbar spine,as well as the compliance of patients.To remove these factors is the main preventive strategy of recurrent lumbar disc herniation.

[Objective]To investigate the surgical treatment of recurrent lumbar disc herniation. [Methods]A total of 17 patients with recurrent lumbar disc herniation were grouped into stable,unstable and severe unstable groups according to the dynamic X-ray film. Patients in stable group and unstable group were treated with open-window discectomy, and those of severe unstable group were treated with full laminectomy, decompression, pedicle screw fixation and fusion. JOA and VAS system were used to follow up before and after operation. Statistic analysis was performed between the stable and unstable groups in pain score and recovery rate.[Results]All the patients were followed up for 3 month to 3 years. The average JOA score was 4.94 before operation, and 12.18 at follow-up,with an average recovery rate of 71.74%. There was no statistic difference between stable group and unstable group in recovery rate.[Conclusion]For patients with spinal instability and chief complaint of leg symptom, reoperative treatment for recurrent lumbar disc herniation can be done with open-window discectomy which may offer good outcome.

[Objective]To evaluated the clinical results of the ulnar osteotomy and external fixation for the treatment of chronic anterior dislocation of head of the radius in children.[Method]From 2002 to 2004,thirteen cases of children with chronic anterior dislocation of the radial head were treated by ulnar osteotomy,external fixation and close or open reduction of elbow joint but without repair of the annular ligament. Their mean age was 5.5 years(2 to 11) and the mean interval between the injury and reconstruction was 19 months(2 months to 3 years).[Result]All radial heads remained reduced at a mean follow-up of 14 months(2 months to 3 years).Normal ranges of movement for flexion,extension,pronation and supination were improved or unchanged in 12 patients.One patient had further decreased in 10? for supination.There were one superficial pin-track infections but with no serious complication.[Conclusion]Angular ulnar osteotomy and external fixation of the ulna can lead to stable reduction of the radial head with minimal complications.Reconstruction of the annular ligament is not necessary if satisfactory re-orientation of the ulnar is achieved in all planes.

Objective To compare the locations and levels of collagen type Ⅲ, laminin, and fibronectin in Mooren's ulcer and normal human corneas. Methods An indirect immunofluorescent technique and immunohistochemical staining were used to determine the distribution of collagen type Ⅲ, laminin, and fibronectin. The positive results were quantitatively analyzed with an image-processing system. Results Collagen type Ⅲ was not detected in the normal cornea. However, the staining could be seen in the corneal stroma close to Mooren's ulcer focus. Laminin was expressed faintly in the basement membrane of the normal cornea and the positive expression increased in the basement membrane and Bowman's membrane of Mooren's ulcer. In the normal cornea basement membrane, fibronectin was located continuously. In Mooren's ulcer basement membrane, however, fibronectin could not be found in all sections in which one expressed in epithelium and the others in stoma close to the ulcer focus. Conclusion Epithelial basement membrane may play a potential role in the pathogenesis of Mooren's ulcer.

Objective To study the treatment of severe dysfunction of knee joint after trauma and explore the operative indication and method for total knee replacement treating such kind of disease. Methods From June 1997 to June 2004, total knee replacement using total knee prosthesis system was carried out in 21 knees of 18 cases with severe dysfunction of knee joint at late stage after knee replacement treating knee trauma, of which 12 knees in 10 cases with severe traumatic arthritis underwent total knee surface replacement. Seven knees in six cases with traumatic arthritis combined with 20?-40?varus or valgus or 20?-90?fixity flexion deformity and two knees in two cases with completely bony ankylosis were treated with rotation hinged knee joint. All cases were followed up for mean 3.5 years, ranging from six months to seven years. The Hospital for Special Surgery (HSS) knee rating score system was used to evaluate the clinical results. Results Pain relief, function recovery, rectification of knee deformities, stability and muscle power were all poor before operation. But postoperative valuation of pain relief, function recovery, rectification of knee deformities, stability and muscle power showed excellent result in 12 cases, good in seven and fair in two, with excellence rate of 90% and rate of patient satisfaction of 100%. Conclusion The knee replacement is an effective method for treating severe dysfunction of knee joint at late stage after knee replacement treating knee trauma.

Objective To investigate the prevalence,their autoantigen and the clinical significants of antiendothelial cell antibodies(AECAs) in systemic vasculitis.Methods Western blotting was performed to detect specific AECA in serum of systemic vasculitis,SLE,RA,SS and healthy donors.Then to analyze the relationships of AECA with the disease manifestation.Results(1)The prevalence of AECA was 77.7% in systemic vasculitis,87.5% in SLE,66.7% in SS,7.14% in RA and 10% in normal group respectively.(2)AECA reacted with a heterogeneous series of endothelial proteins which ranged in molecular size from 16 to 120 ku Furthermore,AECA against a 47 ku endothelial cell antigen were more frequently found in a variety of systemic vasculitis and SLE.(3)Compared with those in AECA-negative patients,the mean levels of ESR in AECA-positive patients with TA and the mean levels of BVAS in patients with WG,MPA and CSS were both significantly higher in AECA-positive patients.Patients with BD who have AECA against 47 ku endothelial cell proteins were more frequently found to have neuropathy than those 47 ku-AECA-negative patients,and the prevalence of inhanced CRP are also more frequent.Conclusion AECA showed to be correlated with the disease manifestation,and the same molecular sizeantigen could be found in a variety of systemic vasculitis and SLE.

Objective:To investigate the clinical efficacy and immunological mechanism of herbal cake-partitioned moxibustion for aging process.Method:The herbal cake-partitioned moxibustion was adopted for 223 cases to observe the aging scores before and after the treatment.Apart from that,the T-lymphocyte subsets and changes of IL-2 and 3-EP were also detected.Results:After treatment,the aging scores of 223 cases were all substantially reduced,along with an improvement of clinical symptoms,a strengthened cellular immune function,and an increase of total T-lymphocyte count.In addition,the CD4+/CD8+ ratio Was restored normal,the synthesis or secretion of IL-2 was increased and the β-EP(as the neurotransmitter to modulate immune function)was substantially improved.Conclusion:The aging process is closely associated with the immune function.Moxibustion Can modulate abnormal immune function and stabilize homeostasis and thus delay the aging process.