Objective The purpose of this study is to evaluate the safety and operation of a modified coaxial portals for posterior ankle arthroscopy. Methods 20 anticeptic-frozen ankle specimens were divided into 2 teams at random equally. In the first team, the original coaxial portals designed by Acevedo were established with K-wires first, then followed by modified coaxial portals. In the second team, modified coaxial portals were created at two levels, one at 1.5 cm proximal to the tip of lateral malleolus and the other at 2.5 cm to the tip. K-wires were left in place for distance measurement between them and the posterior important anatomic structures. Mimic ankle arthroscopy operation was performed on 5 fresh ankle amputations, using 2.7 mm, 30? arthroscopy with the modified coaxial portals technique. Results Results of the anatomic study show that the average distince was (22.07+2.82) mm to the small saphenous vein, (5.39+1.47) mm to flexor hallucis longus tendon, (6.27+1.84) mm to the tibial nerve in modified coaxial portals and (8.54+2.76) mm to the small saphenous, (3.62+1.37) mm to flexor hallucis longus, (4.40+1.40) mm to the tibial nerve in the original one. Only the difference of the average distance to the tibial nerve in the No.2 team has statistic significance. Flexor hallucis longus and flexor digitorum tendon were identified as the inner-safety landmarks. Neither penetration nor contact of nerve or vessel was observed. Conclusion Compared with original ankle posterior coaxial portals, the modified coaxial portals may be superior safety, easier-operated and reproducible.

[Objective]Through a comparitive analysis between hemiarthroplaty and dynamic hip screws in femoral intertrochanteric fracture,to discuss the differences and similaries between two groups of patients.[Method]Using the methods of retrospective review,the author collected 63 cases of femoral intertrochanteric fracture,treated by hemiarthroplasty and dynamic hip screws respectively.Followed for a minimum period of 6 months,the author compared the postoperative complications,cumulative mortality rate and loss of ambulatory grades between two groups.[Result]There was no siganificant difference in operative time and introperative bleeding and no evident distinctions showed in posteroperative general conditions.But in local symptoms,DHS group appeared the cut-out from femoral head and coax vara resulting from the collapse of medial cortex,hemiarthroplaty group emerged the pain in hip without proof of loosening and infection of prosthesis.Hip scores decreased by 8.6% in DHS group and 9.2% in hemiarthroplaty group.In the opinion of the function convalescence,there was no definition to be worth recommending between two groups.[Conclusion]To eldly patients with unstable intertrochanteric fracture,fine function should be expected equal to preoperation after operation,but the chief motive is to provide the conditions which permit the patients earlier activity.So hemiarthroplaty is a reasonable alternative to a sliding screw device to treat intertrochanteric fractures.

Objective To study curative effects of infrared fluoroscopic navigation guided percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Methods A total of 28 cases of osteoporotic vetebral compression fractures(41 vertebrae) underwent infrared fluoroscopic navigation guided percutaneous vertebroplasty.The fracture was located at T_6～L_4 segment,including 16 thoracic vertebrae and 25 lumbar vertebrae.Fluoroscopic images of the spine were obtained,calibrated,and saved after the reference shelf was fixed on the spinous process of fractured vertebrae.The trajectory,a virtual tool corresponding to the tracked tool,was overlaid onto the saved fluoroscopic views in real time.Postoperative X-ray and CT examinations were performed to observe the vertebral body diaplasis as well as the distribution and leakage of bone cement.The vertebral body volume was measured with CT volumetry preoperatively and postoperatively.The visual analogue scale(VAS) scores were compared before and after operation. Results The bone cement was successfully injected in all the 41 vertebrae.Percutaneous vertebroplasty was performed in 13 vertebrae,while percutaneous kyphoplasty was conducted in 28 vertebrae(including balloon expansion in 12 vertebrae and "sky" expansion in 16 vertebrae).Vertebral body injection was performed via unilateral pedicle in 26 vertebrae and via bilateral pedicle in 15 vertebrae.Of the 28 cases,cement injection was carried out in one vertebral body in 17 cases,in two vertebral bodies in 9 cases,and in three bodies in 2 cases.No intraoperative deaths,nerve root or spinal cord injuries,or pulmonary embolism and cardiovascular or cerebrovascular emergencies occurred.The operative time for each vertebra was 7.7～20.7 min(14.2?3.3 min) in percutaneous vertebroplasty and 11.2～32.4 min(21.8?5.4 min) in percutaneous kyphoplasty.The X-ray exposure dose for each vertebra was 5.4～19.6 dGy(12.5?3.6 dGy).The amount of injected cement for each vertebra was 2.2 ～6.8 ml(4.6?1.2 ml).The vertebral volume was elevated from preoperative 21.4?4.6 cm3 to postoperative 25.8?5.4 cm3(t=5.623,P=0.000).The VAS scores decreased from preoperative 7.6?1.2 to postoperative 2.9?0.7(t=12.946,P=0.000).No serious complications or vertebral collapses were found during follow-up examinations for 3~14 months(mean,8 months) in the 28 cases. Conclusions Use of infrared fluoroscopic navigation for guiding percutaneous vertebroplasty is feasible.

[Objective]To study the effect of semi-constrained total elbow arthroplasty in rheumatoid elbow arthritis.[Method]Eighteen semi-constrained total elbow replacements were performed on 22 rheumatoid patients with 28 elbows(Morrey Stage:6 of Ⅲ Stage,17 of Ⅳ Stage,5 of Ⅴ Stage).The elbows were reviewed retrospectively after a followup of mean 26 months(range12~44 months).Mayo Elbow Performance was used to evalue the function of preoperative and postoperative elbow.The curative effect and complications were observed.The statistically significant differences were analyzed.[Result]Elbow arthroplasty was successful in 22 rheumatoid patients with 28 elbows.After 6 weeks function exercise the Mayo Elbow Performance was improved from(31.6?29.2)to(82.1?24.3)with a statistically significant difference(P

Objective To retrospective analyze the treatment of hallux valgus with the procedure of osteotomy of the base of the first metatarsal, combining with osteotomy of the base of the second and/or third metatarsal(s), and to study the indications and effects of this procedure. Methods 35 cases 56 hallux valgus feet were treated by operative procedure from January 1994 to December 2003. 26 cases 43 feet underwent the operative procedure of osteotomy of the base of the first metatarsal, 9 cases 13 feet with painful callus under the second and/or third metatarsal(s) head underwent osteotomy of the base of the first, second and/or third metatarsal(s). The axial and lateral films of all feet with loading were taken before and after operation. The change of anatomic indexes and AOFAS of the patient postoperatively were recorded and analyzed. Results In the group with osteotomy of the base of the first metatarsal, AOFAS score was 47.6?5.8 preoperatively, and 84.3?5.7 postoperatively. In the group with osteotomy of the base of the first, second and/or third metatarsal(s), AOFAS score was 44.7?5.7 preoperatively, and 85.7?4.5 postoperatively. There were significant differences between the preoperative and postoperative rontgenographic index and AOFAS in each group. Conclusion The operative procedure is effective. The operative procedure of osteotomy of the base of the first metatarsal can get good result in moderate and severe hallux valgus patients. Osteotomy of the second and/or third metatarsal(s) were recommended in cases with painful callus under the second and/or third metatarsal(s). Normal forefoot appearance and function can be restored by the procedure to reestablish the transverse arch.

Objective To study the method and clinical results of Infrared Fluoroscopic Navigation Guiding system guided percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures.Methods Twenty-two cases with 32 osteoporotic vertebral compression fractures underwent percutaneous vertebroplasty guided by Infrared Fluoroscopic Navigation Guiding system.The fracture segment was within T6-L 4(14 thoracical vertebrae,18 lumbarver vertebrae).The compression ratio was from 20% to 90% in which 5 vertebral bodies were 75%.12 vertebral bodies underwent PVP,and 20 vertebral bodies underwent PKP in which balloon expansion were used in 12 vertebral bodies and sky expansion were used in 8 vertebral bodies.Single vertebral body injection were in 14 cases,two vertebral body injection were in 6 cases,three vertebral body injection were in 2 cases including 18 vertebral bodies injection via unilateral pedicle of vertebral arch and 14 vertebral bodies injection via bilateral pedicle of vertebral arch.Restoration of vertebra height and cement leakage was observed by postoperative X-ray and CT scan.Changes of preoperative and postoperative vertebral body volume measured by CT volumetry was compared.Preoperative and postoperative Vasual analogue scale(VAS)score was compared.Results PVP was successful in 22 cases with 32 vertebral bodies.No nerve and spinal cord damage,lung embolism and heart and brain vessel acute reaction occurred.Operative time was(18.4?4.5)mins per vertebral body.X-ray dosage was(12.2?3.4)dGy per vertebrae.The amount of bone cement was(4.4?2.5)ml per vertebrae.The vertebral body volume was improved from preoperative(22.2?8.6)cm3 to postoperative(24.8?6.9)cm3 with a significant differences(P

0.05） . Strains of cemented groups were usually less than that of non-cemented ones for all zones except the stem tip zone. Normal group and osteoporosis group had different stress shielding and concentration(P

15?， PASA≥ 11?； typeⅥ has metatarsal- phalangeal osteoarthritis. Each of them has its own particular pathogenesis and should be operated upon by different procedures respectively.

Objective To study the role of first metatarsal sesamoids s y stem in the pathogenesis of hallux valgus. Methods The sesamoids absolute and relative position (TSP) were measured in 245 normal feet and 141 hallux valgus ones, and the results were statistically analysed with hallux valgus angle(HVA), intermetatarsal angle(IMA) and metatarsal phalangeal joint subluxation. Results The absolute position of sesamoids had no difference in the normal feet and ha llux valgus ones. TSP was correlated with HVA,IMA. TSP≤3 was considered normal in 245 normal feet. 92 hallux valgus feet were surgically treated. 20 cases unde rgone Keller procedures which didnt correct TSP were excluded from this study. 19 cases treated with modified McBride procedures, 24 cases with metatarsal met aphyseal osteotomy, 29 cases with metatarsal basal osteotomy. All the cases were followed up for an average of 4 years(ranged 1－6 years). The postoperative HV A was 5?－10?(average 7?)，IMA was 5?－9?(average 7?)，TSP were all 3 or 4 . According to the evaluation standard made by SUN Junying et al, 60 cases(83％) were assessed as excellent， 8 cases(11％) as good， and 4 cases(6％) as worse ， giving an overall excellent and good rate of 94％. Conclusion TSP is an impo rtant parameter that should be routinely used for postoperative prognosis evalua tion and surgical procedures determination. Osteotomy is preferred to restore no rmal metatarsal-sesamoids system function when TSP is abnormal.

Objective To compare the efficacy of two-incision microinvasive and modified Harding approaches for total hip arthroplasty in aged patients.Methods From May 2003 to December 2006,21 old patients(aged 82 on average) received two-incision microinvasive total hip arthroplasty in our hospital.The outcomes of the surgery was compared with those of 39 cases(mean age,83),who underwent the operation through the modified Harding approach.Results No significant difference was observed in intraoperative blood loss between the two groups [(270?94) ml vs(280?107) ml,t=-0.360,P=0.720].On the 2nd day after the surgery,the patients in the two-incision group could raise their legs straight upward without needing help.At day 10,they could raise the legs straight up to a mean of(53?12)?,which was significantly higher than that in the Harding group [(32?16)?,t=5.262,P=0.000].However,the Harris scores were similar in both the groups in 6 months after the operation(80.6?12.6 vs 79.5?13.2,t=0.313,P=0.756).The incidence rates of orthopedics and systemic complications in the two-incision group was not significantly different from those in the Harding group [9.5%(2/21) vs 8.1%(3/37),?2=0.000,P=1.000;19.0%(4/21) vs 37.8%(14/37),?2=2.210,P=0.137].Conclusions The short-term outcomes of microinvasive two-incision total hip arthroplasty is better than that of modified Harding approach in aged patients.However,the long-term results of the two procedures are similar.