Objective To assess the relationship between anterior-inferior glenohumeral instability and glenoid version.Methods Both shoulders in 24 patients with unilateral anterior-inferior glenohumeral instability were scanned with multiplanar spiral CT scanner(MSCT).The scapula and the humerus were reconstructed by the volume rendering technique and multiplanar reformation in 4 slices on axial plane from glenoid top to its bottom.The scapular glenoid version angles of 24 patients were measured bilaterally in 4 levels,and compared bilaterally by statistic analysis.Results From the top to the bottom,the scapular glenoid version angle in the side with anterior-inferior glenohumeral instability was respectively(-15.24?10.18)?,(-8.22?8.47)?,(-2.88?4.56)? and(-2.49?6.43)?,while the angle in the healthy side was respectively(-15.07?12.11)?,(-10.63?7.25)?,(-6.04?3.61)? and(-5.26?3.02)?.Only the difference at the 4th plane was significant between the healthy side and the affected side(P

Objective To investigate method of in vitro measurement of adult Chinese scapula glenoid version angle with MSCT postprocessing technique. Methods Fifty dry scapula specimens and 50 wet anticorrosive shoulder specimens of adult Chinese were scanned with Siemens Somatom Sensation 16 scanner. The scapula glenoid version angle was measured with postprocessing technique of thick or thin multiplanner reformation (MPR), and the data were analyzed statistically. Results The scapula glenoid version angle of dry scapula specimens and wet anticorrosive shoulder specimens was (-0.40±4.10)°, (-3.00±4.49)° with thick MPR, and (-0.34±4.21)°, (-2.70±4.54)° measured with thin MPR, respectively. There was significant difference of the scapula glenoid version angles between the dry scapula specimens and wet anticorrosive shoulder specimens (P<0.05), but not between thick or thin MPR measurement(P>0.05). Conclusion Measuring the scapula glenoid version angle with thick MPR of MSCT is simple and fast. The scapula glenoid version angle is markedly variable between the dry scapula specimens and wet anticorrosive shoulder specimens. The retroversion angle of scapula glenoid is about 3°, which should be considered in the design of shoulder prosthesis.

Objective To evaluate clinical results of arthroplasty with the UNIVERS 3-D prosthesis in unstable shoulder arthritis. Methods 16 cases, which were 10 males and 6 females aging from 35 to 79 years (mean, 56.3 years), underwent shoulder arthroplasty with the UNIVERS 3-D prosthesis because of unstable arthritis. The patients were evaluated before surgery, at 12 months and the most recent follow-up with an average follow-up of 30.8 months(mean, 12-50 months) by Constant and normalised Constant score, and reviewed by the radiological analysis on preoperative and postoperative X-rays including AP, scapular and axillary views. Constant and normalised Constant score improvements at 12 months and the most recent follow-up evaluation were compared with the preoperative scores using paired-samples t test. Results 1) 8 out of 11(72.7%) cases with mild inferior humeral or glenoid exostosis. 2) The Constant score improved from 43.8?13(normalized Constant score, 51.36%?15.40% ) to 70.6?17.69(normalized Constant score, 86.44%?22.12%). The pain, activity, mobility and strength scores had been improved obviously. 3)Only one case had the radiolucent line around the uncemented humeral component with radiolucent index of less than 1. No any periglenoid component radiolucency, no shift or subsidence in humeral component, no migration and tilt in glenoid component, no change and loosening in the junction bolt between humeral stem and head. 4) Two cases were experienced postoperative complications including impingement of prosthesis with osteophytes, and PE-inlay loosening received revision surgery. Conclusion Excellent clinical results can be obtained by the shoulder arthroplasty using the UNIVERS 3-D prosthesis with low incidence of radiolucency and postoperative complication.

Objective To compare the early curative effects of arthroscopic modified suture bridge and single-row modified Mason-Allen suture in repair of supraspinatus tendon tears.Methods A retrospective case-control analysis was made on 28 patients with supraspinatus tendon tears admitted between June 2012 and June 2015.There were 16 males and 12 females,aged 43-63 years (mean,54.2 years).Thirteen patients (13 shoulders) were repaired using the arthroscopic modified suture bridge technique (Group A),and 15 patients (15 shoulders) were treated using the single-row modified Mason-Allen technique (Group B).Operation time and intraoperative blood loss were recorded.American shoulder and elbow surgeons (ASES) score,Constant score and visual analogue score (VAS) were used to evaluate the function and subjective outcomes preoperatively.Meanwhile,MRI was used for analysis of tendon integrity postoperatively.Results The operation time of Group A and B were (56.1 ± 23.2) minutes and (36.1 ± 15.6) minutes,respectively (P ＜ 0.05).The intraoperative blood loss was (30.3 ± 20.5) ml and (28.5 ± 18.2) ml,respectively (P ＞ 0.05).The average follow-up time for Groups A and B were 12 months and 12.6 months,respectively.The symptoms of 28 cases were alleviated after surgery,and the functions were obviously recovered.In Group A,thc VAS was decreased significantly from (7.0 ± 0.8) points preoperatively to (0.8 ± 0.8) points at final follow-up,ASES score was improved from (39.8 ± 3.1) points to (88.1 ± 4.8) points,and Constant score was improved from (54.8 ± 2.7) points to (88.2 ± 3.1) points (all P ＜ 0.05).In Group B,the VAS was decreased significantly from (6.8 ± 0.8) points preoperatively to (0.9 ± 0.8) points at final follow-up,ASES score was improved from (40.7 ± 2.5) points to (89.5 ± 3.2) points,and Constant score was improved from (56.0 ± 4.5) points to (89.3 ± 3.4) points (all P ＜ 0.05).There was no significant difference in the clinical outcomes between the two groups (P ＞ 0.05).The retear rate in Group B was 20％ (3/15),while no retear was presented in Group A (P ＜ 0.05).Conclusion Arthroscopic modified suture bridge technique and single-row modified Mason-Allen technique are both clinically effective for function recovery and pain relief in patients with supraspinatus tendon tears,but the former associated with lower incidence of tendon re-tear is preferred for moderate to large rotator cuff injury or rotator cuff injury with large insertion avulsion.

24 h)with VAS ranging from 5-9 points.There was no occurrence of severe complications such as infection or shoulder malfunction.[Conclusion]The technique of glenohumeral joint injection without any guidance through modified Nevaiser approach is highly accurate.No complication was noted.This thechnique be widely used in glenohumeral joint injection.

Objective To investigate the clinical experiment of arthroscopically assisted debridement and tibiotalar arthrodesis with half-ring sulcated external fixator for treatment of total ankle joints tuberculosis. Methods From January 2001 to April 2005, 6 patients (4 males and 2 females), with a mean age of 33 years old (range, 28 to 44 years old) and mean duration of 13 months, received arthroscopically assisted debridement and tibiotalar arthrodesis with half-ring sulcated external fixator. All patients had received at least 3 weeks standard drug treatment for tuberculosis before the operation. After thoroughly debridement under arthroscopy using anterolateral and anteromedial approaches, a half-ring sulcated external fixator was used to fix the ankle joint at the neutral position. 4 days (2-7 days) after the operation, patients could walk with partially weight bearing. All patients replied to our questionnaire and the average follow-up was 21.3 months, with a range of 6-42 months. Patients returned for a clinical and radiolographic evaluation every week before the tibiotalar joints union. The external fixator apparatus were removed after the joint fused. Results Fusion occurred in all patients, the average time to clinical and radiographic union was 12.5 weeks (9-17 weeks). 3 patients were graded as excellent: no pain with a stable fusion. The others were graded as good: mild pain, occasional limp with a stable fusion. There were no sinus or other complications occurred. Conclusion There are considerable advantages using arthroscopically assisted debridement and tibiotalar arthrodesis with half-ring sulcated external fixator for treatment of total ankle joints tuberculosis without serious bone defect, include: limited invasion, quickly recovery, thoroughly debriding the tuberculose focus. And the half-ring sulcated external compression fixator could achieve stable and elastic fixation with adjustable rigidity. And patients can walk earlier to promote ankle fusion and decrease related complications.

Objective To evaluate the indication, clinical results, and prognosis after arthroscopic release for treatment of the limitation of elbow joint motion. Methods From December 2003 to May 2005, 17 elbows in 17 patients were treated with an arthroscopic procedure for elbow contracture. All patients had trauma as the cause of limitation of elbow joint motion. Previous injuries included fixation after fracture of the olecranon (7 cases), elbow dislocation (5 cases), fracture of the radial head (2 case), and braking after skin graft for burn of elbow (2 cases), one patient underwent a open synovectomy for synovitis. All patients with elbow contractures underwent the arthroscopic capsular release and arthroscopic debridement. The osteophytes in the olecranon and medial or lateral epicondyle and loose bodies were removed, and full debridement of fibrous tissue in elbow were performed. Complete release of the capsule was necessary to regain good functional motion. Postoperative care began from gentle active and passive range of motion of the elbow under patient controlled analgesia(PCA). All elbows were assessed for increase in range of motion(ROM) and Mayo assessment before and after surgery. Score assessment: ≥90 points,excellent; 75-89 points, good; 60-74 points, fair;

[Objective]To evaluate the results of arthroscopic capsular release for the treatment of idiopathic frozen shoulder.[Method]From January 2004 to April 2005,7 patients with diagnosis of idiopathic frozea shoulder,who had symptoms for an average of 8.0 months(5 to 13months)with failed conservative treatment for at least 4 months,were treated with arthroscopic capsular release combined with rehabilitaticon exercises after operation.Under general anesthesia,all the patients underwent arthroscopic capsular release and manipulation.All patients were strictly evaluated by Constant score,normalized Constant score and the Visual Analog Scale(VAS 1 to 15 points,1 = no pain),before operation,at 3 weeks after operation,3 months after operation and 17.2 months after operation respectively.[Result]All patients were followed up with a mean of 17.2 months(8 to 23 months).The average in-hospital day was 8.1 days(7 to 10 days).All patients had significant improvement in terms of functional gain and pain relief after operntion.The preoperative pain score improved from(5.2?2.4)points to(11.2?2.0),(14.6?0.4)and(14.7?0.4)points at 3 weeks after operation,3 months after operation end 17.2 months after operation respectively.The Constant score improved from(24.5?14.2)to(47.0?18.8),(68.9?9.4)and(70.1?7.9),and the normalized Constant score improvad from(31.0%?17.3%)to(60.1%?24.9%),(87.1%?14.5%)and(89.7%?12.1%).There was no complication in the treatment procedures.[Conclusion]Arthrosenpic capsular release is a safe and effective surgical procedure in the management of idiopathic frozen shoulder unresponsive to conservative treatment.It has advantages of little invasive,better recovery,less operation time and less complications.

[Objective]To evaluate the effect of transepicondylar axis of different position on volume rendering technique measuring the humeral head retroversion angle with multi slice spiral CT.[Method]Fifty-one dry humerus specimens were scanned with 16 slice spiral CT scanner,At top view the three-group humeral head retroversion angle decided by the transepicondylar axis of different position were measured by volume rendering technique,As to two-dimension CT method,the distal reference axis of the humeral head retroversion angle was defined by three sections of different levels,the total six-group data on humeral head retroversion angle were analyzed by Statistics.[Result]The humeral head retroversion angle ranged from 4? to 59.8?,the humeral head retroversion angle of six groups were(25.5?10.2)?,(25.0?10.8)?,(25.7?10.8)?,(27.3?10.3)?,(26.3?10.2)?,(25.8?10.4)? respectively.The Statistics showed that the results have no significant difference among them.The more distal the humerus was,the smaller humeral head retroversion angle defined by a line between the epicondyles on two-dimension CT method was.[Conclusion]The humeral head retroversion angle is markedly variable,the humeral head retroversion angle of shoulder joint prosthetic design should be individual.The transepicondylar axis of different position has no effect on volume rendering technique measuring the humeral head retroversion angle with multi slice spiral CT.The top view at which lateral epicondyle of the humerus showing mini-triangulum and the anterior surface of the distal humerus articulation with the forearm being shaded is more simple,faster and precise for the volume rendering technique measuring the humeral head retroversion angle with multi slice spiral CT.

Objective To investigate the clinical outcomes of the medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular for the flatfoot related with accessory navicular.Methods From March 2009 to October 2011,13 patients (16 feet) with flatfoot related with accessory navicular received treatment by the medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular.There were 4 males and 9 females,with an average age of 41.3 years (range,18-64 years).All patients had obvious valgus calcaneus,the angle of which was 11.3°± 1.4°.According to AOFAS ankle-hindfoot scores,the arch height,calcaneus inclination angle (CI),talocalcaneal angle (TC),talar first metatarsal angle (TMT) on the lateral weight-bearing radiograph of foot,and the talocalcaneal angle (TC),talar first metatarsal angle (TMT) on the AP view of the weight-bearing radiograph of foot,and the heel valgus alignment on axial radiographs of the hindfoot were measured on the X-ray film.Results All patients were followed up for 12 to 31 months,with the average of 16.8 months.Eleven patients (13 feet) felt no pain 6 months after operation,while 2(3 feet) felt pain after long walking.There was no complication,including infection,nerve injury,un-union,and so on.The average AOFAS ankle-hindfoot score improved from 56.4-±6.4 preoperatively to 88.1±2.8 at the last follow-up.Radio graphically,all parameters were statistically significant between pre-operation and the last follow-up,including the arch height,CI,TC,TMT modifying from 3.8±0.3 mm,9.5°±1.1°,47.3°±2.5°,17.6°±1.6° to 12.0±1.1 mm,20.1°±1.5°,32.3°±2.5°,6.8°±1.0° respectively on the lateral weight-bearing view; TC improving from 39.5°±2.3° to 26.2°±2.0°and TMT improving from 15.2°±1.7° to 6.3°±1.0° on the AP weight-bearing view.Conclusion The medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular with excellent clinical outcomes.