The management of transarticular fractures is still a difficult clinical problem. Owing to the shape memory effect and its special design,the shape memory com- pression staple could fulfill nearly all the special treatment requirement of the trans- articular fractures.Early bone union and 93.5% satisfactory function restoration were obtained in the series of 121 cases.Stable fixation,early functional exercise and continuous compressive force produced by the staple are the mainofactors contri- buted to the good results.

Objective To observe the ultrastructural alteration and healing characteristics of osteoporotic fracture, and to elucidate its cellular mode of healing. Methods Eighty female SD rats of 8 months old, which had the weight of 290 to 340 g, were randomized into two groups of 40 each: the osteoporotic fracture model(OPFM) and the common fracture model(CFM). After anesthesia, the bilateral posterior transperitoneal approach was performed in the OPFM group and the bilateral ovaries were removed; and in the CFM group, only the sham operations were performed. Three months later, the fracture of femoral middle shaft were created and fixed with a Kirschner pin through medullary cavity. The callus of each rat was examined by transmission electron microscopy(TEM) and scanning electron microscopy(SEM) in 5 days and 1, 2, 4, 6, 8, 12 and 16 weeks postoperatively. Results TEM showed that the number of chondrocyte in OPFM group was greater, but function was lower than that of CFM group. Volume of collagen secreted by the chondrocyte was less and arranged irregularly during the fracture healing period in OPFM group. Number and function of osteoblasts in OPFM group were lower than that of CFM group. Extracellular collagen was disordered and sparse, but function of osteoclasts in OPFM group was more active than that of CFM group. The SEM showed that the collagen in callus of CFM group was dense and arranged in good order or pyknotic. Conclusion The fracture healing of the osteoporotic fractures is due to the decrease of the osteoblastic formation and the increase of the osteoclastic resorption as well as the poor bony healing quality.

Objective To i nv estigate the clinical effect of shape-memory sawtooth-arm em bracing fixator in the management of periprosthetic femoral fracture.Methods Since1994, 21cases of periprosthet-ic femoral fractures had been treated in7hospitals with the shape-memory sawtooth-arm embracing fixator designed and developed b y the Ninth Peoples Hospital,Shanghai Second Medical University(SSMU ).Of the21cases,12were males and9were females,aging from42to83years old. Eighteen of the series ex peri-enced periprosthetic fracture at2weeks to10y ears after joint replacement the fractures were found as oblique,spi ral or comminuted with the fracture lines located between the lesser trochanter and a p oint 5cm distal to the end of prosthetic stem.The other three were revision c ases,in which2cases with osteoporosis had intraoperative spiral fracture and1 case had long segmental osteotomy for removal of the prostheses.One of the 21patients had Z-shaped femoral osteotomy,while the other20cases were clas sified into Jo hannson typeⅠfrac ture in4cases,typeⅡ9cases and typeⅢ7case s.All of them were complete fracture with dis-placement.In practice,the arm s of fixator were expanded firstly by immersing into the ice water to make the tempera ture of the device decrease to4~7℃.After reduction of the fracture ,the body of the fixator was placed on the tensile side of the femur,and th e temperature of the arms was raised with hot saline.With its shape memory ef fect,the sawtooth-arms began to close up and grasped the fracture fragments ti ghtly.Results Surgical process in all of the cases was smoothly done:the frac tures were stable after the fixation,and no ex-ternal fixation was required po stoperatively,except four cases underwent skin traction of the affected lim b for 2weeks.All the patients were able to walk with two crutches at2to4we eks after the operation.The post-operative follow-up lasted from1to7years, and no fracture re-displacement was found.The results of frac-ture healing were good while the functional recovery to the pre-operative level was achieved in the all se ries.Conclusion For periprosthetic femoral fracture,shape memo ry sawtooth-arm embracing fixator is a re liable device being implanted easily and offering stable fixation;it should be the treatment method of the first choice.

Objective To observe the expression of platelet-derived growth factor A(PDGF-A) and PDGF-?R in callus during osteoporotic fracture healing and to explore further into the mechanism or effect of PDGF-A and PDGF-?R on osteoporotic fracture healing. Methods The expression and change of PDGF-A and PDGF-?R in different period of osteoporotic fracture healing(5, 7, 14, 28, 42 days) were investigated by means of immunohistochemistry(ABC method). Results There were different cells origin (chondrocyte, osteoblast, osteocyte, vascular endothelial cell, et al) and degree of expression of PDGF-A and PDGF-?R in callus during different period of osteoporotic fracture healing. Conclusion PDGF-A moderates and participates in osteoporotic fracture healing. The decrease of osteoporotic fracture repair capacity may correlate with abnormality of PDGF-A secretion.

Objective To investigate if the physician's attending could improve the compliance of knee osteoarthritis patients with community exercise therapy.Methods The Questionnaire of Community Rehabilitation of Musculoskeletal Disorder was developed.The knee osteoarthritis patients with or without physicians' attending were surveyed anonymously 3 month after exercise.Results The incidence of compliance in exercise was 87.65% in patients with the physicians' attending,and 70.37% without attending(P<0.05).Conclusion The physicians' attending may improve the compliance of knee osteoarthritis patients in community exercise therapy.

BACKGROUND: Clinical studies demonstrate that the durable stability of the prosthesis depends on a close geometric fit between the prosthesis and femoral medullary cavity.OBJECTIVE: To study the law of the parameters of medullary canal section shape in proximal femur DESIGN: Repeated measurement observation.SETTING: Department of Orthopaedics, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University MATERIALS: Ten femoral samples without any damage was obtained from corpse in the Staff Room of Anatomy of the Shanghai Second Medical University METHODS: The experiment was carried out in the Department of Or thopaedics, Ninth People's Hospital between January 2000 and March 2000. Section morphology of medullary cavity of proximal femur was dealt with image-processing, and conus curve fitted parameter mathematical method was proposed; and at the same time, section of medullary cavity of proximal femur of 10 patients was measured manually.MAIN OUTCOME MEASURES: Computer-aided method and manual method were applied to measure the coordination at the end of extrude and the coordinate of link joint RESULTS: 10 femoral samples entered the stage of result analysis. Com puter was used to measure the coordination of the end of extrude of the section medullary cavity of proximal femur (X,Y) and the coordination of the connection point (X,Y).There was no significant difference of the measuring results between computer-aided method and manual CONCLUSION: Computer-aided imaging-processing method not only reduces the error but also can be completed by computer automatically in measuring section morphology of medually cavity in proximal femur. It is suitable for a variety of morphology measurement.

Objective To explore the effects of alendronate on adipogenic differentiation of bone marrow stremal cells (BMSCs) and the role of mitogen-activated protein kinases (MAPK) signal pathway in this process. Methods BMSCs were derived from 9-month-old ovariectomized SD rats and exposed to 0.01, 0.1, 1, 10 μmol/L of alendronate for 2 weeks. The number of BMSCs was counted under light microscope after oil red O staining. The expression of peroxisome proliferators activated receptor-γ, 2 (PPAR-γ2) was measured by RT-PCR. The effect of alendronate on MAPK signal pathway was detected by Western blot. Results After two weeks of induction of BMSCs by alendronate, BMSCs with positive oil red O staining significantly decreased as the increase of the concentration of alendronate (P <0.01), so did the expression of PPAR-γ2. The expression level of PPAR 2 increased when exposing BMSCs to ERK1/2 or JNK specific inhibitors, PD98059 and SP600125 for two weeks. However, the expression level of PPAR 2 decreased when exposing BMSCs to SB203580 (an inhibitor of p38) for two weeks. Condusion Alendronate can inhibit adipogenic differentiation of BMSCs derived from ovariectomized rats in a doso-dependent manner by activating ERK1/2 and JNK rather than p38.

ObjectiveTo study the influence of stress－ relaxation plate on disorganization andrepair of the cortex under the plate. MethodsA washer made of viscoelastic polyethylene was placedbetween the screw and the screw hole of a conventional stainless rigid plate(RP) to form a stress－ relax-ation plate(SRP). Both SRP and RP were applied to the osteotomized New Zealand rabbit tibia, thefracture healing process of either fixing with SRP or RP(control) was put under comparative study bypolarized light microscopy, in situ hybridization of collagen mRNA and immunohistochemistry tech-nique from 2 to 36 weeks postoperatively. ResultsThe study of plated bone remodeling showed thatthe degree of cortex osteoporosis beneath the plate was similar between the SRP and RP group 12 － weekpostoperatively. The organization of the bone structure in the SRP group happened later and milder thanthat of the RP group, and the repair process began 12 weeks after implantation. So the resorption cavi-ties became smaller and the structure of collagen fibers became well oriented along, and the osteoblastslying on the surface of resorption cavities expressed and synthesized type Ⅰ collagen 8 to 12 weeks afterimplantation. The changes above increased significantly in most cavities by 36 weeks. No expression andsynthesis of any kind of collagen could be observed during 12 to 36 weeks after implantation in the RPgroup. ConclusionWithout removal of the bone plate, the SRP fixation not only reduces the degreeof plated bone osteoporosis, but also makes the disorganized bone structure return to normal by the ex-pression and synthesis of type Ⅰ collagen mRNA of osteoblasts lying on the surface of resorption cavities.

Objective To analyze the practical experiences of design and its clinical application of custom-made tumor prostheses of knee. Methods A retrospective study of 41 cases of distal femur or proximal tibia tumors treated surgically from June 1999 to October 2002, was carried out. In the study, there were 29 males and 12 females aging from 11 to 69 years with an average of 35.0 years. The location of tumors were at distal femur in 23 cases and 9 cases at proximal tibia, of which 15 were osteosarcoma, 13 giant cell tumor, 3 chondrosarcoma, 5 solitary metastatic bone tumor, and 1 each of fibrosarcoma, malignant fibrohistocytoma, Ewings sarcoma, small round cell sarcoma and syndesmofibroma. The custom-made semi-constrained knee prosthesis with femoral or tibial component was implanted after extra-capsular resection of the tumor bone segment. A special femoral component with elongated construction was used in an 11-year old case for further femur lengthening. Resection of femoral artery involved by tumor and reparation by great saphenous vein was performed in one case. Results The operations of the 41 cases were all smoothly performed. 33 cases were followed up from 8 to 37 months with an average of 20.2 months. The daily life ability was recovered in 3 months after the operation. Among them, no loosening or failure of the prostheses was found, and local recurrence was found in 2 cases and distant metastasis in 3 cases. The design of knee prosthesis could provide some proper internal/external rotation and adduction/abduction movements accompanying with the flexion and extension of the knee joint without affecting the stability of the joint. For the case of proximal tibia tumor, a special design and surgical technique was developed to provide the reconstruction of patellar ligament insertion with rather good results; and the recovery of knee extension and stability were satisfied. Conclusion The custom-made semi-constrained tumor prosthesis of knee could be used as an effective method for the limb-savage management either the distal femur or proximal tibia tumor cases.

Objective To evaluate effectiveness of bone marrow derived mesenchymal stem cells(BMSCs) transduced by adenovirus mediated human bone morphogenetic protein-2 (Adv-hBMP-2) gene in the repair of diaphysic segmental bone defects of goats. Methods The tibial bone defects (2.1 cm) of 22 goats, who weighted from 18.1 kg to 29.5 kg, were established and divided into 4 groups: groupⅠ, Adv-hBMP-2 transduced BMSCs group (n=8); groupⅡ, adenovirus mediated ?-galactosidase(Adv-?gal)gene transduced BMSCs group (n=6); groupⅢ, non-transduced BMSCs group (n=6); groupⅣ, untreated group (n=2). Roentgenography, histomorphometrical analysis and biomechanical measurement were studied at various times. Results Roentgenography showed more callus in the bone defect site of group Ⅰ. At 24th week after implantation, the healing rates of group Ⅰ,Ⅱ,Ⅲ, and Ⅳ were 6/7, 1/5, 2/5, and 0/1 respectively. There was statistic significant difference of X-ray grading between groupⅠand groupⅡor Ⅲ. Histomorphometrical analysis showed much more total new trabecular bone area (TBA) of groupⅠthan that of other groups. Biomechanical strength of groupⅠwas superior to that of groupⅡand Ⅲ. Conclusion Adenovirus mediated BMP-2 gene transferred BMSCs can repair segmental bone defect in goat without osteoconductive scaffold.