Objective To compare the efficiency of repairing perimembranous ventricular septal defect (VSD) with continuous stitching to that with interrupted stitching. Methods Of the 158 patients with perimembranous VSD ( 54% males) ,102 ( 65% ) patients underwent the repairing of continuous stitching (continuous group) ,and 56 patients underwent interrupted stitching (interrupted group). All the surgeries were performed under hypothermic cardiopulmonary bypass. Results The cardiopulmonary bypass time and aortic cross-clamp times were (31 ±14) mins and (18 ±12) mins in the continuous group, which was significantly less that those of (42 ± 16) mins and (25 ±11) mins in the interrupted group (t =4.49 and 3. 61 .respectively ,P <0. 05) . No case was died. The main complications involved temporary M atrioventricular block (AVB) of two cases (1 case in each group),which disappeared after 1 week. There were two remnants remaining leak (n =2) which was less than 3 mm and automatically cured after 3-6 months. Complete right bundle branch block(CRBBB) occurred in 3 cases in the continuous group and 6 cases in the interrupted group,of which 3 disappeared after 1 month and 2 disappeared after 12 months. The outcome was good in all cases after 1-3 years follow up. Conclusions Continuous stitching showed a shorter cardiopulmonary bypass and aortic cross-clamp times, and reduced the CRBBB.

Objective To investigate the effect of hyperbaric oxygen (HBO) on expression of GAP 43 in the rats spinal cord following spinal cord injury (SCI). Methods Fifty five Wistar rats were randomly divided into three groups: a normal group, a control group and a HBO treatment group. The rats in the control and HBO treatment group underwent SCI by 10g?5cm impact at the T10 level. The rats in the HBO treatment group were treated by HBO. Western blot was used to observe the change of expression of GAP 43. Results There was weak expression of GAP 43 in the normal spinal cord. The GAP 43 expression increased significantly following SCI. The level of GAP 43 expression in the HBO treatment group was significantly high than that in the control group. Conclusion HBO can increase the level of GAP 43 expression.

BACKGROUND:Operation is the main therapy for protrusion of lumbar intervertebral disc.The researches have indicated that non-operation therapy can improve effectively its clinical symptoms.OBJECTIVE:To observe the effect of "three points and five methods"therapy on analgesia of radiculalgia in protrusion of lumbar intervertebral disc and on recovery of motor function in lumbar region and lower limbs.DESIGN:Non-randomized concurrent control study based on the patients.SETTING:Orthopedic department and college of acupuncture and massage of one university-affiliated Hospital.PARTICIPANTS:Totally 210 inpatients of lumbar vertebral disorders were selected from Orthopedic Department of First Affiliated Hospital of Henan College of Traditional Chinese Medicine and Department of Acupuncture and Massage of Third Affiliated Hospital from March 1999 to June 2003,which were randomized into experimental group (n=108) and control group(n=102).METHODS:"Three points and five methods" therapy was adopted in experimental group and the traditional manipulation was for the control.The evaluation on pain and motor function was carried on at minutes 5,10,30,and hours 1,2,...,24 successively for statistical analysis.RESULTS:Total effective rate was 94.44% and the average time of analgesia was(18.40±2.11) hours in the experimental group.Total effective rate was 82.35% and the average time of analgesia was (10.60±2.63) hours in the control group. The analgesia effect and evaluation results on comprehensive function in the experimental group were superior to that in the control group(t=4.86,4.42,P ＜ 0.01).CONCLUSION: "Three points and five methods" therapy releases lumbar pain, improves lumbar symptoms and recovers motor function of lower limbs for the patients with radiculalgia in protrusion of lumbar intervertebral disc.

[Objective]To investigate the efficacy and the application value of interlocked intramedullary nailing(IIN) for bilateral femoral shaft fracture(FSF).[Method]Twenty-one cases of bilateral FSF were treated by IIN between March 1998 and March 2005.Their average age was 39.6(ranged 29～48).Thirty-five limbs of them were closed fractures,and 7 limbs were opened.Among them,18 limbs had fractures in the upper third of the femoral shaft,11 limbs in the middle third and 13 limbs in the lower third.The continuous passive motion began averaging 5 days after operation.[Result]The average follow-up period was 11.5 months(6 to 32 months).Clinical bone healing was achieved after 15.5 weeks(10~30 weeks).NO fat embolism syndrome(FES),shortening,infection or break of nail occurred in all patients.The long term effect was evaluated according to Ma Yuanzhang's evaluation standard,90.5%(19/ 21) showed excellent function of joints and limbs.[Conclusion]IIN provides a satisfied approach to the treatment of bilateral FSF.It has the advantages of fewer invasions,less blood loss,steady fixation,short healing time,early function recovery and less complication.This kind of treatment is worth to be recommended for the bilateral FSF,prevention of FES should be emphasized on.

[Objective]To summarize the surgical management and clinic results of the minimally invasive percutaneous plate osteosynthesis(MIPPO) technique in treatment of proximal metaphyseal fractures of tibia.[Method]Twenty-five patients with proximal metaphyseal fracture of tibia underwent the MIPPO operation in our department.There were 18 males and 7 females,with a mean age of 42.6 years(ranged from 21 to 66 years).According to AO classification,17 cases were type 41-A,and 8 cases were type 41-C,of the 25 cases,8 were multiple injuries,4 of these were open fractures(2 cases of Gustilo-Anderson type Ⅱ and 2 cases of type ⅢA).According to creiteria of Johner-Wruch,excellent in 14 cases,good in 9 cases,fair in 2 cases,the excellent and good rate was 92%.[Result]The average intra-operative time was 90 minutes(ranged from 70 to 115 minutes).The average blood loss was 260 ml.No patient received blood transfusion.There were no superficial and deep infection occurred in this group.All patients were available for follow-up at an average of 1.8 years(ranged,1 to 2.5 years) after surgery.The mean time for bony union on X ray was 13.8(10～20)weeks,while the mean time for full weight bearing was 14.5(11～28) weeks.No malunion and failure of fixation were observed.[Conclusion]MIPPO is a safe and effective technique for the proximal metaphyseal fracture of tibia with the advantage of less invasion,steady fixation,low infection rate and higher union rate,which is accordant with biological fixation.

[Objective] To summarize the clinical characteristics of type C2 fractures of tibia,to study the surgical management and its results of type C2 fractures of tibia through intramedullary interlocking nail and minimal invasive internal fixation.[Method]From May 2000 to March 2006,30 patients of type C2 fractures of tibia were treated surgically through intramedullary interlocking nail and minimal invasive internal fixation.The patients included 21 men and 9 women with a mean age of 41.5 years(range 20~ 63 years).Forteen closed fractures were treated by the limitedly reamed interlocking intramedullary nail.Sixteen open fractures(including Grade I and Ⅱ injuries)were treated by the unreamed interlocking intramedullary nail.All fractures were fixed statically.The mean time from the injury to surgery was 4.5 days(rang,2 hours~ 12 days).[Result]Mean follow-up period was 16.5 months(7~ 21 months).All patients had bony union within 4~9 months,with the average time of bone union being 6.2 months.The function recovery was evaluated by Johner-Wruch system in which 24 cases were excellent,3 cases were good.No osteofascial compartment syndrome of the lower leg,deep part infection,anterior kneeache,broken nails and screws and malunion were found in this series.Two cases were found delay union.[Conclusion]The type C2 fractures of tibia are often caused by high energy injuries.Most of type C2 fractures happen at the field of tibial shaft.The treatment of type C2 fractures of tibia using intramedullary interlocking nail and minimal invasive internal fixation has advantages of easy operation,less trauma,rigid fixation,high healing rate,lower complications,and satisfactory effect.It is a perfect method.The standard and less invasive operative methods should be paid more attention.

[Objective] To compare the efficacy of interbody fusion with cage versus corpectomy and fusion with plate in treating adjacent two-level cervical spondylosis.[Method] Sixty patients were included in this study.All patients were randomly assigned to anterior interbody fusion with cage (AIFC) group or anterior corpectomy and fusion with plate (ACFP) group. The average follow-up period was 28 months for AIFC group,and 25 months for ACFP group. [Result] The average loss of lordosis angle, the lost correction of segmental height and the scores on the criteria of 40-score method were not statistically significant between these 2 groups. The lordosis correction, operative estimated blood loss, and operative time were statistically better in the AIFC group significantly . [Conclusion] The short-term results of AIFC and ACFP in treating adjacent two-level cervical spondylosis were satisfactory. The advantages of AIFC are the elimination of donor site complications, increasing more segmental lordosis, and reducing blood loss and operative time.

Objective The investigation was to evaluate the efficiency of the frozen shoulder treated by hydraulic distention and manipulation under dynamic arthrography of shoulder joint ,and analyze the in-fluencing factors on the outcome.Methods One hundred patients with frozen shoulders were enrolled the prospective and controlled study,who were divided into two groups randomly.Fifty patients were treated by the hydraulic distention and manipulation under dynamic arthrography of shoulder joint (GroupⅠ),and fifty patients were treated by NSAIDs administration(GroupⅡ).The relationship of clinical results with the amounts of injected fluid during hydraulic distention and manipulation,the range of motion,the visualized rate of the vagina synovialis of long head of biceps brachii tendon and subacromial bursa,and releasing de-gree of joint adherence were observed.The patients consisting of forty-two males and58females aging from42to74years were assessed at two time-intervals.The short term follow-up period ranged from3to6months,and final follow-up from10to21months.Results The clinical results was significantly difference between GroupⅠand GroupⅡdepending on daily activity and range of motion(P

BACKGROUND: Studies in recent years have suggested the involvement of chemoattractant cytokines in the recruitment of peripheral blood cells to the injured spinal tissue. Monocyte chemoattractant protein-1(MCP-1) belongs to the CC-type chemokines and is capable of specific chemotactic attraction of the macrophages.OBJECTIVE: To observe MCP-1 expression in the serum of patients with acute spinal cord injury and explore the possible mechanism of secondary spinal cord injury.DESIGN: A non-randomized and controlled concurrent pilot study.SETTING and PARTICIPANTS: Eight patients with acute incomplete spinal cord injury and 8 with compression fracture of the spine were treated in the Department of Orthopaedics, Renmin Hospital of Wuhan University during the period from January 2001 to December 2002. Another 8 healthy subjects were included as the controls.METHODS: In the next morning after hospitalization, totally(8-10) mL of fasting peripheral venous blood was collected from the patients and the serum separated for determination of MCP-1 level with enzyme-linked immunosorbent assay(ELISA) . Serum MCP-1 level was also measured in the healthy subjects in the same manner.MAIN OUTCOME MEASURES: Serum level of MCP-1 in each group.RESULTS: Serum levels of MCP-1 in the healthy subjects, patients with compression fracture of the spine and those with acute incomplete spinal cord injury were(124 ± 15), (184 ±21) and(428 ± 11) ng/L, respectively, with significant differences between any two groups( P ＜ 0.01 ).CONCLUSION: MCP-1 may induce secondary inflammation by recruiting inflamnatory cells to the injury site and thus aggravate the spinal cord injury.

BACKGROUND: Under wear particles stimulation, mononuclear macrophages, fibroblasts, and osteoblasts can produce a large amount of inflammatory factors, leading to periprosthetic osteolysis. But the precise mechanisms remain unclear. OBJECTIVE: To analyze the molecular biological mechanism underlying osteolysis induced by titanium wear particles . RESULTS AND CONCLUSION: Cleaned titanium particles stimulation induced an unbalanced ratio of RANK mRNA to OPG mRNA. Over-expressed RANK bound to RANK ligand and promoted osteolysis. No RANK mRNA expression was detected in the LPS group, but OPG mRNA expression was transiently increased at 4 hours. NF-κB/inflammatory cytokine, rather than RANK/OPG, is the main signal pathway for LPS to induce osteolysis. After LPS binding to titanium particles, these two signal mechanisms, RANK/OPG and NF-κB/inflammatory cytokine, have synergistic effects during artificial joint loosening.