[Objective]To explore developmental history of extremity in jury and reconstruction,and to reflect the relationship of modern orthopaedic medical treatment modes to the lire nature and natural law.[Method] The author reviewed the history of organic evolution and 'human evolution,and rank the historical era of life origin,birth of cell and bone architecture,formation and development of bone and joint in living nature and final shape construction of vertebrate and human,and summarized the development of extremity injury and reconstruction after foundation of society via evolutive law.[Result]A scientific and order evolutived series that was not created at natureg please can be seen from origin of life,generation of bone and joint,evolution from high-mammal to human boing.The reason of extremity injury,idea and methods of medical treatment are correlated with the development of seciety civilization,the progress of scientific technique,and change of life style.With the great change of science and technique,life style and idea of human,reasons of extremity injury and orthopaedic diseases have also changed,but the life nature of human being is not changed with them.[Conclusion]Various kinds of techniques and methods that are used to treat trauma and bone disease only accustomize the natural process,rather than excessive intervention.The culture idea of human being,requirement of material and spirit should be developed,and the scientific research of non-protoplasm may break some rules,but the study of life science and medical idea should not disobey natural law and human nature.Suitable techniqus of integrated observation,consolation,nursing and modern techniques are still basic principles of orthopaedic treatment.Nature is forever teacher and origin of medical science.

Severe clubfoot has complicated clinical features.Conventional surgical management could hardly get satisfactory results,always with serious trauma,and even smaller foot.This paper summarizes the characteristics of clubfoot in details and its relative assessment standard,principles and advantages of Ilizarov's technique,design of the apparatus and correction procedures.Combination of this and traditional technique and reasonable osteotomy method are also analyzed,complications are discussed for prevention.

[Objective]To study the effect of tibial diaphyseal lengthening on the longitudinal growth of the tibia.[Method]Rabbit models of tibial diaphyseal lengthening and tibial osteotomy were established.Standard radiography of the tibia was taken and the length of the tibia was measured.Histology of the proximal and distal tibia was made and the thickness of the growth plate was measured.[Result]Tibial osteotomy alone stimulated the longitudinal growth of the tibia and increased the thickness of the growth plate.However,tibial diaphyseal lengthening suppressed this stimulation resulting in natural longitudinal growth and normal thickness of the growth plate that matched the normal side.[Conclusion]Diaphyseal lengthening of tibia does not inhibit the longitudinal growth of the tibia.

Objective To evaluate the clinical therapeutic effectiveness of Ilizarov technique for the treatment of congenital brachymetatarsia.Methods We retrospectively analyzed the 5 patients who had been treated in our department for congenital brachymetatarsia (12 metatarsal bones in 10 feet) from January 2008 to January 2011.All of them were female,aged from 22 to 26 years (mean,24.2 years).All cases were bilaterally involved.Three of them suffered from bilateral brachymetatarsia of the first metatarsal bone,one from bilateral brachymetatarsia of the fourth metatarsal bone,and the other one from bilateral brachymetatarsia of the first and fourth metatarsal bones.Bone transport was conducted with a monolateral mini-fixator in 3 patients and with a modified semi-ring Ilizarov fixator in the other 2.Dorsal incision was used for all osteotomy before the external fixator was mounted.Bone transport began 7 days after surgery at a rate of 0.3 mm/d and was completed in 3 times.Results The 5 patients were followed up from 12 to 48 months (mean,22.0 months).The metatarsal bones were lengthened by 13.5 mm(12 to 17 mm) on average.The functions of the toe and ankle joint were normal without skin necrosis,vascular or nerve injury,tylosis of the footplate,or walking pain.The lengthened segments were mineralized well,with an average lengthening index of 48 d/cm(45 to 53 d/cm) and average time of external fixation of 64.8 days.At the last follow-up,the average AOFAS score was 92.2 points (90 to 95 points).Conclusions Although the Ilizarov technique necessitates a patient's prolonged fixation with an external fixator in the treatment of congenital brachymetatarsia,it has advantages of simplicity,minimal invasion,and satisfactory correction of brachymetatarsia.Consequently it is a good treatment for this disease.

Lower limb lengthening, especially femur lengthening and tibia lengthening, is the most commonly used and effective technique in management of limb length discrepancy and dwarfism. However, there are many complications and sequelae in clinic practice, which limits the application and development of this technique to some extent. The reasons may be related to the following two points: one is the lack of sub discipline of limb lengthening in the domestic system of health and medical education, in other word, it is difficult acquired academic and clinical guidance from specialty of "Limb Lengthening and Reconstruction" in orthopedics departments and hospitals. Secondly, limb lengthening and reconstruction with its own theoretical principles and medical model is a systematic engineering and integration discipline, which cannot be completely guided by the classical orthopedic medical paradigm. The complications of lower limb lengthening have been classified according to local and general, immediate, early and late stage, or by infection and non-infection, or by problems, obstacles, complications, etc. Regarding the nature, Qin proposed a new classification for complications, which is divided into five categories: from soft tissue, from joint, from bone, infective and complex. This classification method can reflect the characteristics of different types, reflect the progressive relationship, and is easy to record, distinguish, emphasize and avoid. Different types of complications can occur in different stages of lower limb lengthening, different kinds of complications can occur alone or simultaneous, and different degrees of complications can transform into each other. It requires that surgeon engaged in limb lengthening must have solid knowledge of orthopedics, and be able to quickly identify and effectively deal with various complications; the patients should fully understand and implement the key points of each step during the whole process of limb lengthening, doctors and patients should be friends to avoid and reduce the occurrence of complications.

[Objective]To explore the clinical efficiency,operative methods,apparatus assembly and postoperative administration of Ilizarov technique in the correction of talipes equinovarus.[Method]From January 2003 to May 2006,32 patients were corrected with QIN Si-he's orthotics devices on the Ilizarov principle of tension-stress,which involved 15 males and 17 females,the age ranged from 10 to 25 years.Among these patients,2 were caused by peroneal nerve injury,l by tumor in the vertebral canal,5 by meningocele,11 were caused by poliomyelitis,13 by congenital talipes equino-varus.In accordance with deformities,external fixator and limitied operative methods were dertermined.The limited release of soft tissue were performed in 7 patients,limited osteotomy in 25 patients.The dynamic muscle balance operation were performed in 9 patients with imbalance of muscle strength.According to the Ilizarov technique,the fixative rods were installed.The telescopic rods on the apparatus were rotated one week after the operation,the divices had corrective function in three-dimensional directions.The deformity of talipes equinovarus,internal rotation and drooping of the forefoot were gradually corrected,and the patients could bear weight and walked on the deformed foot.The mean duration of traction were 42 days,then removed the external fixator maintained with plaster for a site time.[Result]All patients were followed up from 12 months to 37 months with an average of 17 months.There was no recurrence of the deformity and feet function was good while walking on full weight-bearing.None of the complication occurred postoperatively sush as infection in the incision,neurovascular injury and ankle dislocation.[Conclusion]With Ilizarov technique to correct talipes equinovarus is a safe,minimally invasive and effective method.Combined with limited operation Ilizarov technique can correct severe talipes equinovarus which is unattainable by traditional orthopedic surgery,and shorten the treatment period,avoid severe complications.

Objective To explore the application of the Ilizarov's principle on tension-stress in correction of adult severe talipes equinovarus. Methods From January 1996 to February 2003, 12 patients (13 feet) were corrected with this method, which involved 9 males and 3 females, whose average age was 26 years old (ranged from 20-36 years). The left foot was afflicted in 4 patients, and the right foot in 7, both side in 1. Among these patients, 3 were congenital, 6 were caused by the poliomyelitis, 1 by trauma, 1 by complication from encephalitic paralysis and 1 by radiotherapy for the cavernous hemangioma of the leg. The Ilizarov distraction apparatus of the ankle and foot joint were equipped in terms of the diseases preoperatively. During the operation, the release of the postero-medial soft tissue and the limited osteotomy of triple joints of the clubfoot were performed. According to the principles of Ilizarov, the wires were inserted and the fixator installed, the distraction devices of the ankle and foot joint which had corrective function in three-dimensional directions were applied to the tibia and foot, the telescopic rods on the apparatus were rotated one week after the operation. The deformity of talipes equinovarus, internal rotation and the drooping of the forefoot were gradually corrected, and the patients could bear weight and walked on the deformity foot during the course of distractive correction. Results All the 12 patients were available at follow-up with a mean duration of 15 months (ranged from 7 months to 4 years). There was no recurrence of the deformity and the feet function was good while walking on full weight-bearing. The mean duration of traction was 71 days. 10 patients (11 feet) could gain 0? in full weight-bearing, 2 patients preserved the drooping feet deformity at 15?-20? (because of shortness in the lower extremety). None of the complications occurred postoperatively, such as infection in the incision or pin tract, necrosis of the flap, neurovascular injury and nonunion. Conclusion Utilizing Ilizarov's principle on tension-stress to correct severe adult talipes equinovarus is a safe, minimally invasive and effective method.

[Objective]To study the safety,clinical effect and therapeutic characteristics of distraction apparatus for correcting flexion contracture deformities of the knee joint by evaluating the clinical outcomes and investigating the results of biomechanic test.[Method]Forty-nine patients (included 52 knees) were treated by the standardized distraction apparatus and the comprehensive assessment standard was adopted to evaluate the clinical outcomes.Five patients were examined by three-dimensional CT of the knee joints pre-operatively and post-operatively to observe the changes in the knee structure.To observe the effect of distraction on the popliteal artery and the limb nerves,the popliteal artery diameter and blood flow speed were examined in 15 patients and the regio cruris electromyogram and nerve conduction velocity were examined in 6 patients before and after treatment.Three different means of distraction and measurement were underwent in 3 patients so as to observe the changes in the flexion curve and force of posterior soft tissues of the knee.[Result]All patients (52 knees) regained congruous structure and better function,the final excellent and good result rate was 65%.Three-dimensional CT examination of 5 patients showed that the postoperative knee joint structures were superior to the preoperative ones and there weren't damage of articular surface.The statistic results indicated that the popliteal arteries weren't obviously disturbed by distraction,whereas the limb nerves were probably disturbed temporarily.Three methods of distraction and measurement in 3 patients showed different outcomes,indicating that the effect of distraction on soft tissues was influenced by the distraction method,the ages of patients and the extents of deformities of the limb.[Conclusion]The distraction speed of therapeutic method is safe,reasonable and effective in correcting flexion contracture of the knee joint;The distraction force on posterior soft tissues of the knee is influenced by various elements,thus,the distraction speed should be individualized.Low-load and steady stretch are advantageous to soft tissue regeneration and safer.

[Objective]To explore the methods and effect of using Ilizarov'techniques for correcting severe flexion contracture of the knee joint.[Method]According to Ilizarov's tension-stress principle and its applying technique,the knee joint distraction apparatus was designed and fixed individually.The joint hinges of the apparatus on the two sides were consistent with the rotational center of the knee joint.Joint distraction of 5 to 10 mm was initially performed and followed by gradual correction of the knee joint flexion contracture at an average rate of 1 mm per day at the level of the knee joint by turning the nuts on the distraction rods at 3～4 rounds per day,with the distraction rate modified according to the patient's tolerance.Regular x-ray exams should be carried out to prevent knee joint dislocation and compression of the articular cartilage.The final requirement of correcting the soft tissue flexion deformity of the knee joint was to overcorrect the joint deformity into 5～10 degrees of hyperextension.As for the joint flexion with anterior bowing deformity of the distal femur,the degree of correcting the knee joint flexion contracture should deduce the degree of the bony deformity.The frame was left on for an additional 2 to 4 weeks.When the frame was removed,the knee joint was immediately casted in full extension for 3 to 4 weeks followed by the range of motion exercise on CPM to regain the knee motion and a long-leg brace was provided simultaneously to maintain the correction for 3 months.Secondary osteotomy was performed on anterior bowing deformity of the distal fermur in 8 patients.[Result]More than 30 degrees of severe flexion contracture of knee joint (mean?sd 58.50?21.28?) in 49 patients (52 knees ) were corrected to an average of 4.12?4.61 degrees after treatment.40 joints of 38 cases were followed for an average of 6.8 months,in which 28 joints maintain the postoperative effect.,while 12 joints had partial relapse of 9.30??8.24?.[Conclusion]Ilizarov's technique for correcting severe flexion contracture of the knee joint,can have satisfactory effect with little complications.It is mini-invasive,reliable and safe.

[Objective]To explore the method and effect of elbow joint distraction arthroplasty in the treatment of post-traumatic elbow joint flexion contracture.[Method]An Ilizarov ring distractor of elbow joint was designed.From March 2003 to July 2005,three cases of elbow joint flexion contracture aged 16～17 years (one male and two females) with a flexion deformity of 70? in one case and 45? in two cases were treated.The joint distractor was applied with the wires in the upper limb and the joint hinge at the rotational centre of the elbow joint.No skin incision was made.To correct the deformity gradually,a continuous distraction force was applied by turning the nut on the distraction bar and periodic X-ray films were taken to confirm the position of the elbow joint.[Result]The elbow joint was finally extended to 0?～10?with an average 45?correction of flexion after an average 32 days of distraction.The range of elbow joint movement increased from pre-operative 75?to post-operative 115?.[Conclusion]The elbow joint distraction arthroplasty is effective in the correcting of the elbow joint flexion contracture and improving of joint function.