[Objective]To discuss the postoperative effect of the posteromedial structure injury (medial collateral ligament,MCL,posterior oblique ligament,POL) of the knee.[Method]Fourteen cases of complex posteromedial structure injury were treated from January 2002 to October 2007,twelve of which combined with ACL injury and two combined with PCL injury.Classification of posteromedial structure injury:typeⅠ,8 cases,ruptured from the femur with small bone fragment;type Ⅱ,2 cases,ruptured from the femur without bone fragment;typeⅢ,2 cases,the structure were torn from the body area,and type Ⅳ,2 cases,ruptured from the tibia.The injury were repaired by different techniques according to the classification.Eight cases applied star-shaped steel plate,four with GⅡ anchor screws(2 attached to the femur and 2 to the tibia adhesion respectively),and 2 cases with end-to-end suture.The ruptured ACL and PCL were reconstructed by arthroscopy.Autologous semitendinosus and gracilis were used for 8 ACL reconstruction and B-T-B technique for the other two ACL reconstruction.Two ruptured PCL were reconstructed with allograft of Achilles tendon.[Result]All cases were followed up for twelve months at average(6-18 months) except two cases only for four months.The functional score of the knees were improved from 56.7(50-60) preoperatively to 81.2(74-94) postoperatively in average valued by Lysholm system.Ten cases received normal knee flexion and extension range after repair of the posteromedial structure while 2 cases with restricted 5 degree extension.Nine cases received excellent result in lateral stress test while 2 cases with "+" and 1 case with "++" at zero angle.[Conclusion]Early repaire for the posteromedial structure injury will deliver excellent knee stability.

[Objective]To explore the value of magnetic resonance imaging (MRI) for articular cartilage lesions after bone bruise of distal femur under arthroscopy.[Method]Articular cartilage lesions of 29 cases of distal femur bruises diagnosed by MRI were examined under arthroscopy,12 cases of them combined with medial and lateral meniscus injury,17 combined with anterior cruiciate ligament rupture.[Result]The distal femur articular cartilage lesions examined under arthroscopy were corresponding to MRI findings.The lesions showed by arthroscopy were in direct proportion to MRI.These lesions were classified into Ⅰ-Ⅳ degrees.[Conclusion]Arthroscopic examination showed correspondent result to MRI findings for articular cartilage lesions.Sometimes MRI couldn't deliver the severity of cartilage lesions because of instrument factors.Arthroscopy is considered as the golden standard of evaluation for articular cartilage lesions after bone bruises.

Objective To observe histomorphology of neo-cartilage obtained with tissue-engineering by combining calcium alginate gel and in vitro cultrue of chondrocytes. Methods Articular chondrocytes from the knee joints of 2-week-old New Zealand white rabbits were harvested, expanded in cell culture, and following the second generation of the culture, the chondrocyte suspension was mixed with calcium alginate gel resulting in a cell density of 5? 10 6/ml. Finally the mixture, which contained 1％ sodium alginate, 40 mmol/L calcium gluconate, 0.135 mol/L NaCl, 0.1 mol/L K 2HPO 4 and 5? 10 6 chondrocytes per milliliter, were injected into the dorsal subcutaneous tissue in rabbits of experimental groups (A and B). Animals of the control groups (C and D) were injected with calcium alginate without chondrocytes or chondrocytes without calcium alginate. Specimens were harvested at the 2nd and 4th week after injection, and stained with HE and toluidine blue. Results In the HE stained specimens in the experimental groups, proliferation of chondrocytes was demonstrated at the 2nd week and the formation of neo-cartilage at the 4th week after injection of calcium alginate chondrocyte-composite. Toluidine blue stained specimens showed positive staining of chondrocytes and cartilage matrix of neo-cartilage. In some animals injected with chondrocytes without calcium alginate, relative small amount of neo-cartilage was also formed and no neo-cartilage was observed in animals injected with calcium alginate without chondrocytes. Conclusion Injectable calcium alginate-chondrocyte-composite can induce tissue engineered neo-cartilage in allogenic animal.

Objective To evaluate the curative effect of arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions.Methods Retrospectively analyzed the clinical data of 35 cases who were admitted into our hospital from June 2015 to October 2016 and underwent arthroscopic surgery for the treatment of first-time shoulder dislocation.All the 35 cases were combined with Bankart lesions,and the lacerated glenoid labrum were repaired with suture anchorsy.The postoperative ASES scroe and Rowe score were adopted for the final evaluation.Results All the 35 cases were followed up for 1 to 6 months,3 months averagely.All the patients had satisfactory shoulder function,with no shoulder dislocation occured again.The ASES score and Rowe score after surgery was better than that before surgery with statistically significant difference(P<0.05).Conclusion Arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions has many advantages such as mini-invasion,rapid recovery and satisfactory outcome in function and motion.

Objective:To investigate biomechanical changes of mandible in the impact injure simulated by finite element method (FEM).Methods:Mimics and Comsol software were used to build a FEM of human craniofacial bone based on CT scan data of a normal adult.LS-DYNA and Hypermesh software were used to simulate the impact with different quality,velocity and angulation pro-duced injures of human mandible,the biomechanical parameters of the mandible in the impact injury process were analysed.Results:A FEMof human maxillofacial bone was established,and the dynamic process of different impact force produced damage was simula-ted.Mandibular chin,angle and condylar neck was the stress concentrated area in the process of mandible injury.There was higher stress peak at the site which was closer to the impact position,the stress peak arrival time was also earlier.When the impactor with the same quality,the bigger the velocity,the greater the stress peak.When the impactor with the same velocity,the bigger the quali-ty,the greater the stress peak.When the impactor with the same velocity and quality,there was greater stress peak under the impact to mandible from angulation of 0 degree.Stress transfered to the surrounding bone from the impact position radially and gradually re-duced.The bone area with small cross-section was prone to high stress and more serious damage.Conclusion:The quality,the ve-locity,the impact angle and the impact site are the factors affecting the severity of impact injury.

Objective To investigate the clinical efficacy of unilateral small incision Quadrant channel assisted MIS?TLIF unilateral pedicle screw fixation system in the treatment of degenerative lumbar disease. Methods From January 2011 to December 2013,a total of 56 cases with low back and leg pain were selected in the People′s Hospital of Dongguan,including 25 cases with lumbar disc herniation,18 cases with lumbar tube stenosis,10 cases with discogenic low back pain,2 cases of recurrence after posterior lumbar spine surgery,1 case of recurrence after transforaminal endoscopic surgery. Unilateral pedicle screw fixation was performed in the treatment of MIS?TLIF with expandable pipeline system. VAS and Oswestry dysfunction index scoring system( ODI) were used to evaluate of pain and functional recovery in patients with preoperative and postoperative pain and functional recovery,the Suk method was used to observe the bone graft fusion. Results There were 5 cases of non operative side waist back pain after operation,and the waist circumference and anti?inflammatory pain relief were improved after treatment. One case of postoperative subcutaneous fat liquefaction, was cured by dressing change. One patient with recurrence of MED intraoperatie cerebrospinal fluid leakage,was cured after treatment by the bed,dehydration and others. Other complications such as infection,screw loosening, nerve root injury and other complications had no found. After 1 month,the VAS score from preoperative ( 6. 82 ±0. 92) points fell to (1. 95±0. 55) points,ODI score from preoperative (35. 21±2. 73) points fell to (10. 05 ±1. 72) points, significantly improved compared with the preoperative, the differences were statistically significant( t=36. 775,65. 858,P<0. 05) ,based on the fusion of Suk judgment method,2 cases of patients with possible fusion,the rest were fusion. Conclusion Unilateral small incision under the quadrant assisted MIS?TILF unilateral pedicle nail stick system has obvious advantages in treatment of degenerative lumbar spine disease,as long as we choose to suitable cases and most patients can obtain satisfactory results.

BACKGROUND: The study of tissue-engineered cartilage with predetermined shaping and regeneration has provided novel ideas and techniques for repair of laryngeal cartilage erosion; however, due to the special natures of the morphology, location and function of laryngeal cartilage, tissue engineering research has not, to date, exhibited its ful advantages in the reconstruction of laryngeal cartilage. OBJECTIVE:To explore the feasibility of building tissue-engineered larynx-shaped cartilage using poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHH) as a scaffold filed and encapsulated with pedicled myofascial flaps. METHODS:Porous PHBHH was prepared and formed into a holow like larynx-shape, and the cel PHBHH composites were cultured for 1 weekin vitro prior to implantationin vivo. The cel-PHBHH composite was filed and encapsulated with myofascial flaps with the pedicle forin situ implantation in nine rabbits as experimental group. PHBHH scaffold with no chondrocytes was implanted alone in three rabbits as control group. Cartilage regeneration was assessed at 6, 12 and 18 weeks after surgery through morphological observation, histological and immunohistochemical detection. RESULTS AND CONCLUSION: In the experimental group, the shape and porosity (> 90%) of the material were ideal, the cels exhibited good adhesion with the material and the blood supply within the myofascial flap with pedicle was rich for effective filing and encapsulation of the cel PHBHH composite. Tissue-engineered laryngeal cartilage with the holow, semi-trumpet shape was idealy formed at 6 weeks after the surgery. Further maturation of the cartilage was observed at 12 and 18 weeks after the surgery. However, there was no cartilage tissue in the control group. This study shows that PHBHH is a suitable material for the formation of a holow, semi-trumpet shape with good celular compatibility. Myofascial flap filing and encapsulating can be used to build tissue-engineered laryngeal cartilage with a holow, semi-trumpet shape.

Objective To evaluate the clinical results of arthroscopic arthrolysis for the treatment of elbow stiffness.Methods Totally 34 cases with elbow stiffness caused by trauma who needed to undergo arthroscopic arthrolysis were selected from General Hospital of Shenyang Military Area Command from October 2014 to February 2016.Among them,3 cases were lost to follow-up,and the other 31 cases were included in the study.All the patients were performed arthroscopic arthrolysis.Removed the hyperplasia of osteophyte and girdle,cleaned the articular cavity,restored the smooth of articular surface,and released the joint capsular and ligament around the elbow joint during the operation.Manipulation release was used coordinate with analgesia and rehabilitation therapy after operation.Mayo scores of elbow were used for function evaluation and range of motion(ROM) was collected.Results Patients were followed-up from 9 months to 12 months,(10.4±1.5) months on average.Before the operation,the mean maximal flexion angle of the elbow was (87.6±5.9)°,the extension angle was (35.5±6.4)°,the pronation angle was (75.9±9.6)°,the rotational angle was (67.2±7.4)°,and it was (125.9±6.5)°,(5.0±1.9)°,(82.0±9.1)°,(81.0±7.0)°respectively after operation,and the differences before and after opreation were statistically significant (P<0.05).The Mayo scores was (61.9±7.6) preoperatively and (88.8±4.7) postoperatively,and the difference was statistically significant(P<0.05).Conclusion Arthroscopic arthrolysis has the advantages of clear operative field,minimal invasion and rapid recovery.It can effectively improve the elbow joint activity and arthroscopic arthrolysis is an effective surgical treatment for elbow stiffness.

ObjectiveTo investigate the injury mechanism,clinical characteristics and surgical treatments of Segond fracture combined with anterior cruciate ligament (ACL) injury.MethodsNine patients suffering from Segond fracture combined with ACL injury were treated between January 2008 and December 2010.All the patients revealed ACL and medial collateral ligament (MCL) breakage under arthroscopy.Furthermore,one patient was associated with lateral collateral ligament (LCL) breakage and medial meniscus injury,four with medial meniscus tear and two with lateral meniscus tear.All the patients underwent arthroscopic tendon allotransplantation,ACL reconstruction and MCL repair.Besides,synchronous LCL reconstruction was performed in one patient,meniscus suture in three and meniscus plasty in four.Six patients with large Segond fracture fragments were fixed with two hollow lag crews and three with relatively small fracture fragments fixed with one hollow lag crew.ResultsThe mean followup period was 12 months,which showed average postoperative Lysholm score of 59 points and satisfactory clinical outcome.ConclusionsSegond fracture is often combined with ACL injury and is predictive for ACL injury.In ACL reconstruction,large Segond fracture blocks should be reduced and fixed and the combined injuries also should be treated in the same period.

Objective To discuss the clinical effects of arthroscopy combined with Brostrom repair in the treatment for chronic ankle instability talofibular ligament injury.Methods From January 2012 to June 2015,42 cases of chronic ankle instability in our hospital were performed modified Brostrom repair.All the cases were evaluated by AOFAS scoring system.Results All the patients were followed up for 9 to 17 months,an average of (12.7±3.5)months.At the last follow-up,all cases could participate in normal daily running training mission.Activity levels of 2 cases with cartilage injury had a decline than before.The others were able to attend the confrontational training.Postoperative AOFAS score(88.4±4.9) increased compared with preoperative score (43.3±7.8),the difference was significant(P<0.05).ConclusionThe curative effect of arthroscopy combined with Brostrom repair in treatment of chronic ankle instability talofibular ligament injury is satifactory.It can be helpful to the wounded rapid rehabilitation and good for the popularization and application in basic-level hospitals.