BACKGROUND: For the orthopedic surgeon, the postoperative functional recovery after total knee arthroplasty, in which the reconstruction of posterior femoral condylar offset plays an important role, is an important goal.OBJECTIVE: To understand the anatomic characteristics of the femoral condylar offset and the mechanism how posterior condylar offset influences the functional recovery of knee joint after total knee arthroplasty.METHODS: The author searched PubMed database and Wanfang database for articles about posterior femoral offset and knee range of motion. The key words were arthroplasty; replacement; knee; femur; posterior condylar offset; range of motion. A total of 96 articles were retrieved, and 38 articles met the inclusion criteria.RESULTS AND CONCLUSION: Posterior condylar offset had differences in gender, ethnics and medial and lateral condyles. To restore the biomechanics of the knee joint, the design of knee prosthesis should consider the difference in genders, ethnics, medial and lateral condyles. The influence mechanism is the femur-tibia impingementand gap balance. However, further clinical research is needed, for contradictory results regarding whether posterior condylar offset has an effect on knee flexion after total knee arthroplasty.

Objective To investigate the effects of autologous platelet-rich plasma in the treatment of refractory wound.Methods Fifteen cases with refactory wound ( 1 1 males and 4 females) involving six cases with diabetic ulcer,five with post-surgical ulcer wounds and four with pressure sore were enrolled into the study.The autologous platelet-rich gel was applied to the wounds after debridement and dressing change was done every week.The results of wound bacterial culture were regularly detected and the growth of granulation was observed.Skin graft or flap graft surgery was performed to close the wound when the wound condition was permitted.Results Of all,three patients had spontaneous healing after the change of dressing,four got healing after flap graft and eight attained healing after skin graft.There was no recurrence or sinus after treatment.Conclusion Autologous platelet-rich gel accelerates wound healing,improves wound condition,and raises success rate of surgical closure of the wound.

[Objective]To discuss the application of the short reconstruction intramedullary nail in treating intertrochanteric fracture.[Method]From Jan 2000 to Aug 2004,35 patients(14 males and 21 females)with femoral intertrochanteric fracture were treated by short reconstruction intramedullary nail.Various data were analyzed for evaluating the characteristics and curative effect.[Result]The mean incision length was 3.5 cm,the average duration of operation and intraoperative X-ray fluoroscopy was 65 min and 0.16 min,respectively.The mean blood loss was 50 ml.None of the complications occurred postoperatively,including nonunion,deep venous thrombosis or infection of the incision etc.except only 1 malunion due to inappropriate surgical skill.Internal fixation loosening didn't appear in 97% of the patients.[Conclusion]Using short reconstruction intramedullary nail to treat intertrochanteric fracture can obtain satisfing outcomes of different concerns,such as time-saving,small incision,few complications,quick recovery and so on,which indicates that it should be the first choice for the treatment of femoral intertrochanteric fracture.

Objective To explore three dimensional relationships of commonly used bony marks of the distal femur, and to investigate its clinical application of distal femur rotational alignment. Methods One hundred and fifteen normal distal femurs of 62 volunteers were studied. With MR sagittal imaging and three dimensional reconstruction, correlative parameters, including PCA (posterior condylar angle), angle between surgical transepicondylar axis (STEA) and posterior condylar line (PCL); CTA(condylar twist angle), angle between clinical transepicondylar axis (CTEA) and PCL; APA, angle between the perpendicular of antero-posterior line (APL) and PCL; ATA, angle between the perpendicular lines of APL and STEA; CSA, angle between CTEA and STEA. All these angles were measured. The parameters of the two groups both in males and females, as well as in right and left knees were analysed. Results PCA: 3.44??1.08? (range, 0.62? to 6.75?); CTA: 6.03??0.86? (range, 2.93? to 8.92?); APA: 4.31??0.64? (range, 1.92? to 7.05?); ATA: 0.87??0.78? (range, -1.72? to 3.84?); CSA: 2.58??0.57? (range, 0.22? to 4.51?). There was no significant difference between left and right knee in terms of all the above mentioned parameters, yet there was significant difference between male and female groups in terms of PCA, CTA and ATA. PCA and CTA were larger in male groups than that of female group, while ATA in female group was larger than that of male group. Conclusion Three dimensional reconstruction based on imagings of MR is a reliable method to study the distal femur rotational alignment. In the normal knees, there is constant relationship between these parameters. Operators should use distal femur rotational alignment according to practical conditions in performing the total knee arthroplasty.

[Objective]To measure the posterior sloope angle of proximal tibial medial meniscus(PSAPTMM) in Chinese adult,provide parameters for improving the design of knee prosthesis more suitable for Chinese and for resecting tibial plateau in total knee arthroplasty.[Method]Sixty-three male knees and 52 female knees of Chinese,without tibial deformity,genu varum and valgum,abnormal change of articular surface,and tibial trauma,with average age of 45.6 years(ranged,20~74 years,were divided into 3 groups according to persons age: group A,18~39 years;group B,40~50 years;group C,more than 60 years.The sagital tomography of medial meniscus of MRI were taken,stored,and measured using JENNY way.The data were analyzed statistically.[Result]By two factors analysis,the sex and age had no significant influence on PSAPTMM,and the angle was not different between the left and right knee.In male adult,the average degree of left PSAPTMM was(2.7?1.8,of the right(2.9?1.7)? with an average degree of both sides of(2.9?1.8.In female adult,the average degree of left PSAPTMM was(3.5?1.7,of the right(2.8?1.6,with the average degree of both sides(3.2?1.7.The average degree of group A were(3.6?1.6,group B(2.7?1.8,group C(2.8?1.7.There showed no significant difference of PSAPTMM between sex,side,and age.[Conclusion]The average degree of PSAPTMM in northern Chinese adult is(3.0?1.7,ranges from(0~6.2,and is larger than that of the westerns.

Objective The measurement of normal tibia was aimed to obtain the value of the posterior slope angle of the medial tibial plateau in Chinese adult and its related parameters in order to improve the design of knee prosthesis more suitable for Chinese people, and also provide an essential features of tibia for resecting tibial plateau in total knee arthroplasty. Methods 450 knees of 428 persons which were healthy Chinese adult long living in North China, were 252 male knees and 198 female knees with an average age of 43.9 years ranging from 18 to 79 years. The criteria of the subjects were no tibial deformity, no genu varum and valgum, abnormal changes of articular surface, and had sustained ever any tibial trauma. Depending on the age of subjects, they were divided into three groups, group A was between 18 and 39 years, group B between 40 to 59 years, and group C more than 60 years. Moreover, 6 tibias harvested from healthy Chinese corpses were measured as well. Computer radiography was used to take standard lateral aspect of X-ray film. The imagines were stored into computer by scanning the films, and so the measurement was taken in computer using Danzig method. The data were analyzed statistically. Results By two factors analysis, the sex and age had no significant influence of the posterior slope angle of the tibia; furthermore, the angle was not different between the left and right tibia. In male adult, the average degrees of left posterior slope angle of the medial tibial plateau were 13.2??4.4?, the right 10.5??5.1?, and the average degrees of posterior slope angle of both sides were 11.7??4.9?. In female adult, the average degrees of left posterior slope angle of the medial tibial plateau were 11.2??3.5?, the right 10.6??4.4?, and the average degrees of posterior slope angle of both sides were 10.8??4.0?. The average degree of group A were 11.7??4.4?, group B 10.4??4.7?, group C 12.3??4.4?. In summary, there was no significant difference of posterior slope angle of the medial tibial plateau between sex, side and age. Conclusion The average degrees of posterior slope angle of the medial tibial plateau in North China adult were 11.3??4.5? ranging from 0??21? to 9?-13?, and were larger than that of the Westerns.

Objective To explore the clinical results of internal fixation of patellar transverse body fracture by comparing figure-of-eight tension band wiring combined with cannulated compression screws technique with traditional modified tension band (AO technique). Methods There were 14 cases in the cannulated screws combined with tension band wire group, it involved 9 males and 5 females, the average age was 46 years. The patients were followed up for an average of 30 weeks with a range from 16 to 48 weeks. Another 20 cases were in the modified tension band group, it involved 13 males and 7 females, the average age was 42 years. The patients were followed up for an average of 42 weeks with a range from 36 to 72 weeks. The t test was used to compare the clinical results between two groups, including the mean knee flexion at the 2nd and 4th week, the mean clinical union time and the mean flexion loss at the 24th week postoperatively. Results In the cannulated screws combined with tension band wire group, the mean knee flexion at the 2nd week and 4th week postoperatively was 59??14.8? and 98??15.1? respectively. The mean clinical union time was (10?3.0) weeks and the mean flexion loss at the 24th week postoperatively was 11??6.3? without any complication. In the traditional modified tension band group, the mean knee flexion at the 2nd week and 4th week was 31??13.3? and 63??13.7? respectively. The mean clinical union time was (13?3.8) weeks and the mean flexion at the 24th week postoperatively was 18??6.2?. In this group, 2 cases failed because loosening of the tension band with the pin pulled out. One was managed with the plaster brace, the other underwent re-operation. Conclusion With stable construct, the internal fixation of transverse patellar body fracture with figure-of-eight tension band wiring combined with cannulated compression screws is less invasive to local soft tissue, optimal on knee functional recovery and fracture union. No complication has occurred, but the long-term clinical result and complication should be followed up for longer time.

Objective To explore the role of fibrogenic cytokines and inflammatory cytokines in the pathogenesis of frozen shoulder. Methods From September, 2014 to April, 2016, 20 patients with frozen shoulder accepted arthroscopic surgery were included, ten of them were diagnosed as primary frozen shoulder (group A), the other ten were secondary frozen shoulder (group B). Other ten patients undergo-ing shoulder arthroscopy for instability (4 cases), rotator cuff injury (3 cases) and subacromial impingement (3 cases) were as the controls (group C). The mRNA levels of matrix metalloproteinase (MMP) 1, MMP3, tumour necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6, IL-8, granulocyte-macrophage colony stimulating factor (GM-CSF) and M-CSF in synovium were analyzed with quantitative polymerase chain reaction. Results The expression of mRNA of MMP1, MMP3, TNF-α, IL-1, IL-6, IL-8, GM-CSF and M-CSF were more in group A and group B than in group C (P<0.05). There was no significant difference between group A and group B (P>0.05). Conclusion The fibro-genic cytokines and inflammatory cytokines may play a role in the pathogenesis of frozen shoulder.

Objective To investigate the effect of Buyanghuanwu decoction(BYHWD) on the expression of growth-associated protein 43(GAP-43) and synaptophysin(SYP) after focal cerebral ischemia in mice.Methods Focal cerebral ischemia was induced by 30 min of middle cerebral artery occlusion followed by reperfusion.BYHWD (20 g/kg) was administered orally 24 h after ischemia and once a day.The neurological score and the corner test were used to evaluate sensorimotor function on 1,3,7,and 14 days after ischemia.The expression of GAP-43 and SYP in the ischemic boundary zone was determined by immunohistochemistry 14 days after ischemia.Results Compared with the model group,BYHWD significantly ameliorated neurological dysfunction at 3,7 and 14 days and reduced the number of right turn at 7 and 14 days after ischemia(P ＜ 0.05).The average optical density of GAP-43 and SYP was 0.217 ±0.012 and 0.278 ±0.019 at the boundary zone in model group 14 days after ischemia,respectively.BYHWD also significantly increased the immunoreactivity of GAP-43 (0.250 ± 0.013)and SYP(0.323 ± 0.017) (P＜ 0.01).Conclusion BYHWD promotes axonal regeneration and synaptic plasticity in the ischemic boundary zone,which may contribute to functional recovery after focal cerebral ischemia.

Objective To analyze and evaluate the effect of the elbow posterior dislocation with radial head and coronoid fractures (the terrible triad of the elbow). Methods Nine patients of the terrible triad of the elbow were treated from January 2004 to March 2009. Among of them, according to Schatzker-Tile classification, the radial head fractures were 4 in type I , 3 in type II , 2 in type Ⅲ. According to Rogan-Morrey classification, the ulnar coronoid fractures were 2 in type I , 5 in type II , 2 in type Ⅲ. The general approach was to repair the damaged structures sequentially from deep to superficial, from coronoid to anterior capsule to radial head to lateral ligament complex to common extensor origin. If there was valgus instability in the elbow after the operation, repaired medial ligament with nonabsorption suture. Plaster was applied for 7-10 days,in position of with elbow flexion in 90° and the forearm in full pronation. Unrestricted morion was then begun, and strengthening was initiated at 8 weeks. Returned to regular occupation depended on the degree of physical activity required, and it typically taken 3 months for heavy physical laborers to return to work. , Results All patients were followed up for 6-60 (31 ± 6) months. Three months postoperatively, the flexion-extension arc of the elbow was 80° -110° (102° ± 3° ), and the pronation-supination arc of the forearm was 100° -150° (135° ±6°) respectively. According to the criteria of the Mayo score, the results were excellent in 5 cases, good in 3 cases, and fair in 1 case. Three cases were heterotopic ossification 6 months postoperatively, 2 cases of them didn't impact the elbow function, didn't treat, 1 case impact the flexion-extension of the elbow, cut the heterotopic ossification from the lateral approach, Mayo score improved from fair to good. Conclusion The key points for treating the terrible triad of the elbow are recovering the elbow normal anatomy and starting early functional exercises in order to avoid the elbow stiff.