0.05） . Strains of cemented groups were usually less than that of non-cemented ones for all zones except the stem tip zone. Normal group and osteoporosis group had different stress shielding and concentration(P

15?， PASA≥ 11?； typeⅥ has metatarsal- phalangeal osteoarthritis. Each of them has its own particular pathogenesis and should be operated upon by different procedures respectively.

Objective To study the spatial change of transverse arch in the metatarsal head during a normal walking cycle, demonstrate the significance of transverse arch in normal walking and the relationship with hallux valgus. Methods A modeling gait cycle was obtained under the C- armed machine, the coronal spatial change of the transverse arch of the metatarsal head were recorded using video tape. On computer work station, the images from video tape were transformed to mpeg files. A model of the transverse arch was created for the analysis of the relationship between the transverse arch index Q and sinking time; between Q and I andⅡ intermetatarsal angle;Ⅰ andⅣ intermetatarsal angle; sinking time and body mass. Results There was a transverse arch formed by the 5 metatarsal heads. In normal walking, during standing phase to toe- off phase, the 2 and 3 metatarsal heads approach the ground resulting in sinking of the transverse arch. The transverse arch index had an adverse relationship with the hallux valgus angle. The time of the transverse arch sinking decrease accompanying with the transverse index Q. Conclusion The transverse arch of metatarsals played an important role during normal gait cycle. During normal walking, when the center of pressure moved forward, the force acting on the 2 and 3 metatarsal was increasing. So, the metatarsal heads drop down resulting in sinking of the transverse arch of the metatarsal head. In hallux valgus patients, the time of transverse arch sinking was earlier than normal and duration was longer. The total force acting on the 2 and (or) 3 metatarsal increased, which may caused disorder of forefoot.

Objective To study the role of first metatarsal sesamoids s y stem in the pathogenesis of hallux valgus. Methods The sesamoids absolute and relative position (TSP) were measured in 245 normal feet and 141 hallux valgus ones, and the results were statistically analysed with hallux valgus angle(HVA), intermetatarsal angle(IMA) and metatarsal phalangeal joint subluxation. Results The absolute position of sesamoids had no difference in the normal feet and ha llux valgus ones. TSP was correlated with HVA,IMA. TSP≤3 was considered normal in 245 normal feet. 92 hallux valgus feet were surgically treated. 20 cases unde rgone Keller procedures which didnt correct TSP were excluded from this study. 19 cases treated with modified McBride procedures, 24 cases with metatarsal met aphyseal osteotomy, 29 cases with metatarsal basal osteotomy. All the cases were followed up for an average of 4 years(ranged 1－6 years). The postoperative HV A was 5?－10?(average 7?)，IMA was 5?－9?(average 7?)，TSP were all 3 or 4 . According to the evaluation standard made by SUN Junying et al, 60 cases(83％) were assessed as excellent， 8 cases(11％) as good， and 4 cases(6％) as worse ， giving an overall excellent and good rate of 94％. Conclusion TSP is an impo rtant parameter that should be routinely used for postoperative prognosis evalua tion and surgical procedures determination. Osteotomy is preferred to restore no rmal metatarsal-sesamoids system function when TSP is abnormal.

Objective To evaluate the medial longitudinal arch of the foot with and without hallux valgus in order to establish the relationship between hallux valgus and the arch. Methods 34 feet of 24 cases with hallux valgus and 34 normal feet of 18 cases were investigated by roentgenography. On the dorsal plantar view while weight-bearing standing, the hallux valgus angle (HVA), the first intermetatarsal angle, and the position of the tibial sesamoid relative to the first metatarsus were measured respectively. On the lateral view while weight-bearing standing, the top angle of the medial longitudinal arch, the anterior angle of the medial longitudinal arch (also named as the first metatarsal inclination angle) and the relative height of the talus, which are similar to measurement of the height of the medial longitudinal arch, were measured respectively. The characteristics of the medial longitudinal arch of the feet with and without hallux valgus were compared, and the correlation between the height of the medial longitudinal arch and the severity of the hallux valgus, which were manifested by the hallux valgus angle, first intermatatarsal angle, the relative position of the tibial sesamoid, was analyzed. Results The top angle of medial longitudinal arch was 136.9??7.6? in hallux valgus feet and 126.7??2.1? in normal feet; the anterior angle of medial longitudinal arch was 10.8??2.6? in hullux valgus feet and 16.6??1.6? in normal feet; the relative ratio of height of talus was 0.159?0.03 in hallux valgus feet and 0.199?0.01 in normal feet , there was significant difference between two groups. While with the increase of the lateral displacement of tibial sesamoid, the angle of hullxus valgus and the first intermetatarsal angle, the top angle of medial longitudinal arch became larger, the anterior angle of arch became smaller, and the relative height of talus became lower. The medial longitudinal arch of the foot with hallux valgus was collapsed, and there was moderate to high relationship between the height of the medial longitudinal arch and the severity of the hallux valgus. Conclusion Hallux valgus is a three dimensional deformity, which will disturb the normal biomechanics of the foot.

[Objective]To study the foot radiographs of rheumatoid arthritis(RA),evaluate the relationship between foot deformity and disease duration,the relationship between flat foot and forefoot deformities in RA,thus to improve understanding of the progression of deformity and provide more appropriate treatment. [Method]Anteroposterior and lateral weight-bearing radiographs were obtained for 112 feet of patients with RA and 104 feet of patients without RA.The hallux valgus angle,the first intermetatarsals angle,the top angle of the medial longitudinal arch,the anterior angle of the medial longitudinal arch,the relative height of the talus were measured.One-Way ANOVA were used to evaluate the difference between two groups,and partial correlations were used to analyze the relationship between the foot deformities and disease duration by control the age,the relationship between flat foot and forefoot deformity by control the age was also analyzed.[Result]The hallux valgus angle was 24.2?14.3 in RA group and 13.2?5.3 in control group,the first intermetatarsals angle was 9.6?5.9 in RA group and was 7.6?4.4 in control group,the top angle of the medial longitudinal arch was 129.4?6.6 in RA group and 124.4?5.2 in control group,the anterior angle of the medial longitudinal arch was14.5?3.0 in RA group and 16.2?4.5 in control group,the relative height of the talus was 0.184?0.024 in RA group and was 0.191?0.032 in control group,there was significant difference between two groups except the anterior angle of the medial longitudinal arch.With the increase of disease duration,the top angle of the medial longitudinal arch,increased in RA group(P

0.05). The length and the angle of the proximal tibial slope were (2.34?0.2) cm and (20.1?4.3)?, respectively. Conclusion The specification of entry point of intramedullary nailing must be individual because the shape of proximal tibia varies in different persons.

To investigate the status of application of Chinese Hypertension Prevention and Treatment Guideline (Guideline) by general practitioners (GPs) in Shanghai.A questionnaire survey was conducted among 260 GPs from 8 communities in Xuhui District of Shanghai during March 2011 to December 2012.Among all participants,94.2％ knew the Guideline.The overall correct rate was 56.2％; that of epidemiology,diagnosis,treatment,two-way referral and community management of hypertension was 49.2％,54.5％,60.6％,56.9％ and 32.3％,respectively.There were significant differences in correct rates of the questionnaire between GPs with different age,gender,education and community (P =0.000,0.035,0.000,0.000).The correct rates of epidemiology and treatment in GP teaching bases (58.5％ and 62.6％) were higher than those in non-teaching bases (39.2％ and 58.4％) (P =0.002,0.040).But there was no difference in overall correct rate between these two groups (P =0.095).The results indicate that the understanding and application of Hypertension Guideline by General practitioners in community is insufficient.Teaching hospitals should carry out systematic,comprehensive,sustained,targeted training course in order to improve the diagnosis and treatment levels of hypertension for general practitioners in community.

Objective To evaluate factors which maintain the stability of the ankle, and discuss indications for trans-syndesmotic fixation. Methods 12 freshly-frozen cadaver legs amputated below the knee were collected and divided into 2 groups. An ankle fracture model of unconstrained pronation-external rotation was then designed. Group A simulated the injury combined with medial malleolus fracture, and Group B the injury combined with deltoid tear. Ligaments were cut off sequentially to simulate the increasing severity of the injury. Fuji super low-pressure sensitive films and displacement transducers were used to measure the contact area of the tibiotalar articular surface and the width of the syndesmosis. The data were analyzed with SPSS to analyze the relationship of ligament injury and ankle stability. Results In Group A, the articular contact area and the syndesmotic width after section of the deltoid were significantly different from those before the section (P

Objective To investigate the result of arthroscopic surgery in the treatment of sinus tarsi syndrome. Methods The study involved 15 patients (6 males and 9 females) with sinus tarsi syndrome admitted to First Hospital of Nanjing from July 2006 to May 2008. The age of the patients ranged from 23 to 63 years ( average 46.3 years). All the patients had one side involvement, including 10 patients with left side involvement and five with right side involvement. All the operations were performed under the tourniquet control and the patients were placed at the lateral decubitus position. The lateral, anterolateral and posterolateral portals were applied intraoperatively and the medial portal was applied when necessary. Visual analogue scale (VAS) and American orthopedic foot and ankle scale (AOFAS) ankle-hindfoot scale were used for follow-up evaluation. Results More than two lesions were found under arthroscope in all patients. The lesions included scar tissue hypertrophy and inflammation in the sinus tarsal canal, soft tissue impingement in the subtalar joint, synovitis, partial tears of subtalar capsule, interosseous talocalcaneal ligament or cervical ligament, cartilage injury and subtalar degeneration. All patients were followed up for 19-35 months (mean 26. 1 months). At the final follow-up, the VAS score was improved from preoperative 7.6 points ( range 6-9 points) to postoperative 2.5 points (range 1-4 points) (P＜0.01 ), and the AOFAS score improved from preoperative 41. 9 points (range 20-67 points) to postoperative 83. 1 points ( range 70-100 points) ( P ＜ 0. 01 ). The excellence rate of the AOFAS score reached 73% at the final follow-up. Conclusion For patients with sinus tarsi syndrome after a failed conservative treatment, arthroscopic surgery should be performed as soon as possible and the clinical result is satisfactory.