BACKGROUND:Knee osteoarthritis can be treated by total knee arthroplasty. To improve therapeutic effect and promote postoperative recovery, we should take effective measures to improve the joint space and postoperative range of motion.
OBJECTIVE:To explore the effectiveness and feasibility of posterior composite release of the knee joint after total knee arthroplasty.
METHODS:118 knee osteoarthritis patients undergoing unilateral total knee arthroplasty in two hospitals from December 2009 to December 2013 were selected, and were randomly divided into control group (59 cases) and observation group (59 cases). After osteotomy during operation, the control group underwent bone removal of conventional condylar hyperplasia. Observation group underwent posterior composite release of the knee joint. Postoperative extension, flexion gap and the time required for postoperative active flexion 90° and 120° were observed in the two groups. Hospital for Special Surgery Knee Score and maximum flexion angle were recorded in 3 months of fol ow up, and compared between the two groups. RESULTS AND CONCLUSION:Through the statistics and comparison, no significant difference in flexion gap was found between the two groups (P>0.05). However, significant differences in extension gap, the time for active flexion 90° and 120°and the maximum flexion angle were detectable between the two groups, and above indexes were better in the observation group than in the control group (P<0.05). Hospital for Special Surgery Knee Score of each index and total score were significantly higher in the observation group than in the control group (P<0.05). These results suggest that rear joint composite release after total knee arthroplasty has certain validity and feasibility, can effectively improve knee extensor gap and the postoperative range of motion during replacement, but does not impact flexion gap during replacement.

The authors adopted an auto control experimental research on 18 male adult dogs with 36 sides of femoral heads and necks which were divided into two groups. They were separately made models of old fracture of femoral neck and avascular necrosis of famoral head. Two wecks later, The free fibula with microvascular an astomosis was tranplanted. All experimental dogs were examined with X-ray, pathohitology, electron microscopy, 99~mTc-MDP scanning and tetracycling labeling after operation.The experiment showed that the free fibular graft with mierovascular anastomosis could provided a new system of vascula supply to the injured femoral head. The hard free fibula and the metallic internal fixation were inserted in femoral head and neck. After the Operation, in the fracture area the fibula formed a bone-bridge which not only diminished the stress force but also prevented rotation displacement of the bone fracture The periosteum of the transplanted fibula also took part in the repair course of avascular nerosis of femoral head.

118 cases with uper and median partialfibulectomy were reported in this paper. Of them50 cases were followed up 1～8 years. The clinicalfunction, foot arch and X-ray of bilaleral ankleswere examined. Ankle joint function was mea-sured with the instrument made by ourself. Afteranalysis and valuation of the results, our conclu-sion is that uper and median partial fibulectormydoes not affect the ankle joint function. Thereforethe fibula being considered as a donor bone is ac-ceptable.

Objective To explore the indications of physiotherapy and operative treatment for gluteal muscles contracture, and discuss the principles and necessity of classification in order to facilitate clinical management. Methods The standards of classification of gluteal muscles contracture were based on the signs and pathological examination, It consisted of three stages upon our standards. 210 patients could be divided into stage Ⅰof 23 cases, stage Ⅱand Ⅲ of 187 cases. For the patients of stageⅠ, physiotherapy was performed; However, all cases of stageⅡand Ⅲ, operative treatment was adopted by small superomedial incision above the greater trochanter. Furthermore, in the cases of stage Ⅱ, tight fibrotic gluteal muscles and thick contracted fascia lata should be released; For stage Ⅲ lesion, the release should be extended to the capsule of hip, and incision of the posterior capsule was necessary. Results In the group of stageⅠ, The symptoms and signs were relieved by maneuver , the rate of excellent and good results was 39%; while in the group of stageⅡand Ⅲ, it was 97% by operative treatment. Conclusion The staging system of gluteal muscles contracture could demonstrate exactly the severity degree of the disease, and is useful in choosing therapeutic method. Non-operatiive method can obtain satisfactory results in about 1/3 cases of stage Ⅰof gluteal muscles contracture; operative method is indicated for the patients of stage Ⅱand Ⅲ.

Objective To discuss the therapeutic effect of fracture operation on multiple bone injuries. Methods The patients with fractures were treated with 3 different methods, ie, emergency, selective and conservative treatments. Early complications such as acute respiratory distress syndrome (ARDS),fat embolism syndrome (FES),duration in insive care unit and mortality rate were compared with the long-term complications of fractures so as to evaluate the curative effect of 3 different methods on multiple bone injuries. Results Among 91 cases (ISS≥30), one died and 2 resulted in FES. Mortality rate, short-term and long-term complications and mean ICU duration were reduced significantly in the emergency treatmentgroup compared with the other two groups ( P

To analyze and discuss ethics of treatment in Heinophilic arhtropathy. Treatment of those patients not only could relieve their distress in thought, but also could improve their quality of life. And we raise operational contraindications are relative,not absolute.

[Objective]To discuss the perioperative management of thoracolumbar fractures fixed with latero-anterior screw-plate system.[Method]The entry point and direction of screw on 30 thoracic and lumbar vertebra specimens were marked based on the principle and demand of implantation of latero-anterior screw-plate system and were determined exactly by anatomic landmarks in order to make reference for operation.Sixty patients with thoracolumbar fractures were treated with anterior decompression,bone grafting and internal fixation from January 2000 to June 2007.Reference data such as the length of vertebral body screw and plate and the height of bracing gotten from the patients'X-ray and CT findings before operation were compared with practical data measured during operation.The entry point and the direction of screw were determined exactly by anatomic landmarks of thoraco lumbar vertebrae and were checked by X-ray during operation.[Result]The judgement of the entry point and the direction of screw was easy and accurate during operation and the reference data were in coincidence with practical data.The effects of operation were satisfactory.[Conclusion]The perioperative management is both scientific and practical.The surgical complications can be reduced in this way.

[Objective]To explore the mechanism of hip joint capsule contracture induced by intragluteal injection. [Method]Thirty young Chinese rabbits were divided into four groups of A(n=6),B(n=6),C(n=6) and D(n=12) at random.Rabbits in groups A,B and C were treated with deep intragluteal injection of penicillin dissolved in 2% benzyl alcohol(group A),2% benzyl alcohol(group B)and penicillin dissolved in physiologic saline(group C).Rabbits in group D were treated with immobilization of unilateral hip joint and deep intramuscular injection of physiologic saline on the homolateral buttock.Each rabbit was injected twice a day for 20 days.Specimens were obtained at 30,60 and 90 days after first injection and the evaluation of the functions of hind limbs was obtained at the same time.The thickness of hip joint capsules were measured with micrometer and sections of joint capsules were stained by Sirius red and were observed with microscope and polarization microscope.[Result]Capsules of hip joint in group A and B became thicker and contractural,and the change of joint capsules was reflected in the change of motion of hind limbs.Sections in groups A and B showed shrinked capsules with thick collagens in disordered arrangement;while there were no gluteus contracture and contracture of joint capsule in the other groups.[Conclusion]Deep intragluteal injection of penicillin dissolved in 2% benzyl alcohol or 2% benzyl alcohol into young rabbits can cause contracture of hip joints.The contracture of joint capsule is largely induced by tissue trauma and repair of joint capsules.The limited locomotion of hip joint induced by the contracture of gluteal muscle does not play an important role in the contracture of joint capsule.

[Objective]To explore the clinical character and the treatment method of wedge-shaped vertebral osteotomy,expanding bone graft and spanning segment pedicle screw-rod system fixation from posterior approach to the thoracolumbar kyphosis caused by old fracture.[Method]From June 2003 to May 2008,26 cases of kyphosis deformity at thoracolumbar segment were treated with wedge-shaped vertebral osteoctomy and long segment pedicle screw-rod internal fixation,including 19 males and 7 females and aging 16-45 years(average age:24.2 years).All kyphosis deformity were caused by old thoracolumbar fracture and patients suffered from back pain.The average disease history were 12.6 years.All the sigittal kyphosis Cobb's angles were more than 40 degree cases.Sixteen patients complicated with nervous symptom.Among them 18 cases were given wedge-shaped vertebral osteoctomy and long segment pedicle screw internal fixation,8 cases were given expanding bone graft in anterior of vertebra after osteotomy.The kyphosis angles from radiographs were given compared between pre-and postoperatively,and complications were given analysis too.[Result]Twenty-two patients had been followed up for 12-48 months(average time:34.6 months),all patients' kyphosis angles were corrected satisfactory,the extend of right angle were 86.45%?4.56%.Besides mesenteric artery compressed syndrome happened in 1 patient,other complication was rare.[Conclusion]This method can correct the kyphosis deformity immediately in operation,its correct extent is large,expanding bone graft in anterior of vertebra after osteotomy can reduce the spine shorten and spinal cord injury rate.

Partial fibulectomy is widely used in fibula transplantation and the treatment of fibular tumor and injury. After follow-up surveys and biomechanical experiments, many authors believe it is important to pay attention to the postoperative complications in leg，which now still remains in dispute. For the first time finite element analysis is used to find out the mechanical characteristics of crural bone before and after partial fibulectomy. Our results show that resection would alter significantly the stress distribution in tibia, fibula and the medial & lateral parts of talus, so influent the ankle joint stability. Causes of postoperative complications were also discussed.